The burden of disease in older people and implications for health policy and practice

Use of primary health care services and mortality in older patients with type 2 diabetes with or without comorbidities

OBJECTIVE

This study aimed to examine primary health care (PHC) service utilization and mortality in older patients with type 2 diabetes (T2D) with or without comorbidities.

DESIGN AND SETTING

A cohort study in PHC in the city of Vantaa, Finland. Follow-up period was set between the years 2011 and 2018.

SUBJECTS

PHC patients aged 60 years or more with a T2D were included.

MAIN OUTCOME MEASURES

Service utilization was defined as the number of face-to-face appointments and telephone contacts between a patient and general practitioner (GP) or nurse. The presence of comorbidities was defined using the Charlson Comorbidity Index (CCI). Mortality was assessed using hazard ratio (HR) and standardized mortality ratio (SMR).

RESULTS

In total, 11,020 patients were included and followed for 71,596 person years. Mean age of the women and men in the beginning of follow-up were 71 and 69 years, respectively. The patients in the study cohort had a mean of eight appointments per person year to the GPs or nurses. Patients with T2D with comorbidities had more appointments than patients with T2D without comorbidities (incidence rate ratio (IRR) 1.44 [95% CI 1.39-1.49]). Increase in the number of all appointments reduced mortality in patients with T2D with and without comorbidities. Between patients with T2D with comorbidities and patients with T2D without comorbidities, the age and sex adjusted HR for death was 1.50 (95% CI 1.39-1.62). The SMR was higher in patients with T2D with comorbidities (1.83 [95% CI 1.74-1.92]) than in patients with T2D without comorbidities (0.91 [95% CI 0.86-0.96]).

CONCLUSIONS

In older patients with T2D, the presence of comorbidities was associated with increased use of PHC services and increased mortality. Increase in the number of appointments was associated with reduced mortality in patients with T2D with or without comorbidities.Key PointsIn older patients with T2D, it has not been studied whether and to what extend multimorbidity affects use of PHC services and mortality.The presence of comorbidities according to the Charlson Comorbidity Index (CCI) was associated with increased use of PHC services.The number of appointments to GPs or nurses was associated with reduced mortality in patients with T2D with or without comorbidities according to the CCI.

Projections of future life expectancy in China up to 2035: a modelling study

BACKGROUND

To plan social and health services, future life expectancy projections are needed. The aim of this study was to forecast the future life expectancy for mainland China and its provinces.

METHODS

Following the same approach as the Global Burden of Disease Study, we used the largest compiled epidemiological and demographic datasets to estimate age-specific mortality and evaluate population data from 1990 to 2019. A total of 21 life expectancy forecasting models were combined by a probabilistic Bayesian model to forecast the life expectancy for mainland China and its provinces in 2035.

FINDINGS

The projected life expectancy at birth in mainland China in 2035 is 81·3 years (95% credible interval 79·2-85·0), and there is a high probability that the national goals of improving life expectancy will be achieved (79 years in 2030, and over 80 years in 2035). At the provincial level, women in Beijing have the highest projected life expectancy in 2035 with an 81% probability of reaching 90 years, followed by Guangdong, Zhejiang, and Shanghai, which all have more than a 50% probability of surpassing 90 years. Men in Shanghai are projected to have the highest life expectancy at birth in 2035, with a 77% probability of life expectancy being over 83 years, the highest provincial life expectancy in mainland China in 2019. The projected gains in life expectancy are mainly derived from older individuals (aged ≥65 years), except those in Xinjiang, Tibet, and Qinghai (for men), in which the main contributions come from younger (0-29 years) or middle-aged (30-64 years) individuals.

INTERPRETATION

Life expectancy in mainland China and its provinces has a high probability of continuing to increase through to 2035. Adequate policy planning of social and health services will be needed.

FUNDING

China National Natural Science Foundation and Social Science Fund of Jiangsu Province.

Serum trimethylamine N-oxide levels among coronary artery disease and acute coronary syndrome patients: a systematic review and meta-analysis

Background and Aim

Recent studies have linked trimethylamine N-oxide (TMAO) to cardiovascular diseases; our study aimed to analyze the association between coronary artery disease (CAD), acute coronary syndrome (ACS), and TMAO.

Methods

PubMed, Scopus, Embase, and Web of Science were searched using terms such as 'CAD' and 'TMAO'. Only observational controlled studies were included. RevMan software version 5.4 was used for the analysis.

Results

A significant association was found between the CAD group and increased serum TMAO levels compared with the control group (MD=1.16, 95% CI=0.54-1.78, P=0.0003). This association remained significant among acute coronary syndrome patients (MD=0.98, 95% CI=0.73-1.23, P<0.00001) and was also detected among young and old CAD patients (MD=0.35, 95% CI=0.06-0.64, P=0.02 and MD=1.36, 95% CI=0.71-2.01, P<0.0001, respectively). On further analysis of intestinal metabolites, the authors detected an insignificant association between choline, betaine, carnitine, and CAD. According to our sensitivity analysis, TMAO is an acceptable diagnostic marker for CAD (0.721, SE was 0.0816, 95% CI: 0.561-0.881).

Conclusion

TMAO is an acceptable diagnostic marker for CAD, with significantly higher levels among these patients regardless of their age. Other metabolites did not show such an association. The role of serum level TMAO in the early diagnosis of CAD should be further explored.

Adherence to dermatologic treatment: A retrospective cross-sectional study on geriatric patients

OBJECTIVE

With the prolongation of the average life expectancy worldwide, diseases including dermatological disorders of the elderly are gaining importance. The presence of comorbidities in this age group may affect the treatment strategies; compliance with follow-up and adherence to medication can be poor. The aim of this study is to evaluate the dermatological disorders of patients aged 65 and over and determine their adherence to dermatologic treatment.

METHODS

A retrospective and cross-sectional study was conducted on patients aged 65 and over applied to a single tertiary dermatology clinic between April 2021 and April 2022. Diagnoses were that clinical and diagnostic tests were performed when only necessary.

RESULTS

A total of 207 admissions to the dermatology clinic by 135 patients were evaluated. Eczema (23.05%) and infections (25.2%) were the most common dermatological diagnoses. The percentage of patients with precancerous and cancerous lesions was 11.9%. Among 123 patients who need at least a follow-up visit, only 37 patients (30.1%) applied for follow-up as advised, and medicines were taken regularly by 23 of these patients (62.2%). Compliance with follow-up was lower among men (OR 0.365, 95% CI 0.160-0.834, and p=0.02) and patients who were treated only with local therapy agents (OR 0.345, 95% CI 0.138-0.863, and p=0.20).

CONCLUSION

Eczema and infections were the most common dermatological diagnoses among geriatric patients in the present study. The majority of geriatric patients with skin conditions were not applying for follow-up visits. Women and patients treated with systemic therapy agents were more compliant. The prevalence of basal cell carcinoma was not low, and this emphasizes the importance of a careful dermatological examination regardless of primary complaint in this age group.

Lifecourse investigation of the cumulative impact of adversity on cognitive function in old age and the mediating role of mental health: longitudinal birth cohort study

OBJECTIVE

To investigate the accumulation of adversities (duration of exposure to any, economic, psychosocial) across the lifecourse (birth to 63 years) on cognitive function in older age, and the mediating role of mental health.

DESIGN

National birth cohort study.

SETTING

Great Britain.

PARTICIPANTS

5362 singleton births within marriage in England, Wales and Scotland born within 1 week of March 1946, of which 2131 completed at least 1 cognitive assessment.

MAIN OUTCOME MEASURES

Cognitive assessments included the Addenbrooke's Cognitive Examination-III, as a measure of cognitive state, processing speed (timed-letter search task), and verbal memory (word learning task) at 69 years. Scores were standardised to the analytical sample. Mental health at 60-64 years was assessed using the 28-item General Health Questionnaire, with scores standardised to the analytical sample.

RESULTS

After adjusting for sex, increased duration of exposure to any adversity was associated with decreased performance on cognitive state (β=-0.39; 95% CI -0.59 to -0.20) and verbal memory (β=-0.45; 95% CI -0.63 to -0.27) at 69 years, although these effects were attenuated after adjusting for further covariates (childhood cognition and emotional problems, educational attainment). Analyses by type of adversity revealed stronger associations from economic adversity to verbal memory (β=-0.54; 95% CI -0.70 to -0.39), with a small effect remaining even after adjusting for all covariates (β=-0.18; 95% CI -0.32 to -0.03), and weaker associations from psychosocial adversity. Causal mediation analyses found that mental health mediated all associations between duration of exposure to adversity (any, economic, psychosocial) and cognitive function, with around 15% of the total effect of economic adversity on verbal memory attributable to mental health.

CONCLUSIONS

Improving mental health among older adults has the potential to reduce cognitive impairments, as well as mitigate against some of the effect of lifecourse accumulation of adversity on cognitive performance in older age.

Factors Affecting Health Policies for Older People in Iran

Globally, the number and proportion of people aged 60 years and older is growing fast. As people age, health needs become more complex, and the health system's responsiveness to older people's needs requires evidence-informed policies. Hence, this study explores the factors affecting the health policy development process for older people in Iran. We conducted 32 interviewers with people aged 60 years and older and 21 interviews with key informants involved in policy making related to older people. Qualitative data were analyzed using thematic analysis. Actors and stakeholders, policy structure, selected health policy processes, the health care service delivery system, government financial support, and community and culture building are the most influential factors in health policy making for older people. Government policies and health priority interventions are needed to address these influential factors for older people to ensure healthy aging over the life course.

Planning for Hospital Discharge for Older Adults in Uganda: A Qualitative Study Among Healthcare Providers Using the COM-B Framework

Background

Proper discharge planning enhances continuity of patient care, reduces readmissions, and ensures safe and timely transition from health facility to home-based care. The current study aimed at exploring the healthcare providers' perspectives of discharge planning among older adults, with respect to barriers and facilitators within the Ugandan health system.

Methods

We conducted a qualitative exploratory study that used one-on-one interviews (Additional file 1) to describe individual perspectives of healthcare providers in their routine clinical care setting. The study included medical doctors (including consultants and physicians), nurses and physiotherapists directly involved in providing care to older adults. We conducted 25 in-depth interviews among healthcare providers for older adults with non-communicable diseases. The audio-recorded interviews were transcribed verbatim. Data were manually organized using a framework matrix guided by the COM-B domains (capability, opportunity and motivation) as the broad themes and sub-themes (physical and psychological capability, social and physical opportunity, reflective and automatic motivation) that influence behavior change (discharge planning).

Results

Discharge planning was facilitated by availability of discharge forms, continuous medical education and working experience. The barriers to discharge planning were understaffing, workload/insufficient time, lack of discharge planning guidelines, lack of multidisciplinary approach and congested inpatient wards. Both barriers and facilitators were at various levels of healthcare service delivery such as patient, caregiver, healthcare provider, health facility and policy levels.

Conclusion

Barriers to discharge planning spread across all levels of healthcare service delivery, but they can be addressed by enhancing the facilitators. This calls for a multi-level action to ensure adequate and quality patient care during and after hospitalization.

The Changing Incidence and Prevalence of Falls and Its Disability Burden Among the Geriatric Population in Saudi Arabia from 1990 to 2019: A Longitudinal Analysis Using Global Burden of Disease Study Data

BACKGROUND

Falls represent a significant and growing public health issue among older adults worldwide. This study provides a comprehensive analysis of the trends in the incidence, prevalence, and disability burden of falls among older adults in Saudi Arabia over 29 years, with a focus on gender disparities.

METHODS

Utilizing the Global Burden of Disease (GBD) Study data, this observational analysis tracked the epidemiology of falls from 1990 to 2019. The study employed ICD-9 and ICD-10 codes to identify falls, analyzing incidence, prevalence, disability-adjusted life years (DALYs), and years lived with disability (YLDs), stratified by gender and reported with 95% uncertainty intervals (UIs).

RESULTS

The incidence and prevalence of falls increased for both genders from 1990 to 2019, with males showing a higher relative increase in prevalence rates (57% for males vs. 26% for females). The disability burden, indicated by DALYs, increased by 4% for males and decreased by 10% for females, whereas YLDs saw an increase of 38% for males and 8% for females. The analysis highlights a notable rise in both the frequency of falls and their associated disability, with gender-specific variations emphasizing greater impacts on males.

CONCLUSIONS

The findings illustrate a significant increase in fall-related incidents and associated disabilities among older adults in Saudi Arabia, with distinct gender differences. These trends call for targeted public health interventions and further research into the underlying causes of falls, risk factors, and effective prevention strategies. Such measures are essential to mitigate the impact of falls, improve health outcomes, and enhance the quality of life for the aging population.

The biology of aging in a social world: Insights from free-ranging rhesus macaques

Social adversity can increase the age-associated risk of disease and death, yet the biological mechanisms that link social adversities to aging remain poorly understood. Long-term naturalistic studies of nonhuman animals are crucial for integrating observations of social behavior throughout an individual's life with detailed anatomical, physiological, and molecular measurements. Here, we synthesize the body of research from one such naturalistic study system, Cayo Santiago, which is home to the world's longest continuously monitored free-ranging population of rhesus macaques (Macaca mulatta). We review recent studies of age-related variation in morphology, gene regulation, microbiome composition, and immune function. We also discuss ecological and social modifiers of age-markers in this population. In particular, we summarize how a major natural disaster, Hurricane Maria, affected rhesus macaque physiology and social structure and highlight the context-dependent and domain-specific nature of aging modifiers. Finally, we conclude by providing directions for future study, on Cayo Santiago and elsewhere, that will further our understanding of aging across different domains and how social adversity modifies aging processes.

The mediating role of self-directed ageism in sexual health among Jewish-Israeli older people

This article examines the relationships between physical health, personal resilience and healthy sexuality in older adults, and the mediating role of self-directed ageism in these relationships. Healthy sexuality, which encompasses sexual partnership satisfaction, sexual behaviors, successful sexual functioning, few negative changes, and few sexual health concerns, is important in old age. Five hundred Jewish-Israeli women and men, aged 60 years and over, participated in the study. Five questionnaires were administered that examined the number of diseases, level of resilience, self-perceptions of aging, and sexual relationships and activities. The data were analyzed using multiple linear and logistic regressions, and path analysis for the mediating role of self-directed ageism. The results showed that higher levels of resilience were positively related to aspects of sexual health, while reporting more diseases and higher self-directed ageism were negatively related to sexual health. Self-directed ageism mediated the relationships between resilience and number of diseases and sexual health. The findings supported the biopsychosocial model of healthy sexuality. It was concluded that sexual health in older age may be promoted by fostering resilience, promoting good health, and reducing self-directed ageism.

Role of diet and exercise in aging, Alzheimer's disease, and other chronic diseases

Alzheimer's disease (AD) is a progressive neurodegenerative disease, characterized by memory loss and multiple cognitive impairments. Genetic mutations cause a small proportion (1-2%) of early-onset AD, with mutations in amyloid precursor protein (APP), presenilin 1 (PS1) and presenilin 2 (PS2). Major contributing factors of late-onset AD are ApoE4 genotype, traumatic brain injury, diabetes, obesity, hypertension, cardiovascular conditions, in addition to lifestyle factors, such as unhealthy diet and lack of physical exercise. Disease progression can be delayed and/or prevented to a greater extent by adopting healthy lifestyle with balanced and antioxidant enriched diet and daily exercise. The interaction and interplay of diet, exercise, age, and pharmacological interventions holds a crucial role in the progression, pathogenesis and management of AD and its comorbidities, including diabetes, obesity, hypertension and cardiovascular conditions. Antioxidant enriched diet contributes to brain health, glucose control, weight management, and cardiovascular well-being. Regular exercise removes toxins including free radicals and enhances insulin sensitivity, and supports cardiovascular function. In the current article, we discussed, the role of diet, and exercise in aging, AD and other conditions including diabetes, obesity, hypertension, cardiovascular conditions. This article also highlights the impact of medication, socioeconomic and lifestyle factors, and pharmacological interventions. These aspects were discussed in different races and ethnic groups in Texas, and the US.

Socioeconomic inequalities in physical, psychological, and cognitive multimorbidity in middle-aged and older adults in 33 countries: a cross-sectional study

BACKGROUND

Many physical, psychological, and cognitive disorders are highly clustered among populations with low socioeconomic status. However, the extent to which socioeconomic status is associated with different combinations of these disorders is unclear, particularly outside high-income countries. We aimed to evaluate these associations in 33 countries including high-income countries, upper-middle-income countries, and one lower-middle-income country.

METHODS

This cross-sectional multi-region study pooled individual-level data from seven studies on ageing between 2017 and 2020. Education and total household wealth were used to measure socioeconomic status. Physical disorder was defined as having one or more of the self-reported chronic conditions. Psychological and cognitive disorders were measured by study-specific instruments. The outcome included eight categories: no disorders, physical disorder, psychological disorder, cognitive disorder, and their four combinations. Multivariable-adjusted logistic regression models were used to estimate odds ratios (ORs) and 95% CIs for the associations of socioeconomic status with these outcomes separately for high-income countries, upper-middle-income countries, and the lower-middle-income country.

FINDINGS

Among 167 376 individuals aged 45 years and older, the prevalence of multimorbidity was 24·5% in high-income countries, 33·9% in upper-middle-income countries, and 8·1% in the lower-middle-income country (India). Lower levels of education, household wealth, and a combined socioeconomic status score were strongly associated with physical, psychological, and cognitive multimorbidity in high-income countries and upper-middle-income countries, with ORs (low vs high socioeconomic status) for physical-psychological-cognitive multimorbidity of 12·36 (95% CI 10·29-14·85; p<0·0001) in high-income countries and of 23·84 (18·85-30·14; p<0·0001) in upper-middle-income countries. The associations in the lower-middle-income country were mixed. Participants with both a low level of education and low household wealth had the highest odds of multimorbidity (eg, OR for physical-psychological-cognitive multimorbidity 21·21 [15·95-28·19; p<0·0001] in high-income countries, 37·07 [25·66-53·56; p<0·0001] in upper-middle-income countries, and 54·96 [7·66-394·38; p<0·0001] in the lower-middle-income country).

INTERPRETATION

In study populations from high-income countries, upper-middle-income countries, and the lower-middle-income country, the odds of multimorbidity, which included physical, psychological, and cognitive disorders, were more than ten times greater in individuals with low socioeconomic status. Equity-oriented policies and programmes that reduce social inequalities in multimorbidity are urgently needed to achieve Sustainable Development Goals.

FUNDING

Zhejiang University, Fundamental Research Funds for the Central Universities, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Wellcome Trust, Medical Research Council, National Institute on Aging, and Academy of Finland.

TRANSLATION

For the Chinese translation of the abstract see Supplementary Materials section.

A Physiotherapy-Led Transition to Home Intervention for Older Adults Following Emergency Department Discharge: A Pilot Feasibility Randomised Controlled Trial (ED PLUS)

Background

Older adults frequently attend the emergency department (ED) and experience high rates of subsequent adverse outcomes including functional decline, ED re-presentation and unplanned hospital admission. The development of effective interventions to prevent such outcomes is a key priority for research and service provision. Our aim was to evaluate the feasibility of a physiotherapy-led integrated care intervention for older adults discharged from the ED (ED PLUS).

Patients and Methods

Older adults presenting to the ED of a university teaching hospital with undifferentiated medical complaints and discharged within 72 hours were computer randomised in a ratio of 1:1:1 to deliver usual care, Comprehensive Geriatric Assessment (CGA) in the ED, or ED PLUS. ED PLUS is an evidence-based and stakeholder-informed intervention to bridge the care transition between the ED and community by initiating a CGA in the ED and implementing a six-week, multi-component, self-management programme in the patient's home. Feasibility and acceptability were assessed quantitatively and qualitatively. All clinical and process outcomes were assessed by a research nurse blinded to group allocation. Data analyses were primarily descriptive.

Results

Twenty-nine participants were recruited indicating a 67% recruitment rate. At 6 months, there was 100% retention in the usual care group, 88% in the CGA group and 90% in the ED PLUS group. ED PLUS participants expressed positive feedback, and there was a trend towards improved function and quality of life and less ED revisits and unscheduled hospitalisations in the ED PLUS group.

Conclusion

ED PLUS bridges the transition of care between the index visit to the ED and the community and is feasible using systematic recruitment strategies. Despite recruitment challenges in the context of COVID-19, the intervention was successfully delivered and well received by participants. There was a lower incidence of functional decline and improved quality of life in the ED PLUS group.

Trial Registration

The trial was registered in Clinical Trials Protocols and Results System as of 21st July 2021, with registration number NCT04983602.

Differences in the healthcare needs of older adults attending primary health centers in urban and rural areas of Taiwan

PURPOSE

As the older adult population in Taiwan continues to increase, primary health centers (PHCs) play a crucial role in geriatric care. This study explored the differences in the PHC experiences and usage needs of older adults in urban versus rural areas.

METHODS

A qualitative study was conducted. Twenty-one older adults were recruited from PHCs in northern, central, southern, and eastern Taiwan. Semistructured interviews were used to collect data, and the interview guidelines included their reasons for visiting PHCs, the health-care services they received, their evaluation of the services, and the advantages and disadvantages of these centers. The data were analyzed using thematic content analysis.

RESULTS

The PHC usage needs of older adults in urban areas differ from those of older adults in rural areas in the following 3 aspects: (1) Medical services: older adults in rural areas demand clinics specializing in various medical domains, mobile and home medical care, and case management, whereas those in urban areas demand mobile health examinations. (2) Environment and transportation: older adults in rural areas demand diverse medical equipment, shuttle services, and accessible facilities, whereas those in urban areas demand recreational facilities. (3) Active aging: older adults in rural areas demand health education courses, and those in urban areas demand diverse senior citizen courses as well as opportunities to volunteer and build interpersonal relationships.

CONCLUSION

The older adults in urban and rural areas had different PHC usage needs. The older adults in rural areas generally focused on medical care and transportation services in PHCs, whereas those in urban areas generally focused on health promotion as a means of social participation and active aging.

Depression by gender and associated factors among older adults in India: implications for age-friendly policies

Inspite of implementing policies to control mental health problems, depression remains a severe health concern among older adults in India. We examined self-reported differences in the depression among older men and women in India and examined associated factors for gender differences in depression at the population level. We utilized nationally representative data from the Longitudinal Aging Study in India (LASI) wave I, for years 2017-2019. Our analytical sample comprised of 30,637 older adults ages 60 years and above (14,682 men and 15,655 women). We conducted descriptive statistics and Chi-Square tests followed by binary logistic regression and multivariate decomposition analyses to examine our study objectives. Depression was reported in - 7.4% (95% CI 7.0, 7.8) of older men and 9.5% (CI 9.1, 10.0) of older women. Poor self-rated health, multimorbidity status, physical activity, difficulty in activities of daily living (ADL) and instrumental ADL (IADL) were the significant health-related factors associated with depression among older men and women. Not being satisfied with one's life, not being satisfied with their present living arrangement, receiving any type of ill-treatment, and being widowed were the significant factors associated with depression among older men and women. We found gender disparity in self-reported depression. Marital status contributed-to 36.7% of the gender gap in depression among older adults. Additionally, ADL and IADL difficulties among men and women contributed to 17.6% and 34.0%, gender gap, self-rated health contributed to 18.8% gap, whereas not having equal social participation (4.4%) and not satisfied in present living arrangements (8.1%) were other factors that contributed to gender gap for depression in India. Depression is a critical and persistent public health problem among-older females in India. Our findings provide a broader framework for policymakers and health practitioners to focus on gender-specific strategies to mitigate this highly emergent problem.

Predictors of Unmet Needs in Chilean Older People with Dependency: A Cross-Sectional Study

Approximately one in five Chilean older adults has some degree of dependency. Limited evidence is available on self-perceived needs in Latin-American older people. The main aim of this study was to identify predictors of unmet needs of dependent older persons without cognitive impairment, considering personal and primary informal caregivers' factors. This cross-sectional study was conducted with a sample of 77 dyads of older people with dependency and their caregivers. A survey was administered, evaluating sociodemographic characteristics, anxious and depressive symptomatology, health-related quality of life, and social support. Older people's self-reported met and unmet needs and caregivers' burden and self-efficacy were also assessed. To determine predictors of unmet needs, a multiple regression analysis was carried out. Most participants had mild to moderate levels of dependency. The most frequent unmet needs were "daytime activities" (33.8%), "company" (23.4%), "benefits" (23.4%), and "psychological distress" (24.7%). Older people's higher level of dependency and anxious symptomatology were predictors of a higher number of unmet needs, with a model whose predictive value was 31%. The high prevalence of anxious symptomatology and its relationship with the presence of unmet needs highlight the importance of making older people's psychological and social needs visible and addressing them promptly.

What is the impact of one's chronic illness on his or her spouse's future chronic illness: a community-based prospective cohort study

BACKGROUND

Integrating a joint approach to chronic disease management within the context of a couple has immense potential as a valuable strategy for both prevention and treatment. Although spousal concordance has been reported in specific chronic illnesses, the impact they cumulatively exert on a spouse in a longitudinal setting has not been investigated. We aimed to determine whether one's cumulative illness burden has a longitudinal impact on that of their spouse.

METHODS

Data was acquired from a community-based prospective cohort that included Koreans aged 60 years and over, randomly sampled from 13 districts nationwide. Data from the baseline assessment (conducted from November 2010 to October 2012) up to the 8-year follow-up assessment was analyzed from October 2021 to November 2022. At the last assessment, partners of the index participants were invited, and we included 814 couples in the analysis after excluding 51 with incomplete variables. Chronic illness burden of the participants was measured by the Cumulative Illness Rating Scale (CIRS). Multivariable linear regression and causal mediation analysis were used to examine the longitudinal effects of index chronic illness burden at baseline and its change during follow-up on future index and spouse CIRS scores.

RESULTS

Index participants were divided based on baseline CIRS scores (CIRS < 6 points, n = 555, mean [SD] age 66.3 [4.79] years, 43% women; CIRS ≥ 6 points, n = 259, mean [SD] age 67.7 [4.76] years, 36% women). The baseline index CIRS scores and change in index CIRS scores during follow-up were associated with the spouse CIRS scores (β = 0.154 [SE: 0.039], p < 0.001 for baseline index CIRS; β = 0.126 [SE: 0.041], p = 0.002 for change in index CIRS) at the 8-year follow-up assessment. Subgroup analysis found similar results only in the high CIRS group. The baseline index CIRS scores and change in index CIRS scores during follow-up had both direct and indirect effects on the spouse CIRS scores at the 8-year follow-up assessment.

CONCLUSIONS

The severity and course of one's chronic illnesses had a significant effect on their spouse's future chronic illness particularly when it was severe. Management strategies for chronic diseases that are centered on couples may be more effective.

Predictors of Outcomes After Lumbar Intra-Articular Facet Joint Injections and Medial Branch Blocks: A Scoping Review

STUDY DESIGN

A scoping review.

OBJECTIVE

We aimed to identify and describe the factors associated with the patient-reported response after lumbar intra-articular facet joint (FJ) injections or medial branch blocks (MBBs).

SUMMARY OF BACKGROUND DATA

FJ osteoarthritis is among the most common causes of chronic low back pain. Management often includes FJ intra-articular injection and MBBs (which may be followed by radiofrequency ablation of the nerves innervating these joints). However, the success of these approaches is variable, prompting interest in identifying patient characteristics (imaging features, clinical signs, and among others) associated with response to these types of facet injections.

MATERIALS AND METHODS

We performed a literature search on factors associated with patient-reported outcomes after lumbar FJ intra-articular injections or MBBs for patients with low back pain published in English or Spanish between 2000 and 2023. We excluded duplicate papers that did not describe factors associated with outcomes or those describing other interventions. We collected data on the association of these factors with patient-reported outcomes.

RESULTS

Thirty-seven studies met the inclusion criteria and were analyzed. These studies evaluated factors, such as age, depression, and single photon emission computed tomography (SPECT), and among variables. Age and imaging findings of facet arthropathy were the most frequently described factors. Imaging findings of FJ arthropathy and positive SPECT were often associated with positive results after intra-articular FJ injections or MBBs. In contrast, younger age and smoking were frequently associated with less favorable clinical outcomes.

CONCLUSION

Numerous factors were considered in the 37 studies included in this review. Imaging findings of facet arthropathy, duration of pain, and positive SPECT were consistently associated with favorable results after facet interventions.

Effect of Aging on Tendon Biology, Biomechanics and Implications for Treatment Approaches

Tendon aging is associated with an increasing prevalence of tendon injuries and/or chronic tendon diseases, such as tendinopathy, which affects approximately 25% of the adult population. Aged tendons are often characterized by a reduction in the number and functionality of tendon stem/progenitor cells (TSPCs), fragmented or disorganized collagen bundles, and an increased deposition of glycosaminoglycans (GAGs), leading to pain, inflammation, and impaired mobility. Although the exact pathology is unknown, overuse and microtrauma from aging are thought to be major causative factors. Due to the hypovascular and hypocellular nature of the tendon microenvironment, healing of aged tendons and related injuries is difficult using current pain/inflammation and surgical management techniques. Therefore, there is a need for novel therapies, specifically cellular therapy such as cell rejuvenation, due to the decreased regenerative capacity during aging. To augment the therapeutic strategies for treating tendon-aging-associated diseases and injuries, a comprehensive understanding of tendon aging pathology is needed. This review summarizes age-related tendon changes, including cell behaviors, extracellular matrix (ECM) composition, biomechanical properties and healing capacity. Additionally, the impact of conventional treatments (diet, exercise, and surgery) is discussed, and recent advanced strategies (cell rejuvenation) are highlighted to address aged tendon healing. This review underscores the molecular and cellular linkages between aged tendon biomechanical properties and the healing response, and provides an overview of current and novel strategies for treating aged tendons. Understanding the underlying rationale for future basic and translational studies of tendon aging is crucial to the development of advanced therapeutics for tendon regeneration.

Exploring the roles and functions of champions within community-based interventions to support older adults with chronic conditions: A scoping review protocol

BACKGROUND

Health care solutions are needed to meet the need of an ageing population. Health care champions are people who endorse the adoption of new initiatives being implemented within health care settings. Although the role of champions has been cited as key to the success of numerous community-based interventions implemented to improve the care of older adults with chronic conditions, no synthesis of their implementation experiences have been conducted. We report on a scoping review protocol that will be applied to collect evidence on the role of champions within community-based health interventions to support older adults with chronic conditions. Specifically, we will identify how the term 'champion' is used and defined (i.e., conceptualized) and identify the roles (i.e., professional background) and functions of champions (i.e., responsibilities). We will also explore how this role impacts program implementation.

METHODS

This is a scoping review protocol informed by guidelines for Scoping Reviews (PRISMA-ScR) and a six-stage scoping review methodology. Peer-review literature will be retrieved from Medline, CINAHL, PubMed, PsycInfo, Cochrane JBI and Scopus databases, using a peer-reviewed search strategy developed in collaboration with an Information Specialist. The scoping review will consider all empirical studies published in English. Two reviewers will pilot-test the screening criteria and data abstraction forms, and then independently screen the literature. Extracted data will be analyzed numerically and thematically. Self-identified champions will be consulted to refine the practice recommendations from this work.

DISCUSSION

This scoping review will broadly and systematically identify, define and expand existing knowledge on champions' impact in implementing community-based interventions to support older adults with chronic conditions. We anticipate that our results will lead to a greater understanding of the characteristics and role champions play within these interventions, which will be relevant to a wide range of knowledge users, including researchers, decision-makers, and health care providers.

Relationship between Composite Dietary Antioxidant Index and Aging

BACKGROUND

Numerous studies have demonstrated a close relationship between antioxidant-rich diets and comorbidities as well as mortality. However, the relationship between such diets and aging remains unclear. The purpose of this study was to investigate the association between the Composite Dietary Antioxidant Index (CDAI) and aging.

METHODS

All participants were from the National Health and Nutrition Examination Survey (NHANES) 2001-2010. Phenotypic age was calculated using a formula and subtracted from the chronological age to determine the aging. When the phenotypic age exceeded the chronological age, it was considered as aging. A weighted logistic regression model was employed to explore the relationship between CDAI and aging. Restricted cubic splines (RCSs) were used to examine the potential nonlinear relationship between them. Subgroup analysis and joint analysis were conducted to explore the effect of modifiers in these relationships.

RESULTS

A total of 19,212 participants (weighted: 165,285,442 individuals) were included in this study. The weighted logistic regression model showed a significant correlation between CDAI and the risk of aging (OR = 0.90, 95% CI: 0.84-0.96). RCS analysis revealed an L-shaped dose-response relationship between CDAI and the risk of aging. Subgroup analysis indicated that the association between CDAI and aging was more pronounced in middle-aged individuals and non-smokers. The joint analysis demonstrated that although smoking accelerated aging among participants, a high CDAI diet could still offset these damages.

CONCLUSIONS

The association between high CDAI and reduced risk of aging is particularly significant in young and middle-aged individuals and non-smokers. Consuming foods rich in CDAI components may potentially lower the risk of aging.

Effects of personal and health characteristics on the intrinsic capacity of older adults in the community: a cross-sectional study using the healthy aging framework

BACKGROUND

Intrinsic capacity (IC) can better reflect the physical functioning of older adults. However, few studies have been able to systematically and thoroughly examine its influencing factors and provide limited evidence for the improvement of intrinsic capacity. The objective of this study was to provide a comprehensive description of the overall decline in intrinsic capacity among older persons in the community. Additionally, the study aimed to analyze the composition of the five domains of reduction, compare the rate of decline among older adults and investigate the factors that influence this decline.

METHODS

This was a cross-sectional study conducted in the Chinese community. The self-designed general characteristics questionnaire was created based on the healthy aging framework and a systematic review. Intrinsic capacity was assessed with the Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS-15), Community Health Record Management System (CHRMS), Mini Nutritional Assessment Brief Form (MNA-SF), and Short Physical Performance Battery (SPPB). The influencing factors of intrinsic capacity were investigated using stepwise logistic regression.

RESULTS

A total of 968 older adults with a mean age of 71.00 (68.00, 76.75) were examined, and 704 older adults (72.7%) showed a decline in intrinsic capacity. There was a decline in at least one domain in 39.3% of older adults, with reductions in each domain ranging from 5.3% (psychological) to 52.4% (sensory). The study examined the composition of domains that experienced a decline in intrinsic capacity. It was found that a combination of sensory and locomotor domains showed the most significant decrease in 44.5% (n = 106) of individuals who experienced a decline in the two domains. Furthermore, a combination of sensory, cognitive, and locomotor domains exhibited a significant decrease in 51.3% (n = 44) of individuals who experienced a reduction in three domains. Lastly, a combination of sensory, vitality, cognitive, and locomotor domains showed the most significant decline in four domains, accounting for 60.0% (n = 15) of the population. Older adults had a higher risk of intrinsic capacity decline if they were older (95% CI:1.158-2.310), had lower education, lived alone (95% CI: 1.133-3.216), smoked (95% CI: 1.163-3.251), high Charlson Comorbidity Index (95% CI: 1.243-1.807) scores, did not regular exercise (95% CI:1.150-3.084), with lower handgrip strength (95% CI: 0.945-0.982).

CONCLUSIONS

We found a relatively high prevalence of intrinsic capacity; more attention should be paid to older adults who are older, less educated, live alone, and have more comorbidities. It is imperative to prioritize a healthy lifestyle among older persons who exhibit smoking habits, lack regular exercise, and possess inadequate handgrip strength.

Self-care interventions of community-dwelling older adults: a systematic review and meta-analysis

Introduction

The current notion of "care in old age" should be reconceptualized in the ageing societies of the 21st century. Currently, "being old" means that one is actively involved in their care and has the desire to retain control and independence.

Objective

Understand and analyze the efficacy of interventions in the physical and psychological self-care practices of healthy community-dwelling older people.

Methodology

Systematic review and meta-analysis. The guidelines of the PRISMA guide were followed. The methodological quality of the studies was checked using Cochrane Effective Practice and Organisation of Care criteria, and the search was performed between 2016 and 2021.

Results

Of the 1,866 evaluated, 8 studies met the criteria. The systematic review reveals that self-care interventions focus on physical health-related variables but not on psychological variables. The meta-analysis shows that interventions significantly improve physical health-related variables (care visits, hospital admission, medication, and gait speed).

Conclusion

Self-care training programs should include psychological variables to increase health and well-being in healthy older people.

Prospective Association Between Plasma Concentrations of Fatty Acids and Other Lipids, and Multimorbidity in Older Adults

Biological mechanisms that lead to multimorbidity are mostly unknown, and metabolomic profiles are promising to explain different pathways in the aging process. The aim of this study was to assess the prospective association between plasma fatty acids and other lipids, and multimorbidity in older adults. Data were obtained from the Spanish Seniors-ENRICA 2 cohort, comprising noninstitutionalized adults ≥65 years old. Blood samples were obtained at baseline and after a 2-year follow-up period for a total of 1 488 subjects. Morbidity was also collected at baseline and end of the follow-up from electronic health records. Multimorbidity was defined as a quantitative score, after weighting morbidities (from a list of 60 mutually exclusive chronic conditions) by their regression coefficients on physical functioning. Generalized estimating equation models were employed to assess the longitudinal association between fatty acids and other lipids, and multimorbidity, and stratified analyses by diet quality, measured with the Alternative Healthy Eating Index-2010, were also conducted. Among study participants, higher concentrations of omega-6 fatty acids [coef. per 1-SD increase (95% CI) = -0.76 (-1.23, -0.30)], phosphoglycerides [-1.26 (-1.77, -0.74)], total cholines [-1.48 (-1.99, -0.96)], phosphatidylcholines [-1.23 (-1.74, -0.71)], and sphingomyelins [-1.65 (-2.12, -1.18)], were associated with lower multimorbidity scores. The strongest associations were observed for those with a higher diet quality. Higher plasma concentrations of omega-6 fatty acids, phosphoglycerides, total cholines, phosphatidylcholines, and sphingomyelins were prospectively associated with lower multimorbidity in older adults, although diet quality could modulate the associations found. These lipids may serve as risk markers for multimorbidity.

The effect of older population on public health spending: Evidence from Spain

Background

The gradual ageing of the population, and its effect on public spending, constitutes an urgent challenge for advanced economies. Through this study, we analyse the effect of older people, and their health and individual characteristics, on public health spending.

Methods

Using logistic regression methods, we have analysed the use of different health services and health technologies by older people in Spain, controlled for several health, socioeconomic, and other individual factors.

Results

The main factors that explain the consumption of both health services and health technology, above age, are related to the so-called need factors: self-reported health status, presence of chronic diseases, and disability.

Conclusion

Knowing the main factors that imply greater public health spending is a topic of special interest for designing efficient health policies, in a context of growth in public health spending. In this way, preventive attention on the so-called need factors may be an important driver to improve the effectiveness of spending.

Global burden of neoplasms attributable to specific occupational carcinogens over 30 years: a population-based study

OBJECTIVES

The study aimed to analyze the global burden of occupational neoplasms from various epidemiological perspectives.

STUDY DESIGN

In this cross-sectional study, secondary analyses were conducted to assess the burden of neoplasms attributable to occupational carcinogens and their distribution characteristics using data from GBD 2019 and the World Bank database.

METHODS

Based on the GBD 2019 and the World Bank database, we analyzed the global burden of occupational neoplasms including the age-period-cohort model, decomposition analysis, health inequality analysis, and panel model. All analyses were conducted in R (version 4.0.3) and Joinpoint (version 4.9.1).

RESULTS

The absolute number of neoplasms burden attributable to occupational carcinogens has continued to rise over 30 years. In 2019, occupational neoplasms caused 333,867 [95% uncertainty interval (UI): 263,491 to 404,641] mortalities and 6,964,775 (95% UI: 5,467,884 to 8,580,431) disability-adjusted life years (DALYs) globally. Greenland, Monaco, the Netherlands, and Andorra suffered the highest burden. The burden was higher in countries with a higher sociodemographic index. The age effect was prominent in the elderly, and the 1925 birth cohort had the highest cohort effect. Population growth was the most significant driver of the mortalities (89%) and DALYs (111%) change. Moreover, the proportion of urban population was significantly positively associated with the disease burden, while GDP per capita was negatively correlated with the disease burden.

CONCLUSIONS

The burden of occupational neoplasms was unevenly distributed across locations and populations. The need for rational allocation of healthcare resources was urgent.

Preventive health behaviors among the middle-aged and elderly in China: Does social capital matter?

This study explores the status quo of preventive care use and social capital among middle-aged and elderly people (≥45 years old) in China, and employs a multi-level model to analyze whether social capital at different levels is associated with preventive care use. The data are derived from the 2018 China Health and Retirement Longitudinal Study (CHARLS), which includes 11,503 respondents and 450 communities. Preventive care use covers the utilization of routine physical examination services. Individual social capital is measured by the level of social network and social activities participation. Social network includes contacting with children or other people, for example, by phone, text message. Social activities participation is measured by the involvement in social activities, for example, playing mahjong, going to community club. Community social capital is evaluated by the richness of community facilities. Results reveals that the utilization of preventive care is 48.94% among middle-aged and elderly in China. The most used preventive service is routine blood test. The intra-class correlation (ICC) coefficient indicates that preventive health behaviors of the respondents are clustered at communities where they live. Multi-level regression shows that influence of social network is not significant to preventive care use (p ＞ 0.05). Community facilities and individual social activities participation are significantly associated with preventive care use (p < 0.05). The association between social capital and preventive care use could be considered as an important factor when making policies to promote preventive care use.

An Integrated Patient-Centred Medical Home (PCMH) Care Model Reduces Prospective Healthcare Utilisation for Community-Dwelling Older Adults with Complex Needs: A Matched Observational Study in Singapore

The global ageing population is associated with increased health service use. The PCMH care model integrates primary care and home-based care management to deliver comprehensive and personalised healthcare to community-dwelling older adults with bio-psycho-social needs. We examined if an integrated PCMH reduced healthcare utilisation burden of older persons in Singapore. We compared the healthcare utilisation between the intervention group and coarsened exact matched controls for a follow-up of 15 months. Baseline matching covariates included socio-demographics, health status, and past healthcare use. We accounted for COVID-19 social distancing effects on health-seeking behaviour. The intervention group consisted of 165 older adults with complex needs. We analysed national administrative healthcare utilisation data from 2017 to 2020. We applied multivariable zero-inflated regression modelling and presented findings stratified by high (CCI ≥ 5) and low disease burden (CCI < 5). Compared to controls, there were significant reductions in emergency department (β = -0.85; 95%CI = -1.55 to -0.14) and primary care visits (β = -1.70; 95%CI = -2.17 to -1.22) and a decrease in specialist outpatient visits (β = -0.29; 95%CI = -0.64 to 0.07) in the 3-month period immediately after one-year enrolment. The number of acute hospitalisations remained stable. Compared to controls, the intervention group with high and low comorbidity burden had significant decreases in primary care use, while only those with lower comorbidity burden had significant reductions in utilisation of other service types. An integrated PCMH appears beneficial in reducing healthcare utilisation for older persons with complex needs after 1 year in the programme. Future research can explore longer-term utilisation and scalability of the care model.

Prevalence and Trends of Slow Gait Speed in the United States

Gait speed is a simple, effective indicator of age-related disease and disability. We sought to examine the prevalence and trends of slow gait speed in older Americans. Our unweighted analytic sample included 12,427 adults aged ≥ 65 years from the 2006-2016 waves of the Health and Retirement Study. Gait speed was measured in participant residences. Persons with gait speed < 0.8 or <0.6 m/s were slow. Sample weights were used to generate nationally representative estimates. The overall estimated prevalence of slow gait speed with the <0.8 m/s cut-point was 48.6% (95% confidence interval (CI): 47.4-49.8) in the 2006-2008 waves yet was 45.7% (CI: 44.3-47.1) in the 2014-2016 waves, but this downward trend was not statistically significant (p = 0.06). The estimated prevalence of slowness with the <0.6 m/s cut-point was 21.3% (CI: 20.4-22.3) for the 2006-2008 waves, 18.5% (CI: 17.5-19.4) for the 2010-2012 waves, and 19.2% (CI: 18.2-20.2) for the 2014-2016 waves, but there were again no significant trends (p = 0.61). Our findings showed that the estimated prevalence of slow gait speed in older Americans is pronounced, and different cut-points largely inform how slowness is categorized. Continued surveillance of slowness over time will help guide screening for disablement and identify sub-populations at greatest risk for targeted interventions.

Association between cardiovascular diseases and dementia among various age groups: a population-based cohort study in older adults

The link between cardiovascular (CV) risk factors or diseases and dementia is documented. There is conflicting evidence whether age moderates the association. We need to study this gap so that research and clinical initiatives target appropriate age groups. A cohort of 320,630 adult patients without dementia was built using Quebec healthcare databases (1998-2010). The CV risk factors were hypertension, diabetes and dyslipidemia, while diseases included stroke, myocardial infarction (MI), chronic heart failure (HF), and atrial fibrillation (AF). Dementia risk and CV risk factors or diseases were assessed using incidence rate ratios and Cox regression across age groups. The cohort presented by mainly female sex (67.7%) and mean age of 74.1 years. Incident rate of dementia increased with age, ranging from 4.1 to 93.5 per 1000 person-years. Diabetes, stroke, HF and AF were significantly associated with dementia risk, hazard ratios ranged from 1.08 to 3.54. The strength of association decreased in advanced age for diabetes, stroke and HF. The results suggest that prevention of diabetes, stroke, HF and AF are crucial to mitigate dementia risk. The pathophysiology of dementia in younger and older populations seems to differ, with less impact of CV risk factors in advanced age.

Direct Estimation of Equivalent Bioelectric Sources Based on Huygens' Principle

An estimation of the electric sources in the heart was conducted using a novel method, based on Huygens' Principle, aiming at a direct estimation of equivalent bioelectric sources over the heart's surface in real time. The main scope of this work was to establish a new, fast approach to the solution of the inverse electrocardiography problem. The study was based on recorded electrocardiograms (ECGs). Based on Huygens' Principle, measurements obtained from the surfaceof a patient's thorax were interpolated over the surface of the employed volume conductor model and considered as secondary Huygens' sources. These sources, being non-zero only over the surface under study, were employed to determine the weighting factors of the eigenfunctions' expansion, describing the generated voltage distribution over the whole conductor volume. With the availability of the potential distribution stemming from measurements, the electromagnetics reciprocity theorem is applied once again to yield the equivalent sources over the pericardium. The methodology is self-validated, since the surface potentials calculated from these equivalent sources are in very good agreement with ECG measurements. The ultimate aim of this effort is to create a tool providing the equivalent epicardial voltage or current sources in real time, i.e., during the ECG measurements with multiple electrodes.

Physical Activity Intervention for Leisure-Time Activity Levels Among Older Adults: A Cluster Randomized Trial

Importance

Current randomized trial evidence of the effects of physical activity interventions in older adults is mainly from developed countries, with little reliable evidence from low- and middle-income countries, such as China, where race, culture, and lifestyles differ substantially from those in Western populations.

Objective

To evaluate the effects of a multilevel intervention for increasing leisure-time activity levels in Chinese older adults.

Design, Setting, and Participants

This cluster randomized trial was conducted from May 2021 to May 2023, including an 8-week intervention period and a follow-up period of 24 months. Eight villages in China were randomly assigned to the intervention (4 villages) or the control (4 villages) group. Potentially eligible participants were 60 years or older. A total of 511 older adults from the selected 8 villages were enrolled.

Interventions

The intervention group received an 8-week socioecological model-based intervention, comprising individual, interpersonal, and community-level components, whereas the control group did not.

Main Outcome and Measure

The primary outcome was the change in leisure-time activity at 8 weeks, measured by the Physical Activity Scale for the Elderly (PASE). Possible PASE scores for leisure-time activity range from 0 to 502, with higher scores indicating higher activity levels.

Results

A total of 511 older adults from 8 villages were recruited and randomly allocated to the intervention (240 participants, 4 villages) or control (271 participants, 4 villages) groups. The mean (SD) age was 70.95 (5.72) years, and 284 (55.6%) were female participants. Seven serious adverse events (unrelated deaths) were reported. Participants in the intervention group increased leisure-time activity more than those in the control group, with a mean difference in PASE scores of 13.74 points (95% CI, 8.58-18.91 points) between the groups at 8 weeks (P < .001). Significant differences in leisure-time activity were also found over 24 months (mean difference in scores at 4 weeks, 11.66 points; 95% CI, 6.41-16.90 points; P < .001; at 6 months, 12.35 points; 95% CI, 7.19-17.50 points; P < .001; at 12 months, 11.55 points; 95% CI, 6.32-16.78 points; P < .001; and at 24 months, 14.51 points; 95% CI, 9.28-19.75 points; P < .001).

Conclusions and Relevance

In this cluster randomized trial, the multilevel intervention was effective in promoting leisure-time activity over 24 months of follow-up in older adults from China. This finding suggests that implementation of such interventions could be an important step in addressing physical inactivity in older adults in low- and middle-income countries.

Trial Registration

Chinese Clinical Trial Registry Identifier: ChiCTR2100045653.

Delivering Rehabilitation Care Around the World: Voices From the Field

OBJECTIVES

To identify the challenges and common issues that the rehabilitation health workforce experienced in delivering services in different practice settings across the world. These experiences could suggest approaches to improving rehabilitation care to people in need.

DESIGN

A semi-structured interview protocol centering on 3 broad research questions was conducted to collect data. The data were analyzed to identify common themes across the cohort interviewed.

SETTING

Interviews were conducted using Zoom. Interviewees not able to access Zoom provided written responses to the questions.

PARTICIPANTS

Participants included 30 key rehabilitation opinion leaders from different disciplines from 24 countries, across world regions and income levels (N=30).

INTERVENTIONS

NA.

MAIN OUTCOME MEASURES

Although rehabilitation care deficiencies differ in severity, participants reported that the demand for services consistently outstrips available care, regardless of world region or income level. Access and social barriers, particularly in rural areas and remote regions, are common challenges for those delivering and receiving rehabilitation care.

RESULTS

Individual voices from the field reported both challenges and hopeful changes in making rehabilitation services available and accessible.

CONCLUSIONS

The descriptive approach undertaken has allowed individual voices, rarely included in studies, to be highlighted as meaningful data. Although the research findings are not generalizable beyond the convenience cohort included without further analysis and validation in specific local practice contexts, the authentic voices that spoke out on these issues demonstrated common themes of frustration with the current state of rehabilitation services delivery but also hopefulness that more solutions are on the horizon.

Trends in the use of home care services among Norwegians 70+ and projections towards 2050: The HUNT study 1995-2017

BACKGROUND

Life expectancy (LE) is increasing worldwide, while there is lack of information on how this affects older individuals' use of formal home care services.

AIM

We aimed to decompose LE into years with and without home care services and estimate projected number of users towards 2050 in Norway for people 70 years or older.

METHODS

This study is based on a sample of 25,536 participants aged 70 years and older in the Trøndelag Health Study (HUNT) survey 2 (1995-1997), 3 (2006-2008), or 4 (2017-2019) linked with national data on mortality. Prevalence of home care services was standardised to the Norwegian population by age and sex. The Sullivan method was used to estimate expected years with and without home help services and nursing services for the years 1995, 2006 and 2016. Data from HUNT4 and Statistics Norway were used to estimate projected use of these services between 2020 and 2050.

RESULTS

During 1995-2017, the use of home help services decreased from 22.6% to 6.2% (p < 0.001), and from 6.4% to 5.5% (p = 0.004) for home nursing services. Adjusted for age and sex, the use of home help services decreased significantly over time (p < 0.001), while home nursing services were stable (p = 0.69). LE at age 70 increased from 11.9 to 15.3 years in men (p < 0.05) during 1995-2017, and from 14.7 to 17.1 in women (p < 0.05). In the same period, the expected years receiving home help decreased from 2.6 to 1.1 in men (p < 0.05), and from 4.4 to 2.1 in women (p < 0.05). The expected years receiving home nursing increased from 0.6 to 0.9 in men (p < 0.05), and from 1.3 to 1.7 in women (p < 0.05). Projected numbers of people 70+ in Norway in need of either of these services were estimated to rise from 64,000 in 2020 to 160,000 in 2050.

CONCLUSION

While overall life expectancy increased, the expected years receiving home help have decreased and home nursing slightly increased among the Norwegian population aged 70 years and older during 1995-2017. However, the substantial increase in the projected number of older adults using home care services in the future is an alert for the current health care planners.

Evidence-based models of rural palliative care: A systematic review

BACKGROUND

Forty-five percent of the world's population lives in rural areas, yet their access to palliative care is quite limited. Identifying the care elements rural populations with palliative care needs require is critical to improving care outcomes.

AIM

To identify the key care elements that optimise palliative care for people in rural communities.

DESIGN AND DATA SOURCES

A systematic review of articles studying the impact of novel rural model of care interventions was undertaken in May 2022. This study is reported using the PRISMA Statement and was registered with Prospero (CRD42020154273). Three databases were searched, and the data analysed according to Popay's narrative synthesis, and elements classified using the WHO Innovative Care for Chronic Conditions (ICCC) Framework.

RESULTS

Of the 9508 identified papers, 15 met the inclusion criteria, reporting on 14 studies involving 1820 rural patients. Care received spanned 12/18 of the WHO ICCC Framework elements, with wide variability in how these elements were operationalised. The five elements that signal improved outcomes were: (1) Promote continuity and coordination; (2) Prepared, informed and motivated health care teams; (3) Prepared, informed and motivated patients and families; (4) Organise and equip health care teams and (5) Promote consistent financing.

CONCLUSIONS

A well-coordinated multidisciplinary team approach, led by clinicians with specialist palliative care expertise, integrated across local health care settings, using information systems and care planning, is critical to optimising rural palliative care patient outcomes. Rural patients and their families require timely input from specialist palliative care clinicians and information to address their needs.Prospero registration ID: CRD42020154273 https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=154273.

Review of self-efficacy assessment scales for geriatric patients with urinary incontinence

Urinary incontinence is a common condition in the elderly, which can be improved with rehabilitation. However, compliance with the rehabilitation regimen is influenced by the level of self-efficacy. Self-efficacy of elderly patients in dealing with urinary incontinence can be clinically assessed and understood by using a suitable scale, to implement specific improvement measures. At present, the tools used for assessing the self-efficacy of elderly patients with urinary incontinence include the General Self-Efficacy Scale (GSES), the Pelvic Floor Muscle Self-efficacy Scale, the Geriatric Self-efficacy Index for Urinary Incontinence, and the Yoga Self-Efficacy Scale. Most of these tools are suitable for female patients with urinary incontinence, but lack relevance to the disease characteristics of geriatric patients. In this study, we reviewed the self-efficacy assessment tools for geriatric patients with urinary incontinence, to provide a reference for related research. It is important to accurately assess the self-efficacy of patients with geriatric UI to effectively enhance their level of self-efficacy, so that patients with geriatric UI can avail early help and quickly reintegrate with family and society.

A protocol for a wait list control trial of an intervention to improve pain and depressive symptoms among middle-aged and older African American women

BACKGROUND

Pain and depression frequently co-occur among older adults with comorbidities and can exacerbate one another. The intersection of race, gender and age puts older African American women at high risk of experiencing comorbid pain and depression. The purpose of this study is to test the feasibility and acceptability of a 12-week behavioral activation intervention called DAPPER (Depression and Pain Perseverance through Empowerment and Recovery) that uses non-pharmacological, tailored strategies to target pain and mood symptoms. We will measure pain intensity and depressive symptoms as outcomes, although we are not powered to test differences.

METHODS

We describe the protocol for this study that uses a randomized waitlist control design to examine acceptability and feasibility of an intervention. The study population is comprised of self-identified African American women, 50 years of age or older with chronic pain and who self-report of depressive symptoms. Participants must also be pre-frail or frail and have an ADL or IADL limitation. The intervention consists of eight 1-2-h visits with a nurse interventionist via in-person or virtual telecommunication methods and two visits for non-invasive specimen collection. The primary outcomes include goal attainment, pain and depressive symptoms. Secondary outcomes include stress, frailty, and communication with providers. Follow-up qualitative interviews are conducted with participants to assess intervention acceptability.

DISCUSSION

Findings from this pilot study will provide further evidence supporting the use of non-pharmacological techniques to intervene in the cycle of pain and depression among an at-risk sub-population.

Estimating the causal effects of work-related and non-work-related stressors on perceived stress level: A fixed effects approach using population-based panel data

OBJECTIVES

Prolonged or excessive stress can have a negative impact on health and well-being, and stress therefore constitutes a major public health issue. A central question is what are the main sources of stress in contemporary societies? This study examines the effects of work-related and non-work-related stressors and perceived social support on perceived stress within a causal framework.

METHODS

Panel data were drawn from two waves (2013 and 2017) of the population-based health survey "How are you?" conducted in the Central Denmark Region. The analytical sample comprised 9,194 subjects who had responded to both surveys. Work-related and non-work-related stressors included major life events, chronic stressors, daily hassles and lack of social support. Perceived stress was measured with the 10-item Perceived Stress Scale (PSS). Data were analysed using fixed effects regression in a fully balanced design.

RESULTS

The largest effects on PSS were seen in own disease, work situation and lack of social support. Other stressors affecting the perceived stress level were financial circumstances, relationship with partner, relationship with family and friends, and disease among close relatives. Most variables had a symmetrical effect on PSS.

CONCLUSIONS

The results point to the need for comprehensive policies to promote mental health that span life domains and include both the individual and the group as well as organizational and societal levels. The study indicates that there are multiple potential entry points for stress prevention and stress management. However, it also shows that disease, work situation and social support weigh heavily in the overall picture. This points to the healthcare system and workplace as key institutional venues for action.

Developing a comprehensive model of home-based formal care for elderly adults in Iran: A study protocol

BACKGROUND

Due to the increasing Iran's aging population, designing a home care model is necessary. However, the data on designing the home care model for elderly adults among developing countries are limited. This study will be carried out to develop a formal home-based care model for elderly adults in Iran.

METHODS

This multi-method study will include three phases: First, Mixed-methods sequential explanatory study including two steps: One, survey to determine the prevalence of dependence on formal and informal caregivers among people aged ≥ 60 years living in Tabriz metropolis; and two, content analysis approach includes face-to-face, semi-structured interviews with the older adults receiving formal care at home, their caregivers and relevant key informants on the characteristics of care and caregiver, challenges and expectations of standard care. In phase 2, a scoping review will be used to find out the components of home care in other countries, such as care provider organization, caregivers training, and financing. PubMed, Scopus, Web of Science, EMBASE, Google scholar databases and grey literature will be run to retrieve relevant evidence using proper MeSH terms. In phase3, the triangulation method (using the results of the previous phases, reviewing national upstream documents and the focus group discussion) will be done to reach consensus and design the initial model for the Iranian context. In the following, a Delphi study will be conducted on the validation and feasibility of the developed model.

DISCUSSION

The current health infrastructure in Iran is focused on caring for younger people, despite the near future population aging. Most studies have addressed the challenges of geriatric care, but no study has addressed the various dimensions of home care in Iran and how to provide this service to elderly adults. Providing a comprehensive model of home care for the elderly can improve the quality of life and satisfaction of the elderly and their caregivers.

Association of Influenza Vaccination With Risk of Bell Palsy Among Older Adults in Taiwan

Importance

Annual administration of the influenza vaccine (fluVc) is currently the most effective method of preventing the influenza virus in older adults. However, half of adults older than 65 years remain unvaccinated in Taiwan, possibly because of concern about adverse events, such as Bell palsy (BP). Currently, studies on the association between fluVc and risk of BP are inconsistent.

Objective

To determine whether the incidence of BP increases following fluVc in older adults.

Design, Setting, and Participants

A self-controlled case series study design was used. Days 1 through 7, days 8 through 14, days 15 through 30, and days 31 through 60 following fluVc were identified as risk intervals, and days 61 through 180 were considered the control interval. A total of 4367 vaccinated individuals aged 65 years or older who developed BP within 6 months following fluVc were enrolled. Population-based retrospective claims data were obtained between 2010 and 2017; data were analyzed from April 2022 through September 2022.

Exposure

Government-funded seasonal fluVc.

Main Outcomes and Measures

The outcome of interest was BP onset in risk intervals compared with control intervals. Three or more consecutive diagnoses of BP within 60 days following fluVc were used as the definition of a patient with BP. Poisson regression was used to analyze the incidence rate ratio (IRR) of risk intervals compared with control intervals.

Results

In total, 13 261 521 patients who received the fluVc were extracted from the National Health Insurance Research Database in Taiwan from January 1, 2010, to December 31, 2017. Of those, 7 581 205 patients older than 65 years old met the inclusion criteria. The number of patients with BP diagnosed within 6 months following fluVc enrolled for risk analysis was 4367 (mean [SD] age, 74.19 [5.97] years; 2349 [53.79%] female patients). The incidence rate of BP among all observed fluVc older adults was 57.87 per 100 000 person-years. The IRRs for BP on days 1 through 7, days 8 through 14, and days 15 through 30 were 4.18 (95% CI, 3.82-4.59), 2.73 (95% CI, 2.45-3.05), and 1.67 (95% CI, 1.52-1.84), respectively. However, there was no increase during days 31 through 60 (IRR, 1.06; 95% CI, 0.97-1.16). The postvaccination risk of BP was consistent across all subgroups stratified by sex, age group, and baseline conditions.

Conclusions and Relevance

The present self-controlled case series indicated that the risk of BP in individuals older than 65 years increased within the first month, especially within the first week, following fluVc. But overall, the adverse event rate of BP was low, and considering the morbidity and mortality of influenza infection, the benefits of fluVc still outweigh the risks.

Intrinsic and environmental basis of aging: A narrative review

Longevity has been a topic of interest since the beginnings of humanity, yet its aetiology and precise mechanisms remain to be elucidated. Aging is currently viewed as a physiological phenomenon characterized by the gradual degeneration of organic physiology and morphology due to the passage of time where both external and internal stimuli intervene. The influence of intrinsic factors, such as progressive telomere shortening, genome instability due to mutation buildup, the direct or indirect actions of age-related genes, and marked changes in epigenetic, metabolic, and mitochondrial patterns constitute a big part of its underlying endogenous mechanisms. On the other hand, several psychosocial and demographic factors, such as diet, physical activity, smoking, and drinking habits, may have an even more significant impact on shaping the aging process. Consequentially, implementing dietary and exercise patterns has been proposed as the most viable alternative strategy for attenuating the most typical degenerative aging changes, thus increasing the likelihood of prolonging lifespan and achieving successful aging.

Framingham risk score conventional risk factors are potent to predict all-cause mortality using machine learning algorithms: a population-based prospective cohort study over 40 years in China

Predicting all-cause mortality using available or conveniently modifiable risk factors is potentially crucial in reducing deaths precisely and efficiently. Framingham risk score (FRS) is widely used in predicting cardiovascular diseases, and its conventional risk factors are closely pertinent to deaths. Machine learning is increasingly considered to improve the predicting performances by developing predictive models. We aimed to develop the all-cause mortality predictive models using five machine learning (ML) algorithms (decision trees, random forest, support vector machine (SVM), XgBoost, and logistic regression) and determine whether FRS conventional risk factors are sufficient for predicting all-cause mortality in individuals over 40 years. Our data were obtained from a 10-year population-based prospective cohort study in China, including 9143 individuals over 40 years in 2011, and 6879 individuals followed-up in 2021. The all-cause mortality prediction models were developed using five ML algorithms by introducing all features available (182 items) or FRS conventional risk factors. The area under the receiver operating characteristic curve (AUC) was used to evaluate the performance of the predictive models. The AUC and 95% confidence interval of the all-cause mortality prediction models developed by FRS conventional risk factors using five ML algorithms were 0.75 (0.726-0.772), 0.78 (0.755-0.799), 0.75 (0.731-0.777), 0.77 (0.747-0.792), and 0.78 (0.754-0.798), respectively, which is close to the AUC values of models established by all features (0.79 (0.769-0.812), 0.83 (0.807-0.848), 0.78 (0.753-0.798), 0.82 (0.796-0.838), and 0.85 (0.826-0.866), respectively). Therefore, we tentatively put forward that FRS conventional risk factors were potent to predict all-cause mortality using machine learning algorithms in the population over 40 years.

Dyadic Archetypes of Patient Self-Care and Caregiver Contribution to Self-Care in Dyads With Multiple Chronic Conditions: An Observational Study

Self-care of multiple chronic conditions (MCCs) and caregiver contribution to self-care have been theorized as dyadic. However, the different dyadic archetypes are still unknown. This cross-sectional study aimed to identify dyadic archetypes related to how in patient-caregiver dyads manage the patient's MCCs and to describe other ways in which the dyadic archetypes differ. A sample of 340 MCCs patient-caregiver dyads was enrolled in outpatient and community settings. Patients had a mean age of 76.7 (±7.3) years and were mostly female (54.5%). Caregivers had a mean age of 54.6 (±15.1) years and were mostly female (71.5%). Four dyadic archetypes were observed: "autonomous," "compensatory," "balanced," and "complementary" care. Clinical programs should consider the different characteristics of dyads to support self-care.

General diseases and medications in 687 patients reporting on adverse effects from dental materials

OBJECTIVES

Examination of patients claiming adverse effects from dental materials can be very challenging. Particularly, systemic aspects must be considered besides dental and orofacial diseases and allergies. Therefore, the aim of this study was to investigate a cohort of 687 patients reporting on adverse effects from dental materials focusing on findings related to known general diseases or conditions or medication-related findings with relevance to their subjective complaints.

METHODS

Six hundred eighty-seven patients visiting a specialized consultation on claimed adverse effects from dental materials were retrospectively investigated for their subjective complaints, findings related to known general diseases or conditions, medication-related findings, dental and orofacial findings, or allergies with relevance to their subjective complaints.

RESULTS

The most frequent subjective complaints were burning mouth (44.1%), taste disorders (28.5%), and dry mouth (23.7%). In 58.4% of the patients, dental and orofacial findings relevant to their complaints could be found. Findings related to known general diseases or conditions or medication-related findings were found in 28.7% or 21.0% of the patients, respectively. Regarding medications, findings related to antihypertensives (10.0%) and psychotropic drugs (5.7%) were found most frequently. Relevant diagnosed allergies toward dental materials were found in 11.9%, hyposalivation in 9.6% of the patients. In 15.1% of the patients, no objectifiable causes for the expressed complaints could be found.

CONCLUSIONS

For patients complaining of adverse effects from dental materials, findings related to known general diseases or conditions and medications should be given particular consideration, while still in some patients, no objectifiable causes for their complaints can be found.

CLINICAL RELEVANCE

For patients complaining about adverse effects from dental materials, specialized consultations and close collaboration with experts from other medical fields are eligible.

Educational Needs for Coaching Judo in Older Adults: The EdJCO Focus Groups

Judo coaches are urged to develop specific competencies and skills for addressing the special needs of older practitioners. Thus, the purpose of this study was to investigate the experts' opinions on judo training in late adulthood to develop sound educational programs for coaches of older judo practitioners. Overall, eighty-eight experts from an international consortium of judo and educational partners participated in national focus groups. During the focus groups, experts discussed five themes and generated statements pertinent to educate coaches to support older judo practitioners (e.g., benefits; necessary knowledge; risks; training groups definition; tools; and tests for monitoring training plans). The initial list of 262 statements was synthesized, validated, analyzed, and organized into a final list of 55 statements and six macro-areas: aging process (n = 10); safety and first aid (n = 6); physiology and fitness (n = 12); psychology and mental health (n = 11); organization and environment (n = 5); adapted judo teaching and training (n = 11). The present international eminence-based study, harmonizing diverse intercultural perspectives, highlighted the specific needs of older judo practitioners. The results of this study will contribute to the structure of a sound educational program for coaches of older judo practitioners to enhance the quality of older adults' sports experiences by linking safety, enjoyment, social interactions, and learning principles.

Primary mental healthcare for older people in India: between stigmatization and community orientation

BACKGROUND

Questions of equitable access to primary mental healthcare (PMHC) for older persons in India have been examined mostly in terms of the coverage of services, although perceptions of mental health and old age and social norms at the community level should be considered in the shaping of PMHC approaches. The present qualitative study, therefore, examined how social perceptions and norms of mental health in old age are and should be considered in the design and implementation of primary healthcare approaches in India.

METHODS

A secondary thematic analysis of semi-structured interviews with key stakeholders (n = 14) of PMHC in India was conducted.

RESULTS

Four key themes emerged from the analysis, in which social perceptions and norms were discussed: (1) family participation and low threshold access to mental healthcare, (2) the position of community health workers as an important pillar of old age and mental health-sensitive community-based care, (3) the role of social cohesion and traditional values in fostering a positive and supportive community environment for old age mental health, and (4) the empowerment of communities, families and older persons through mental health education.

CONCLUSIONS

PMHC, with its focus on mental health promotion, could be an important anchor for combatting negative attitudes about mental health and old age. The findings presented in this study can inform age-sensitive policies and programmes for mental health in India and could inform future research on the subject.

Ultrasound Elastography in Children

Ultrasound elastography is a novel ultrasound technique, being extensively researched in children in the last decade. It measures tissue elasticity with the observation of tissue response after an external stimulus. From research to clinical practice, ultrasound elastography has evolved significantly in liver fibrosis evaluation in children; however, several other applications of the technique are available in both clinical practice and research environments. Practically, in children any organ can be assessed, including the brain in early ages, along with muscle and connective tissue elasticity evaluation, spleen, kidney, skin, lymphatic tissue, etc. The elastography method, age, body mass index and technical points should be considered when performing ultrasound elastography. This review highlights its vast potential as a diagnostic tool in the pediatric population, where ultrasound is a dominant imaging tool; however, the indications and exam protocol for its clinical use in several fields in pediatrics have yet to be elucidated.

Risk of hip fracture in meat-eaters, pescatarians, and vegetarians: a prospective cohort study of 413,914 UK Biobank participants

BACKGROUND

Meat-free diets may be associated with a higher risk of hip fracture, but prospective evidence is limited. We aimed to investigate the risk of hip fracture in occasional meat-eaters, pescatarians, and vegetarians compared to regular meat-eaters in the UK Biobank, and to explore the role of potential mediators of any observed risk differences.

METHODS

Middle-aged UK adults were classified as regular meat-eaters (n = 258,765), occasional meat-eaters (n = 137,954), pescatarians (n = 9557), or vegetarians (n = 7638) based on dietary and lifestyle information at recruitment (2006-2010). Incident hip fractures were identified by record linkage to Hospital Episode Statistics up to September 2021. Multivariable Cox regression models were used to estimate associations between each diet group and hip fracture risk, with regular meat-eaters as the reference group, over a median follow-up time of 12.5 years.

RESULTS

Among 413,914 women, 3503 hip fractures were observed. After adjustment for confounders, vegetarians (HR (95% CI): 1.50 (1.18, 1.91)) but not occasional meat-eaters (0.99 (0.93, 1.07)) or pescatarians (1.08 (0.86, 1.35)) had a greater risk of hip fracture than regular meat-eaters. This is equivalent to an adjusted absolute risk difference of 3.2 (1.2, 5.8) more hip fractures per 1000 people over 10 years in vegetarians. There was limited evidence of effect modification by BMI on hip fracture risk across diet groups (p_interaction = 0.08), and no clear evidence of effect modification by age or sex (p_interaction = 0.9 and 0.3, respectively). Mediation analyses suggest that BMI explained 28% of the observed risk difference between vegetarians and regular meat-eaters (95% CI: 1.1%, 69.8%).

DISCUSSION

Vegetarian men and women had a higher risk of hip fracture than regular meat-eaters, and this was partly explained by their lower BMI. Ensuring adequate nutrient intake and weight management are therefore particularly important in vegetarians in the context of hip fracture prevention.

TRIAL REGISTRATION

NCT05554549, registered retrospectively.

Underestimated Factors Regarding the Use of Technology in Daily Practice of Long-Term Care: Qualitative Study Among Health Care Professionals

BACKGROUND

Increasing life expectancy is resulting in a growing demand for long-term care; however, there is a shortage of qualified health care professionals (HCPs) to deliver it. If used optimally, technology can provide a solution to this challenge. HCPs play an important role in the use of technology in long-term care. However, technology influences several core aspects of the work that HCPs do, and it is therefore important to have a good understanding of their viewpoint regarding the use of technology in daily practice of long-term care.

OBJECTIVE

The aim of this study was to identify the factors that HCPs consider as relevant for using technology in daily practice of long-term care.

METHODS

In this qualitative study, 11 focus groups were organized with 73 HCPs. The focus group discussions were guided by an innovative game, which was specifically developed for this study. The content of the game was categorized into 4 categories: health care technology and me; health care technology, the patient, and me; health care technology, the organization, and me; and facilitating conditions. The perspectives of HCPs about working with technology were discussed based on this game. The focus groups were recorded and transcribed, followed by an inductive thematic analysis using ATLAS.ti 9x (ATLAS.ti Scientific Software Development GmbH).

RESULTS

Overall, 2 main domain summaries were developed from the data: technology should improve the quality of care and acceptance and use of technology in care. The first factor indicates the need for tailored and personalized care and balance between human contact and technology. The second factor addresses several aspects regarding working with technology such as trusting technology, learning to work with technology, and collaboration with colleagues.

CONCLUSIONS

HCPs are motivated to use technology in daily practice of long-term care when it adds value to the quality of care and there is sufficient trust, expertise, and collaboration with colleagues. Their perspectives need to be considered as they play a crucial part in the successful use of technology, transcending their role as an actor in implementation. On the basis of the findings from this study, we recommend focusing on developing technology for situations where both efficiency and quality of care can be improved; redefining the roles of HCPs and the impact of technology hereon; involving HCPs in the design process of technology to enable them to link it to their daily practice; and creating ambassadors in care teams who are enthusiastic about working with technology and can support and train their colleagues.