It's never too late: health promotion and illness prevention in older persons

The effectiveness of preventive home visits on resilience and health-related outcomes among community dwelling older adults: A systematic review

BACKGROUND

This research aimed to assess the effectiveness of preventive home visits (PHVs) in enhancing resilience and health-related outcomes among older adults living in the community.

METHODS

A comprehensive literature search was conducted in nine databases (PubMed, MEDLINE, CINAHL, Embase, Emcare, Web of Science (WOS), Scopus, PsycINFO and Cochrane Library. The search was undertaken between March 15 and 31, 2022 with subsequent updates performed on October 15, 2023 and April 10, 2024. This review also included grey literature sourced via Google, Google Scholar and backward citation searches.

RESULTS

Out of 5,621 records, 20 articles were found to meet the inclusion criteria with a total of 8,035 participants involved and the mean age ranged from 74.0 to 84.4 years. Using McMaster Critical Review Form for Quantitative Studies, we ascertained that the studies included in our analysis had moderate to high levels of quality. In addition to health-related outcomes, PHV interventions were also conducted to evaluate psychological effects (16 studies) and social outcomes (seven studies). Five studies conducted financial assessment to evaluate the costs of health and social care utilisation during PHV interventions. Regarding the results of the review, seven studies showed favourable outcomes, five indicated no effect and eight had equivocal findings. Only one study assessed resilience and determined that PHV had no effect on the resilience of the subjects.

CONCLUSION

This review found that the effectiveness of PHV interventions was uncertain and inconclusive. PHV interventions often prioritise health-related objectives. The incorporation of a holistic approach involving psychosocial health into PHV interventions is relatively uncommon. Due to the paucity of research on resilience as PHV outcome, we are unable to draw a conclusion on the effectiveness of PHV on resilience. Resilience should be prioritised as a psychological assessment in the future development of comprehensive PHV interventions, as it enables older adults to adapt, manage, and respond positively to adversities that may arise with age. Performing financial analysis such as costs and benefits analysis to incorporate the return on investment of PHV interventions is an added value for future research on this topic.

CLINICAL TRIAL REGISTRATION

PROSPERO registration number: CRD42022296919.

Adult and elderly in vitro digestibility patterns of proteins and carbohydrates as affected by different commercial bread types

Carbohydrate and protein digestibility were assessed in different commercial bread types, i.e., soft, durum, and whole wheat, by applying in vitro digestion protocols mimicking adult or elderly physiological conditions. Protein digestibility was measured after the gastric and intestinal phases by the o-phthalaldehyde spectrophotometric assay (OPA). Carbohydrate digestibility was assessed by determining the incremental area under glucose curve during the intestinal phase of digestion to estimate the glycaemic index (GI_e). Finally, the correlation between protein and carbohydrate digestibility was computed. Bread proteins presented a high gastric resistance, with a digestibility < 10% in all cases while after the intestinal phase, protein digestibility increased, ranging from 40 to 70%. Protein digestibility was affected both by formulation, with whole wheat bread presenting the lowest values, and by physiological conditions, with restrained digestibility under elderly conditions compared to adult ones. The GI_e decreased in the order durum > soft > whole, under both adult (119, 101, and 82, respectively) and elderly (107, 93, and 65, respectively) conditions. The extent of differences under different physiological settings varied depending on the bread type, without significant changes for soft wheat bread (ΔGI_e = 8), whereas elderly conditions significantly reduced GI_e both for durum (ΔGI_e = 12) and whole (ΔGI_e = 17) wheat bread. An almost strong positive correlation between protein digestibility and GI_e was observed (p = 0.69), indicating that concomitantly addressing sarcopenia and type 2 diabetes can only be pursued by a compromise solution or more desirably requires identifying technological strategies to maximize protein digestibility while restraining the glycaemic response.

Social Inequalities and Loneliness as Predictors of Ageing Well: A Trend Analysis Using Mixed Models

Background: This study examines if education, income, and loneliness are associated with physical functioning and optimism in an ageing population in Germany. Furthermore, time trends of physical functioning and optimism as well as of associations with social inequality and loneliness are analyzed. Methods: The German Ageing Survey (DEAS), a longitudinal population-based survey of individuals aged 40 years and older, was used (four waves between 2008 and 2017, total sample size N = 23,572). Physical functioning and optimism were introduced as indicators of ageing well. Educational level, net equivalent income, and loneliness were used as predictors in linear mixed models for longitudinal data. Results: Time trends show that physical functioning decreases over time, while optimism slightly increases. Education and income are positively associated with physical functioning, while higher loneliness correlates with lower physical functioning. Higher optimism was associated with higher income and particularly with lower loneliness. Income and notable educational inequalities in physical functioning increase over time. Time trends of the associations with optimism show decreasing income inequalities and increasing disparities in loneliness. Conclusions: Increasing educational inequalities in physical functioning and a strong association of loneliness with optimism provide information for further interventions. Targeted health promotion among the aged and addressing maladaptive social cognition are options to tackle these issues. Key areas for action on healthy ageing include, for instance, the alignment of health systems to the needs of older populations or the creation of age-friendly environments.

Experiences and views of older people on their participation in a nurse-led health promotion intervention: "Community Health Consultation Offices for Seniors"

Background

The growing number of community-dwelling older adults and the increased risks of adverse health events that accompany ageing, call for health promotion interventions. Nurses often lead these interventions. The views and experiences of older adults participating in these interventions have rarely been studied. To understand the views of targeted older adults, qualitative studies are essential. The aim of this study was to investigate the views and experiences of older adults on their participation in a nurse-led intervention, taking into account their views on healthy aging.

Methods

In a qualitative study, nineteen Dutch older adults aged 62 to 92 years participated in semi-structured interviews. These were transcribed verbatim and coded with the Qualitative Data Analysis Miner software program. The Qualitative Analysis Guide of Leuven was used for data analysis.

Results

Based on the analysis of the interviews, the following main themes emerged from the data reflecting the experiences of the participants: 1) awareness of aging, 2) experienced interaction with the nurse, and 3) perception of the consultations as a check-up and/or personal support.

Conclusions

This study underscores the importance of nurse-led interventions that match older adults’ personal views concerning healthy living, and their views and experiences concerning these interventions. Older adults’ holistic views of healthy living were not always assessed and valued by the nurses. Also, our study shows a wide variety of expectations, views and experiences among the participating older adults. This implies that health professionals should adjust their working and communication methods to the older adult’s views on life.

Understanding the gastrointestinal tract of the elderly to develop dietary solutions that prevent malnutrition

Although the prevalence of malnutrition in the old age is increasing worldwide a synthetic understanding of the impact of aging on the intake, digestion, and absorption of nutrients is still lacking. This review article aims at filling the gap in knowledge between the functional decline of the aging gastrointestinal tract (GIT) and the consequences of malnutrition on the health status of elderly. Changes in the aging GIT include the mechanical disintegration of food, gastrointestinal motor function, food transit, chemical food digestion, and functionality of the intestinal wall. These alterations progressively decrease the ability of the GIT to provide the aging organism with adequate levels of nutrients, what contributes to the development of malnutrition. Malnutrition, in turn, increases the risks for the development of a range of pathologies associated with most organ systems, in particular the nervous-, muscoskeletal-, cardiovascular-, immune-, and skin systems. In addition to psychological, economics, and societal factors, dietary solutions preventing malnutrition should thus propose dietary guidelines and food products that integrate knowledge on the functionality of the aging GIT and the nutritional status of the elderly. Achieving this goal will request the identification, validation, and correlative analysis of biomarkers of food intake, nutrient bioavailability, and malnutrition.

Attitudes towards Bearing the Cost of Care in Later Life across the World

The aging population is recognized by many as a unique global phenomenon and has become a subject of interest among multidisciplinary professionals. Perhaps one of the most common key concerns among individuals and family members in many countries today is to meet the increasing demand for elderly healthcare, particularly the real challenges and crisis in old age morbidity and health. As the socioeconomic, demographic and cultural context of populations varies from one setting to another, the intergenerational support as well as responsibility for the cost of care also varies across the globe. In particular, issues related to elderly healthcare financing and its support are growing steadily and are becoming dominant topics in social gerontology. The aim of this study is to examine the effects of age, gender and employment on the perceptions of people with regard to their own care costs in later life. The data for the study come from the global aging study (GLAS), popularly known as “The Future of Retirement.” The initial field surveys were completed in two successive years—2004 and 2005—and involved interviewing around 22,329 individuals aged 18 years and over across 20 countries and territories covering four major regions of the world. A cross-sectional survey design was employed in which respondents were selected randomly. Each respondent was asked a number of questions on their socioeconomic and demographic situation; their retirement and pension plans; health, wellbeing and quality of life, and voluntary contributions and inter-generational support. Among others two questions were asked directly about the responsibility of the financial cost of care in retirement and these were: “who should bear” as well as “who will bear” most of the financial costs of care in retirement. These questions were then further explored to see how the responses varied with respect to the age, gender and employment status of the respondents. It has been found that age, gender and employment status play significant roles in determining people's perceptions towards bearing the cost of care in retirement or old age. There is a significant gap between the respondents' perceptions of who “should” and “will” bear the cost of care. The article concludes with a brief discussion on policy implications.

Alcohol use patterns and trajectories of health-related quality of life in middle-aged and older adults: a 14-year population-based study

OBJECTIVE

A 14-year multiwave panel design was used to examine relationships between longitudinal alcohol-consumption patterns, especially persistent moderate use, and change in health-related quality of life among middle-aged and older adults.

METHOD

A nationally representative sample of 5,404 community-dwelling Canadians ages 50 and older at baseline (1994/1995) was obtained from the longitudinal National Population Health Survey. Alcohol-consumption patterns were developed based on the quantity and frequency of use in the 12 months before the interview. Health-related quality of life was assessed with the Health Utilities Index Mark 3 (HUI3). Latent growth curve modeling was used to estimate the change in HUI3 for each alcohol pattern after adjusting for covariates measured at baseline.

RESULTS

Most participants showed stable alcohol-consumption patterns over 6 years. Persistent non-users, persistent former users, those decreasing their consumption levels, and those with unstable patterns (i.e., U shaped and inverted U shaped) had lower HUI3 scores at baseline compared with persistent moderate drinkers. A more rapid decline in HUI3 scores than that observed for persistent moderate users was seen only in those with decreasing consumption (p < .001). In a subgroup identified as consistently healthy before follow-up, longitudinal drinking patterns were associated with initial HUI3 scores but not rates of change.

CONCLUSIONS

Persistent moderate drinkers had higher initial levels of health-related quality of life than persistent nonusers, persistent former users, decreasing users, U-shaped users, and inverted U-shaped users. However, rates of decline over time were similar for all groups except those decreasing their consumption, who had a greater decline in their level of health-related quality of life than persistent moderate users.

Pharmacist Approach to Geriatrics

Pharmacists have traditionally focused on the appropriate use of medications to enhance the functional status of the elderly patient. However, in the proper provision of pharmaceutical care, the influence of lifestyle factors on the use and misuse of medications cannot be ignored. The pharmacist collaborates with other members of the health care team to ensure that drugs are dosed according to known changes occurring with age such as pharmacokinetic and pharmacodynamic alterations. Also, medications that may decrease cognitive function, impair gait/balance, or reduce sensory stimulation must be avoided. The appropriate use of medications can improve the functional status and reduce morbidity in the elderly patient, and drug adherence issues should be addressed to ensure that the elderly patient can receive the optimal benefit from his or her medication regimen. Pharmacists, in collaboration with physicians and other health care providers, can help to ensure that a comprehensive approach to patient care occurs, one that involves medications, diet, and exercise as it embraces the mind, body, and spirit.

Successful aging in the United States: prevalence estimates from a national sample of older adults

OBJECTIVES

To estimate the prevalence of successful aging in the United States, with the broad aim of contributing to the dialogue on Rowe and Kahn's concept of successful aging.

METHODS

Using data from the Health and Retirement Study, the prevalence of successful aging was calculated for adults aged 65 years and older at four time points: 1998, 2000, 2002, and 2004. Successful aging was operationalized in accordance with Rowe and Kahn's definition, which encompasses disease and disability, cognitive and physical functioning, social connections, and productive activities.

RESULTS

No greater than 11.9% of older adults were aging "successfully" in any year. The adjusted odds of successful aging were generally lower for those of advanced age, male gender, and lower socioeconomic status. Between 1998 and 2004, the odds of successful aging declined by 25%, after accounting for demographic changes in the older population.

DISCUSSION

Few older adults meet the criteria put forth in Rowe and Kahn's definition of successful aging, suggesting the need for modification if the concept is to be used for broad public health purposes. Disparities in successful aging were evident for socially defined subgroups, highlighting the importance of structural factors in enabling successful aging.

Dietary intervention in older adults with early-stage Alzheimer dementia: early lessons learned

In older adults, an adequate diet depends on their ability to procure and prepare food and eat independently or the availability of dietary assistance when needed. Inadequate food intake or increased nutritional requirements lead to poor nutritional status, which is considered a key determinant of morbidity, increased risk of infection, and mortality in elderly individuals. Weight loss among seniors also heralds increased morbidity and mortality. Dietary behaviour disorders affecting food consumption, nutrition status and maintenance of body weight are common in older adults, and have a substantial impact on nutritional status and quality of life among older adults with Alzheimer Dementia (AD). The Nutrition Intervention Study (NIS) is ongoing. It employs a quasi-experimental pre-post intervention design in physically-well, community-dwelling early stage AD patients aged 70 y or older. To date, 34 intervention group patients and 25 control group participants have been recruited with their primary caregivers (CG) from 6 hospital-based memory and geriatric clinics in Montreal. The NIS uses clinical dietetics principles to develop and offer tailored dietary strategies to patients and their CG. This paper reports on the application of dietary intervention strategies in two intervention group participants; one was deemed successful while the other was considered unsuccessful. The report documents challenges encountered in assessing and counselling this clientele, and seeks to explain the outcome of intervention in these patients.

A national study on lipid management

BACKGROUND

Hyperlipidemia remains a major cause of morbidity in Western countries. The objective of this study was to document the percentage of adults who underwent periodical LDL measurement, and the percentage of patients with diabetes and post-angioplasty who were treated to goal.

METHODS

Using a national database, data were obtained on the percentage of adults who had an LDL performed and the percentage of adults with an LDL at pre-specified levels. We also assessed the attainment of target LDL levels in diabetic and post-angioplasty patients. Data were also collected from patients with an acute coronary syndrome (ACS) admitted to seven hospitals within a 5 year period (2000-2004).

RESULTS

Primary prevention: In 2005, 64.6% of the total population of 754,910 aged 35-44 had at least one record of LDL cholesterol measurement documented. This figure was 79.6% in the 717,617 adults aged 45-54. Secondary prevention: Of 253,233 diabetics in 2005, 220,023 (86.9%) have undergone at least one annual LDL measurement. The percentage of patients on statin therapy 3 and 12 months after an ACS admission increased significantly during the years 2000-2004 and reached 87%. Of the 42,292 patients who underwent PTCA during 2005, 34,346 (81.2%) have purchased at least 3 prescriptions of statins during 2005, 35,261 (83.4%) have performed at least one LDL measurement and 57.8% attained an LDL level of <100 mg/dl.

CONCLUSIONS

We have shown an improvement in primary and secondary preventions of CV disease as documented by LDL measured and attainment of treatment goals, but further efforts are needed.

Successful aging: the contribution of early-life and midlife risk factors

OBJECTIVES

To test whether early-life factors (education, height, father's social position) and midlife social, behavioral, and psychosocial factors were associated with entering older age without disease and with good functioning.

DESIGN

A longitudinal, British civil service-based cohort study. Participants were followed for 17 years to assess successful aging. This was defined as being free of major disease and in the top tertile of physical and cognitive functioning measured in 2002 to 2004.

SETTING

Twenty London-based Civil Service departments.

PARTICIPANTS

Four thousand, one hundred forty men and 1,823 women, free of major disease at baseline in 1985 to 1988 (mean age 44, range 35-55).

MEASUREMENTS

Behavioral, biological, and psychosocial risk factors; physical and cognitive functioning; and disease outcomes.

RESULTS

Five hundred forty eight (12.8%) men and 246 (14.6%) women were successfully aging at follow-up. Midlife socioeconomic position strongly predicted this (age-adjusted odds ratio, highest vs lowest=7.1, 95% CI=3.4-14.6, for men and 7.7, 95% CI=4.9-12.1, for women). Height, education (in men), not smoking, diet, exercise, moderate alcohol (in women), and work support (in men) were related to a favorable older life after adjustment for age and socioeconomic position.

CONCLUSION

Interventions to promote healthy adult behavior may attenuate harmful effects of less-modifiable risk factors and reduce social inequalities.

Behavioral determinants of healthy aging

With global trends in population aging, many nations are developing and implementing healthy aging policies to promote quality as well as years of healthy life. To broaden the evidence base for such policy development, a review of the literature was conducted to summarize the existing evidence regarding the behavioral determinants of healthy aging. Such research is needed so that the efficacy of modes of intervention can be better understood. The outcome of "healthy" or "successful" aging was selected for this review since this nomenclature dominates the literature describing a global measure of multidimensional functioning at the positive end of the health continuum in older age. Studies published between 1985 and 2003 that reported statistical associations between baseline determinants and healthy aging outcome were identified from a systematic search of medical, psychological, sociological, and gerontological databases. Eight studies satisfied the search criteria. Modifiable risk factors among the behavioral determinants included smoking status, physical activity level, body mass index, diet, alcohol use, and health practices. On the basis of these findings, effective healthy aging policies need to enhance opportunities across the life span for modification of lifestyle risk factors. Efforts to standardize concepts and terminology will facilitate further research activity in this important area.

The use of complementary and alternative medical therapies among older persons around the world

Defining complementary and alternative medicine (CAM) helps in understanding what it offers, why older patients are attracted to and find effectiveness in these therapies, and how conventional practitioners can deal with their increasing use. The most common definition in United States medical literature is "those practices neither taught widely in United States medical schools nor gene-rally available in United States hospitals." Patient interviews must include inquiry into CAM use; providers need to know about potentially risky therapies. Integration of CAM into our health care system, although burdensome in the short term, will benefit patients in the long run, where benefit is due. Integration of CAM into treatment does not mean acknowledging its effectiveness, but taking advantage of any benefits it has to offer.