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De Lucia A, Perlini C, Chiarotto A, Pachera S, Pasini I, Del Piccolo L, Donisi V. eHealth-Integrated Psychosocial and Physical Interventions for Chronic Pain in Older Adults: Scoping Review. J Med Internet Res 2024; 26:e55366. [PMID: 39073865 PMCID: PMC11319891 DOI: 10.2196/55366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/11/2024] [Accepted: 04/30/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND Chronic noncancer pain (CNCP) is highly present among older adults, affecting their physical, psychological, and social functioning. A biopsychosocial multimodal approach to CNCP management is currently extensively suggested by international clinical practice guidelines. Recently, the growing development and application of eHealth within pain management has yielded encouraging results in terms of effectiveness and feasibility; however, its use among the older population remains underexamined. OBJECTIVE The overall aim of this scoping review was to systematically map existing literature about eHealth multimodal interventions (including both physical and psychosocial components) targeting older adults with CNCP. METHODS This review adhered to the JBI methodology, a protocol was a priori registered as a preprint on the medRxiv platform, and the results were reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Four electronic databases (PubMed, Cochrane Central Register of Controlled Trials, Web of Science, and PsycINFO) were systematically searched for relevant articles. Studies were included if they reported on multimodal interventions (including both physical and psychosocial components) delivered through any eHealth modality to an older population with any type of CNCP. Two reviewers selected the studies: first by screening titles and abstracts and second by screening full-text articles. The quality of the included studies was evaluated using the Quality Assessment Tool for Studies with Diverse Designs. The results of the studies were summarized narratively. RESULTS A total of 9 studies (n=6, 67% published between 2021 and 2023) with quality rated as medium to high were included, of which 7 (78%) were randomized controlled trials (n=5, 71% were pilot and feasibility studies). All the included studies evaluated self-management interventions, most of them (n=7, 78%) specifically designed for older adults. The participants were aged between 65 and 75 years on average (mean 68.5, SD 3.5 y) and had been diagnosed with different types of CNCP (eg, osteoarthritis and chronic low back pain). Most of the included studies (5/9, 56%) involved the use of multiple eHealth modalities, with a higher use of web-based programs and video consulting. Only 1 (11%) of the 9 studies involved a virtual reality-based intervention. The evaluated interventions showed signs of effectiveness in the targeted biopsychosocial outcomes, and the participants' engagement and ratings of satisfaction were generally positive. However, several research gaps were identified and discussed. CONCLUSIONS Overall, of late, there has been a growing interest in the potential that eHealth multimodal interventions offer in terms of improving pain, physical, and psychosocial outcomes in older adults with CNCP. However, existing literature on this topic still seems scarce and highly heterogeneous, with few proper randomized controlled trials, precluding robust conclusions. Several gaps emerged in terms of the older population considered and the lack of evaluation of comorbidities. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1101/2023.07.27.23293235.
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Affiliation(s)
- Annalisa De Lucia
- Section of Clinical Psychology, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Cinzia Perlini
- Section of Clinical Psychology, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Alessandro Chiarotto
- Department of General Practice, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Sara Pachera
- Fondazione Casa di Riposo S Giuseppe Nonprofit Organization of Social Utility, San Martino Buon Albergo (Verona), Italy
| | - Ilenia Pasini
- Section of Clinical Psychology, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Lidia Del Piccolo
- Section of Clinical Psychology, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Valeria Donisi
- Section of Clinical Psychology, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Shi Y, Stanmore E, McGarrigle L, Todd C. Social-media based Health Education plus Exercise Programme (SHEEP) to improve muscle function among community-dwelling young-old adults with possible sarcopenia in China: A study protocol for intervention development. PLoS One 2024; 19:e0286490. [PMID: 38547178 PMCID: PMC10977808 DOI: 10.1371/journal.pone.0286490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 02/07/2024] [Indexed: 04/02/2024] Open
Abstract
Possible sarcopenia refers to low muscle strength. Prevalence of possible sarcopenia is estimated to be significantly higher in community-dwelling older adults than that of confirmed or severe sarcopenia. However, there are currently far fewer non-pharmacological intervention strategies for possible sarcopenia than for sarcopenia in the community. Meanwhile, one type of non-pharmacological intervention in sarcopenic area, health education, is under-researched, and older people's awareness about sarcopenia is extremely low, necessitating an immediate dissemination tool for prevention. Social media may be a potential, scalable, low-cost tool for this. This study protocol outlines how a social media-based multicomponent intervention will be co-designed with stakeholders to address this evidence gap. Guided by the Medical Research Council's framework, the proposed research covers two phases that employ a co-design approach to develop a theory-based multicomponent intervention to increase sarcopenia prevention in the community. The participants will be recruited from young-old adults (60~69) with possible sarcopenia in the community of Changsha, China. Maximum sample size will be 45 participants in total, with 18~25 participants in the development phase and 15~20 participants in the pre-test phase. During two rounds of focus groups with older adults, a social-media based intervention strategy will be developed from a theory-based conceptual model and an initial intervention plan formulated by the research group. After this, there will be a three-week pre-test phase, followed by a semi-structured interview to further modify the theory-based conceptual model and the social-media based intervention strategy. The focus of the data analysis will be on thematic analysis of qualitative data primarily derived from the group interview and the semi-structured interview with key stakeholders.
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Affiliation(s)
- Ya Shi
- School of Health Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, United Kingdom
- School of Nursing & School of Public Health, Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Emma Stanmore
- School of Health Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, United Kingdom
- Manchester Institute for Collaborative Research on Ageing, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Manchester, United Kingdom
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Lisa McGarrigle
- School of Health Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, United Kingdom
- Manchester Institute for Collaborative Research on Ageing, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Chris Todd
- School of Health Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, United Kingdom
- Manchester Institute for Collaborative Research on Ageing, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Manchester, United Kingdom
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
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Souza CCD, Fernandes MP, Bertoldi AD, Demarco FF, Gonzalez MC, Bielemann RM. [Prevalence of water intake among non-institutionalized elderly individuals in Southern Brazil]. CIENCIA & SAUDE COLETIVA 2023; 28:1903-1914. [PMID: 37436305 DOI: 10.1590/1413-81232023287.14692022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 12/21/2022] [Indexed: 07/13/2023] Open
Abstract
The scope of this study was to determine the percentage of elderly individuals receiving an adequate water intake and associated factors among non-institutionalized elderly individuals in the urban area of Pelotas, Rio Grande do Sul. It involved a cross-sectional, population-based study carried out in 2014 with elderly participants (≥ 60 years) of the "COMO VAI?" survey. The amount of water ingested per day of the interviewees was investigated, considering the intake of at least eight glasses per day to be adequate. The independent variables were sociodemographic, behavioral, and health characteristics, and Poisson Regression was used to investigate associations. A total of 1,451 elderly people were interviewed, with only 12.6% (95%CI 10.8; 14.7) drinking a sufficient amount. A higher percentage of the elderly with adequate water consumption was observed in younger elderly individuals, those overweight, those with five or more diseases, and those who were more impaired. A low percentage of the elderly with an adequate water intake was observed among the elderly adults in the study. The decreasing trend of water intake in relation to age highlights the importance of developing actions for the higher risk population to stress adequate water intake and the possible consequences of the lack of adequate consumption.
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Affiliation(s)
- Carolina Corrêa de Souza
- Faculdade de Nutrição, Universidade Federal de Pelotas. R. Gomes Carneiro 1, 2º andar, Prédio 1. 96010-610 Pelotas RS Brasil.
| | - Mayra Pacheco Fernandes
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas. Pelotas RS Brasil
| | - Andréa Dâmaso Bertoldi
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas. Pelotas RS Brasil
| | - Flávio Fernando Demarco
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas. Pelotas RS Brasil
- Programa de Pós-Graduação em Odontologia, Universidade Federal de Pelotas. Pelotas RS Brasil
| | - Maria Cristina Gonzalez
- Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas. Pelotas RS Brasil
| | - Renata Moraes Bielemann
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas. Pelotas RS Brasil
- Programa de Pós-Graduação em Nutrição e Alimentos, Universidade Federal de Pelotas. Pelotas RS Brasil
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Rüggeberg A, Nickel EA. Unrestricted drinking before surgery: a structured patient interview. Anaesthesia 2023. [PMID: 36929501 DOI: 10.1111/anae.15997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2023] [Indexed: 03/18/2023]
Affiliation(s)
- A Rüggeberg
- Helios Klinikum Emil von Behring, Berlin, Germany
| | - E A Nickel
- Helios Klinikum Emil von Behring, Berlin, Germany
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Čypienė A, Gimžauskaitė S, Rinkūnienė E, Jasiūnas E, Rugienė R, Kazėnaitė E, Ryliškytė L, Badarienė J. The Association between Water Consumption and Hyperuricemia and Its Relation with Early Arterial Aging in Middle-Aged Lithuanian Metabolic Patients. Nutrients 2023; 15:nu15030723. [PMID: 36771428 PMCID: PMC9921948 DOI: 10.3390/nu15030723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 01/25/2023] [Accepted: 01/28/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Hyperuricemia is well-known as an independent risk factor for the development of hypertension, metabolic syndrome, and cardiovascular disease. Water is essential to most bodily functions, and its consumption rates appear to decline with age. The aim was to evaluate the influence of water intake on early vascular aging in metabolic middle-aged patients with hyperuricemia. MATERIALS AND METHODS The study included 241 men aged 40-55 years and 420 women aged 50-65 years from the Lithuanian High Cardiovascular Risk (LitHiR) primary prevention program. Anthropometric characteristics, blood pressure, laboratory testing, and the specialized nutrition profile questionnaire were evaluated. Carotid-femoral pulse wave velocity (cfPWV), assessed using applanation tonometry, was evaluated as an early vascular aging parameter in patients with hyperuricemia and with normal serum uric acid (sUA) levels. RESULTS 72.6% of men and 83.1% of women drink insufficient amounts of water (less than 1.5 L per day). However, our results showed statistically significant relationships only among a group of women. The women in the hyperuricemic group had a higher cfPWV than women with normal sUA levels. In hyperuricemic women, drinking less than 0.5 L per day in combination with other risk factors, such as age, increasing fasting glucose, and systolic blood pressure, was statistically significantly associated with an increased cfPWV (R2 = 0.45, Adj. R2 = 0.42, p < 0.001). CONCLUSION Drinking an insufficient amount of water daily is associated with increased arterial stiffness and has a negative effect on vascular health in metabolic women with hyperuricemia.
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Affiliation(s)
- Alma Čypienė
- State Research Institute Centre for Innovative Medicine, 08406 Vilnius, Lithuania
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania
| | - Silvija Gimžauskaitė
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania
- Correspondence:
| | | | - Eugenijus Jasiūnas
- Center of Informatics and Development, Vilnius University Hospital Santaros Klinikos, 08661 Vilnius, Lithuania
| | - Rita Rugienė
- State Research Institute Centre for Innovative Medicine, 08406 Vilnius, Lithuania
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania
| | - Edita Kazėnaitė
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania
| | - Ligita Ryliškytė
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania
| | - Jolita Badarienė
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania
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Park K, Byeon J, Yang Y, Cho H. Healthcare utilisation for elderly people at the onset of the COVID-19 pandemic in South Korea. BMC Geriatr 2022; 22:395. [PMID: 35524173 PMCID: PMC9072758 DOI: 10.1186/s12877-022-03085-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 04/25/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND At the onset of the coronavirus disease 2019 (COVID-19) pandemic, health care systems were severely disrupted in many countries and in particular, elderly people vulnerable to COVID-19 may have been reluctant to receive their medical treatment. METHODS We conducted interrupted time series analyses (ITSA) using nationwide medical claim data between January 2020 and July 2020, with focus on different disease categories for the patients of 65 to 84-year-olds, i.e., acute upper respiratory infections (AURIs) vs. chronic diseases. RESULTS AURIs and chronic diseases showed a sharp contrast with respect to the change in healthcare service utilisation. First, the utilisation rate for chronic diseases changed little whereas for AURIs it dropped by 20.4% year-over-year (yoy) at the onset of the pandemic (week 6, 2020). Second, as social distancing relaxed (week 17, 2020), the AURIs patients trended up and even reached to 7.8% above yoy whereas no significant change found for chronic diseases. CONCLUSIONS The uninterrupted treatment for chronic diseases in contrast to the AURIs implies that the governmental and public responses to the pandemic outbreak worked for efficient healthcare provision to patients in needs of regular check-ups and treatment in the middle of an infectious disease crisis.
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Affiliation(s)
- K. Park
- Health Insurance Research Institute, National Health Insurance Service, Wonju, 26464 South Korea
| | - J. Byeon
- Health Insurance Research Institute, National Health Insurance Service, Wonju, 26464 South Korea
| | - Y. Yang
- Health Insurance Research Institute, National Health Insurance Service, Wonju, 26464 South Korea
| | - H. Cho
- Health Insurance Research Institute, National Health Insurance Service, Wonju, 26464 South Korea
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Virameteekul S, Phokaewvarangkul O, Bhidayasiri R. Profiling the most elderly parkinson's disease patients: Does age or disease duration matter? PLoS One 2021; 16:e0261302. [PMID: 34937068 PMCID: PMC8694485 DOI: 10.1371/journal.pone.0261302] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 12/01/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Despite our ageing populations, elderly patients are underrepresented in clinical research, and ageing research is often separate from that of Parkinson's disease (PD). To our knowledge, no previous study has focused on the most elderly ('old-old', age ≥ 85 years) patients with PD to reveal how age directly influences PD clinical progression. OBJECTIVE We compared the clinical characteristics and pharmacological profiles, including complications of levodopa treatment, disease progression, disabilities, and comorbidities of the old-old with those of comparable younger ('young-old', age 60-75 years) PD patients. In addition, within the old-old group, we compared those with a short disease duration (< 10 years at the time of diagnosis) to those with a long disease duration ≥10 years to investigate whether prognosis was related to disease progression or aging. METHODS This single-centre, case-control study compared 60 old-old to 92 young-old PD patients, matched for disease duration. Patients in the old-old group were also divided equally (30:30) into two subgroups (short and long disease duration) with the same mean age. We compared the groups based on several clinical measures using a conditional logistic regression. RESULTS By study design, there were no differences between age groups when comparing disease duration, however, the proportion of men decreased with age (p = 0.002). At a comparable length of PD duration of 10 years, the old-old PD patients predominantly had significantly greater postural instability and gait disturbance (p = 0.006), higher motor scope of the Unified Parkinson's Disease Rating Scale (UPDRS-III, p<0.0001), and more advanced Hoehn & Yahr (H&Y) stage (p<0.0001). The Non-Motor Symptoms Questionnaire (NMSQuest) score was also significantly higher among the old-old (p<0.0001) compared to the young-old patients. Moreover, the distribution of NMS also differed between ages, with features of gastrointestinal problems (p<0.0001), urinary problems (p = 0.004), sleep disturbances and fatigue (p = 0.032), and cognitive impairment (p<0.0001) significantly more common in the old-old group, whereas sexual problems (p = 0.012), depression, and anxiety (p = 0.032) were more common in the young-old. No differences were found in visual hallucinations, cerebrovascular disease, and miscellaneous domains. While young-old PD patients received higher levodopa equivalent daily doses (p<0.0001) and developed a significant greater rate of dyskinesia (p = 0.002), no significant difference was observed in the rate of wearing-off (p = 0.378). Old-old patients also had greater disability, as measured by the Schwab and England scale (p<0.0001) and had greater milestone frequency specifically for dementia (p<0.0001), wheelchair placement (p<0.0001), nursing home placement (p = 0.019), and hospitalisation in the past 1 year (p = 0.05). Neither recurrent falls (p = 0.443) nor visual hallucinations (p = 0.607) were documented significantly more often in the old-old patients. CONCLUSIONS Age and disease duration were independently associated with clinical presentation, course, and progression of PD. Age was the main predictor, but disease duration also had a strong effect, suggesting that factors of the ageing process beyond the disease process itself cause PD in the most elderly to be more severe.
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Affiliation(s)
- Sasivimol Virameteekul
- Faculty of Medicine, Department of Medicine, Chulalongkorn Centre of Excellence for Parkinson’s Disease & Related Disorders, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Onanong Phokaewvarangkul
- Faculty of Medicine, Department of Medicine, Chulalongkorn Centre of Excellence for Parkinson’s Disease & Related Disorders, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Roongroj Bhidayasiri
- Faculty of Medicine, Department of Medicine, Chulalongkorn Centre of Excellence for Parkinson’s Disease & Related Disorders, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- The Academy of Science, The Royal Society of Thailand, Bangkok, Thailand
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Perucca L, Robecchi Majnardi A, Frau S, Scarano S. Normative Data for the NeuroCom ® Sensory Organization Test in Subjects Aged 80-89 Years. Front Hum Neurosci 2021; 15:761262. [PMID: 34867246 PMCID: PMC8641293 DOI: 10.3389/fnhum.2021.761262] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/04/2021] [Indexed: 12/02/2022] Open
Abstract
Aging is known to increase the risk of falling. In older people, whose share in the total population is rising sharply, the Sensory Organization Test (SOT, Equitest NeuroCom) is a useful tool during rehabilitation and in clinical research for assessing postural stability, risk of falling, and balance improvement. Normative data for the SOT in the healthy population older than 79 years have not been previously published. We recruited 53 recreationally active healthy subjects aged 80 years and older from the general population in a cross-sectional study. We presented the normative data for SOT for the 80–84 and 85–89 years groups. Our results showed that the “vestibular” balance control tended to be affected by aging more than the vision and proprioception-based systems. A striking reduction in performance after the age of 85 years was observed. These findings will be useful for clinical and research purposes.
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Affiliation(s)
- Laura Perucca
- Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | | | - Silvia Frau
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Stefano Scarano
- Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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Jin B, Roumell EA. "Getting Used to It, but Still Unwelcome": A Grounded Theory Study of Physical Identity Development in Later Life. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9557. [PMID: 34574481 PMCID: PMC8470261 DOI: 10.3390/ijerph18189557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/04/2021] [Accepted: 09/06/2021] [Indexed: 11/16/2022]
Abstract
Given the global trends toward an aging society and the increased desire for healthy aging in late life, this study examines older adults' perceptions of aging and their physical identity through their engagement in physical activities. Adopting a grounded theory, we interviewed 15 individuals aged 65 years and older, who were involved in physical activities on a regular basis. This study provided a final model depicting (a) divergent and convergent modes of strategies and socioemotional aspects of physical identity development in later life and (b) different strategies employed between younger-old versus older-old age groups and between participants who have underlying health conditions and those who do not. These findings add a contextual explanation of identity development in later life and stress the recurring process of physical identity development.
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Affiliation(s)
- Bora Jin
- The Gerontology Institute, Georgia State University, Atlanta, GA 30303, USA
| | - Elizabeth A. Roumell
- Department of Educational Administration & Human Resource Development, Texas A&M University, College Station, TX 77843, USA;
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Wang K, Tian J, Zheng C, Yang H, Ren J, Liu Y, Han Q, Zhang Y. Interpretable prediction of 3-year all-cause mortality in patients with heart failure caused by coronary heart disease based on machine learning and SHAP. Comput Biol Med 2021; 137:104813. [PMID: 34481185 DOI: 10.1016/j.compbiomed.2021.104813] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/25/2021] [Accepted: 08/25/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND This study sought to evaluate the performance of machine learning (ML) models and establish an explainable ML model with good prediction of 3-year all-cause mortality in patients with heart failure (HF) caused by coronary heart disease (CHD). METHODS We established six ML models using follow-up data to predict 3-year all-cause mortality. Through comprehensive evaluation, the best performing model was used to predict and stratify patients. The log-rank test was used to assess the difference between Kaplan-Meier curves. The association between ML risk and 3-year all-cause mortality was also assessed using multivariable Cox regression. Finally, an explainable approach based on ML and the SHapley Additive exPlanations (SHAP) method was deployed to calculate 3-year all-cause mortality risk and to generate individual explanations of the model's decisions. RESULTS The best performing extreme gradient boosting (XGBoost) model was selected to predict and stratify patients. Subjects with a higher ML score had a high hazard of suffering events (hazard ratio [HR]: 10.351; P < 0.001), and this relationship persisted with a multivariable analysis (adjusted HR: 5.343; P < 0.001). Age, N-terminal pro-B-type natriuretic peptide, occupation, New York Heart Association classification, and nitrate drug use were important factors for both genders. CONCLUSIONS The ML-based risk stratification tool was able to accurately assess and stratify the risk of 3-year all-cause mortality in patients with HF caused by CHD. ML combined with SHAP could provide an explicit explanation of individualized risk prediction and give physicians an intuitive understanding of the influence of key features in the model.
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Affiliation(s)
- Ke Wang
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, People's Republic of China; Department of Epidemiology and Biostatistics, Xuzhou Medical University, Xuzhou, People's Republic of China; Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment, Shanxi Medical University, Taiyuan, People's Republic of China
| | - Jing Tian
- Department of Cardiology, The First Affiliated Hospital of Shanxi Medical University, Taiyuan, People's Republic of China
| | - Chu Zheng
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, People's Republic of China; Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment, Shanxi Medical University, Taiyuan, People's Republic of China
| | - Hong Yang
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, People's Republic of China; Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment, Shanxi Medical University, Taiyuan, People's Republic of China
| | - Jia Ren
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, People's Republic of China
| | - Yanling Liu
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, People's Republic of China; Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment, Shanxi Medical University, Taiyuan, People's Republic of China
| | - Qinghua Han
- Department of Cardiology, The First Affiliated Hospital of Shanxi Medical University, Taiyuan, People's Republic of China
| | - Yanbo Zhang
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, People's Republic of China; Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment, Shanxi Medical University, Taiyuan, People's Republic of China.
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Niemeier JP, Hammond FM, O'Neil-Pirozzi TM, Venkatesan UM, Bushnik T, Zhang Y, Kennedy RE. Refining understanding of life satisfaction in elderly persons with traumatic brain injury using age-defined cohorts: a TBI model systems study. Brain Inj 2021; 35:1284-1291. [PMID: 34516315 DOI: 10.1080/02699052.2021.1972153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Examine effects of age cohort on post-injury life satisfaction in elderly persons with TBIDesign: Retrospective cohortSetting: TBI Model Systems centers. PARTICIPANTS 5,109 elderly participants with TBI in the TBI Model Systems National DatabaseInterventions: Not applicableMain Outcome Measures: Demographics, injury characteristics and cause, outcomes, age at time of analysis, time to follow commands, maximum follow-up period, and scores on the Satisfaction With Life Scale (SWLS) and Participation Assessment with Recombined Tools-Objective (PART-O) scores at 1, 2, 5, or 10 years post-injury. RESULTS Life satisfaction post-TBI across groups increased with age. The young-old sub-group demonstrated the poorest life satisfaction outcomes, while the oldest sub-group experienced greatest life satisfaction. In contrast, participation decreased with age. CONCLUSIONS Findings show diversity in satisfaction with life following moderate to severe TBI for three elderly age-cohorts. Differences may be due to variations in generation-based lived experience, in perceived meaningfulness of participation, could echo prior evidence of greater resilience in the oldest group, or could reflect bias within the study sample. Further research into between- and within- differences for elderly TBI age cohorts is needed to more precisely meet their needs for physical and functional rehabilitation as well as psychological supports.
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Affiliation(s)
- Janet P Niemeier
- Department of Psychology, University of Alabama, Birmingham, Alabama, United States
| | - Flora M Hammond
- Indiana University School of Medicine, Rehabilitation Hospital of Indiana, Indianapolis, Indiana, United States
| | - Therese M O'Neil-Pirozzi
- Spaulding Rehabilitation Hospital, Northeastern University, Boston, Massachusetts, United States
| | | | - Tamara Bushnik
- Rusk Rehabilitation, New York University Langone Health, New York, New York, United States
| | - Yue Zhang
- University of Alabama, Birmingham, Alabama, United States
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12
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Davis G, Baboolal N, Tripathi V, Stewart R. Health status risk factors and quality of life in 75-84-year-old individuals assessed for dementia using the short 10/66 dementia diagnostic schedule. PeerJ 2021; 9:e12040. [PMID: 34466297 PMCID: PMC8380427 DOI: 10.7717/peerj.12040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 08/02/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Trinidad is an island that not only has a population at high vascular risk but also one that is in epidemiological transition with high dementia prevalence. The aim of the study was to investigate modifiable risk factors associated with dementia in middle-old (75-84 years) individuals. METHODS As part of a large national community survey of dementia prevalence in Trinidad, 811 people aged 75-84 years were evaluated for dementia using the 10/66 short algorithm. Demographic data collected included information on age, gender, ethnicity, religion, education, occupation, living accommodation, smoking, alcohol consumption, self-reported medical conditions, impairments and ability to do instrumental activities of daily living (IADL). Data were analysed using multivariable logistic regression models. RESULTS Of the 811 participants, nearly 55% were female. The mean age was 78.8 (SD = 2.8) years and dementia was present in 198 (24.4%). Having less than ten years of education, being an agricultural worker, skilled labourer or housewife and having more than four co-morbidities were significantly associated with dementia. The odds ratio for dementia for those having self-reported stroke was 4.93 (95% CI [2.64-9.23]) and for diabetes was 1.76 (95% CI [1.17-2.65]) adjusting for age, age2, gender, ethnicity, religion, education and occupation. Impairment in eyesight, hearing, climbing stairs, and walking were also more common in the group with dementia. Ability to perform IADLs was linked with dementia. Individuals with dementia were more likely to be unable to perform any of the eight IADLs. Those who did not exercise at all (OR 6.95, 95% CI [2.02-23.90]) and those who did low exercise (OR 1.83, 95% CI [1.07-3.13]) compared to those who did moderate to high exercise were also more likely to have dementia. CONCLUSION In the middle-old population in Trinidad having diabetes and stroke, low IADL score, and no exercise were more common in people with dementia.
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Affiliation(s)
- Gershwin Davis
- Department of Paraclinical Sciences, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, St. Augustine Campus, Trinidad, Trinidad and Tobago
| | - Nelleen Baboolal
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad, Trinidad and Tobago
| | - Vrijesh Tripathi
- Department of Mathematics and Statistics, Faculty of Science and Technology, The University of the West Indies, St. Augustine, Trinidad, Trinidad and Tobago
| | - Robert Stewart
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London,, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
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13
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The effects of falls on the prediction of osteoporotic fractures: epidemiological cohort study. Arch Osteoporos 2021; 16:110. [PMID: 34245374 DOI: 10.1007/s11657-021-00977-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/18/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED Fall is the major risk factor of fracture that has not been included in FRAX®. Whether different age may determine the effect of falls on FRAX® is still uncertain. This epidemiological cohort study reveals that history of fall is a significant predictor of incident fracture independent of FRAX probability, especially in subjects < 75 years old. INTRODUCTION The Fracture Risk Assessment Tool (FRAX) calculates 10-year fracture risk using 11 clinical risk factors and bone mineral density (BMD); however, it does not include fall history in its risk assessment. Here, we investigated whether fall history is an independent risk factor on fracture prediction after adjustment of FRAX scores in two age subgroups (40-75 and ≥ 75 years). METHODS Beginning in 2009 to 2010, 1975 people (914 men) from Taiwan were followed for 6.8 ± 1.1 years by matching them with their records in the 2008-2016 National Health Insurance databank. We validated FRAX predictive accuracy with or without fall history by Cox proportional hazards regression. RESULTS After adjusting for FRAX risk, a history of falling was still a significant predictor of major osteoporotic fractures (MOFs) (using BMD, hazard ratio [HR], 1.47; p = 0.03; without using BMD, HR, 1.54; p = 0.01). A history of recurrent falls was also a significant predictor of both incident MOFs and hip fractures. However, when the subjects were stratified based on age group, a history of falling and recurrent falls were strong predictors of MOFs and hip fractures in the younger but not the older subgroup. CONCLUSION A fall history can predict incident fracture independently of FRAX probability, particularly in subjects younger than 75 years old.
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Yu X, Zhang W, Kobayashi LC. Duration of Poverty and Subsequent Cognitive Function and Decline Among Older Adults in China, 2005-2018. Neurology 2021; 97:e739-e746. [PMID: 34099525 DOI: 10.1212/wnl.0000000000012343] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 05/13/2021] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To investigate the relationship between late-life duration of poverty exposure and cognitive function and decline among older adults in China. METHODS Data were from 3,209 participants ≥64 years of age in the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Duration of poverty, defined according to urban and rural regional standards from the China Statistical Yearbook, was assessed according to annual household income from 2005 to 2011 (never in poverty; one-third of the period in poverty; two-thirds or more of the period in poverty). Cognitive function was measured by the Chinese Mini-Mental State Examination (CMMSE) from 2011 to 2018. We used attrition-weighted, multivariable mixed-effects Tobit regression to examine the association of duration of poverty with cognitive function and rate of decline. RESULTS A total of 1,162 individuals (36.21%) were never in poverty over the period from 2005 to 2011; 1,172 (36.52%) were in poverty one-third of the period; and 875 (27.27%) were in poverty two-thirds or more of the period. A longer poverty duration was associated with lower subsequent CMMSE scores with a dose-response relationship (one-third vs never in poverty: β = -0.98; 95% confidence interval -1.61 to -0.35; two-thirds or more vs never in poverty: β = -1.55; 95% confidence interval -2.29 to -0.81). However, a longer duration of poverty was associated with a slower rate of CMMSE score decline over time from 2011 to 2018. CONCLUSION These findings provide valuable evidence for the role of cumulative late-life poverty in relation to cognitive health among older adults in a rapidly urbanizing and aging middle-income country. Our findings may support a compensation hypothesis for cognitive reserve in this setting.
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Affiliation(s)
- Xuexin Yu
- From the West China Biomedical Big Data Center (X.Y., W.Z.), West China Hospital, Sichuan University; and Department of Epidemiology (X.Y., L.C.K.), University of Michigan School of Public Health, Ann Arbor
| | - Wei Zhang
- From the West China Biomedical Big Data Center (X.Y., W.Z.), West China Hospital, Sichuan University; and Department of Epidemiology (X.Y., L.C.K.), University of Michigan School of Public Health, Ann Arbor
| | - Lindsay C Kobayashi
- From the West China Biomedical Big Data Center (X.Y., W.Z.), West China Hospital, Sichuan University; and Department of Epidemiology (X.Y., L.C.K.), University of Michigan School of Public Health, Ann Arbor.
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15
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Tsotsoros CE, Mooney A, Earl JK, Hershey DA. Retirees’ perceptions of goal expectancy in five resource domains. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01771-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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16
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Gebremichael SG, Yismaw E, Tsegaw BD, Shibeshi AD. Determinants of water source use, quality of water, sanitation and hygiene perceptions among urban households in North-West Ethiopia: A cross-sectional study. PLoS One 2021; 16:e0239502. [PMID: 33886565 PMCID: PMC8062053 DOI: 10.1371/journal.pone.0239502] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 02/18/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Clean water is an essential part of human healthy life and wellbeing. More recently, rapid population growth, high illiteracy rate, lack of sustainable development, and climate change; faces a global challenge in developing countries. The discontinuity of drinking water supply forces households either to use unsafe water storage materials or to use water from unsafe sources. The present study aimed to identify the determinants of water source types, use, quality of water, and sanitation perception of physical parameters among urban households in North-West Ethiopia. METHODS A community-based cross-sectional study was conducted among households from February to March 2019. An interview-based a pre-tested and structured questionnaire was used to collect the data. Data collection samples were selected randomly and proportional to each of the kebeles' households. MS Excel and R Version 3.6.2 were used to enter and analyze the data; respectively. Descriptive statistics using frequencies and percentages were used to explain the sample data concerning the predictor variable. Both bivariate and multivariate logistic regressions were used to assess the association between independent and response variables. RESULTS Four hundred eighteen (418) households have participated. Based on the study undertaken,78.95% of households used improved and 21.05% of households used unimproved drinking water sources. Households drinking water sources were significantly associated with the age of the participant (x2 = 20.392, df = 3), educational status (x2 = 19.358, df = 4), source of income (x2 = 21.777, df = 3), monthly income (x2 = 13.322, df = 3), availability of additional facilities (x2 = 98.144, df = 7), cleanness status (x2 = 42.979, df = 4), scarcity of water (x2 = 5.1388, df = 1) and family size (x2 = 9.934, df = 2). The logistic regression analysis also indicated that those factors are significantly determining the water source types used by the households. Factors such as availability of toilet facility, household member type, and sex of the head of the household were not significantly associated with drinking water sources. CONCLUSION The uses of drinking water from improved sources were determined by different demographic, socio-economic, sanitation, and hygiene-related factors. Therefore; the local, regional, and national governments and other supporting organizations shall improve the accessibility and adequacy of drinking water from improved sources in the area.
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Affiliation(s)
| | - Emebet Yismaw
- Department of Statistics, Debre Tabor University, Debre Tabor, Ethiopia
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Bron AJ, Willshire C. Tear Osmolarity in the Diagnosis of Systemic Dehydration and Dry Eye Disease. Diagnostics (Basel) 2021; 11:387. [PMID: 33668748 PMCID: PMC7996182 DOI: 10.3390/diagnostics11030387] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/17/2021] [Accepted: 02/18/2021] [Indexed: 12/23/2022] Open
Abstract
Systemic dehydration due to inadequate water intake or excessive water loss, is common in the elderly and results in a high morbidity and significant mortality. Diagnosis is often overlooked and there is a need for a simple, bedside diagnostic test in at-risk populations. Body hydration is highly regulated with plasma osmolality (pOsm) being tightly controlled over a wide range of physiological conditions. By contrast, normal tear osmolarity (tOsm) is more variable since the tear film is exposed to evaporation from the open eye. While plasma hyperosmolality is a diagnostic feature of systemic dehydration, tear hyperosmolality, with other clinical features, is diagnostic of dry eye. Studies in young adults subjected to exercise and water-deprivation, have shown that tOsm may provide an index of pOsm, with the inference that it may provide a simple measure to diagnose systemic dehydration. However, since the prevalence of both dry eye and systemic dehydration increases with age, the finding of a raised tOsm in the elderly could imply the presence of either condition. This diagnostic difficulty can be overcome by measuring tear osmolality after a period of evaporative suppression (e.g., a 45 min period of lid closure) which drives tOsm osmolality down to a basal level, close to that of the pOsm. The arguments supporting the use of this basal tear osmolarity (BTO) in the diagnosis of systemic dehydration are reviewed here. Further studies are needed to confirm that the BTO can act as a surrogate for pOsm in both normally hydrated subjects and in patients with systemic dehydration and to determine the minimum period of lid closure required for a simple, "point-of-care" test.
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Affiliation(s)
- Anthony J. Bron
- Nuffield Department of Clinical Neurosciences and Nuffield Laboratory of Ophthalmology, University of Oxford, Oxford OX2 6HZ, UK
| | - Catherine Willshire
- Ophthalmology Research, Hinchingbrooke Hospital, North West Anglia Trust, Huntingdon PE29 6NT, UK;
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18
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Zhou P, Zhang WW, Bao Y, Wang J, Lian CL, He ZY, Wu SG. Chemotherapy and 21-gene recurrence score testing for older breast cancer patients: A competing-risks analysis. Breast 2020; 54:319-327. [PMID: 33278648 PMCID: PMC7718160 DOI: 10.1016/j.breast.2020.11.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 11/09/2020] [Accepted: 11/26/2020] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To evaluate the effect of the 21-gene recurrence score (RS) assay in breast cancer-specific mortality (BCSM) and decision-making for chemotherapy in older (aged ≥65 years) breast cancer. METHODS We retrospectively included older patients with T1-2N0 and estrogen receptor-positive breast cancer in the Surveillance, Epidemiology, and End Results database. Cox regression model and competing-risks model were used for data analysis. RESULTS This study included 8524 patients, 1987 (23.3%) had low RS, 5059 (59.4%) had intermediate RS, and 1478 (17.3%) had high RS. Chemotherapy was administrated in 2.0%, 8.6%, and 51.2% for low, intermediate, and high RS cohorts, respectively (P < 0.001). A total of 597 deaths were recorded, including one-quarter of breast cancer-related deaths and three-quarters as competing causes of death. The 5-year BCSM was 5.4%, 4.7%, and 9.1% for low, intermediate, and high RS cohorts, respectively (P < 0.001), using the Cox regression model, and was 0.8%, 0.9%, and 5.2% for low, intermediate, and high RS cohorts using the competing-risks regression, respectively (P < 0.001). RS was independently correlated with BCSM in both prognostic models. The stratified analysis demonstrated that chemotherapy was not correlated with a lower risk of BCSM in intermediate and high RS cohorts in both prognostic models. Sensitivity analyses replicated similar findings after stratification by the year of diagnosis and patients' age. CONCLUSIONS The competing-risks model is useful in dealing with multiple end events for older breast cancer patients. 21-gene RS was independently associated with BCSM. However, chemotherapy did not significantly decrease the risk of BCSM in intermediate and high RS cohorts.
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Affiliation(s)
- Ping Zhou
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, 361003, People's Republic of China
| | - Wen-Wen Zhang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, 510060, People's Republic of China
| | - Yong Bao
- Department of Radiation Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, People's Republic of China
| | - Jun Wang
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, 361003, People's Republic of China
| | - Chen-Lu Lian
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, 361003, People's Republic of China
| | - Zhen-Yu He
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, 510060, People's Republic of China.
| | - San-Gang Wu
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, 361003, People's Republic of China.
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Just KS, Dormann H, Schurig M, Böhme M, Steffens M, Plank‐Kiegele B, Ettrich K, Seufferlein T, Gräff I, Igel S, Schricker S, Jaeger SU, Schwab M, Stingl JC. The phenotype of adverse drug effects: Do emergency visits due to adverse drug reactions look different in older people? Results from the ADRED study. Br J Clin Pharmacol 2020; 86:2144-2154. [PMID: 32250457 PMCID: PMC7576634 DOI: 10.1111/bcp.14304] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 02/03/2020] [Accepted: 03/10/2020] [Indexed: 12/15/2022] Open
Abstract
AIMS Older patients in particular suffer from adverse drug reactions (ADR) when presenting in the emergency department. We aimed to characterise the phenotype of those ADRs, to be able to recognise an ADR in older patients. METHODS Cases of ADRs in emergency departments collected within the multicentre prospective observational study (ADRED) were analysed (n = 2215). We analysed ADR-associated diagnoses, symptoms and their risk profiles. We present frequencies and odds ratios (OR) with 95% confidence intervals for adults (18-64 years) compared to older adults (≥65 years; young-old 65-79, old-old ≥80 years) and regression coefficients (B) for each year of age. RESULTS Most prominent differences were seen for drug-associated confusion, dehydration, and bradycardia (OR 6.70 [1.59-28.27], B .054; OR 6.02 [2.41-15.03], B .081, and 4.82 [2.21-10.54], B .040), more likely seen in older adults. Bleedings were reported in all age groups, but gastrointestinal bleedings occurred with more than doubled chance in older adults (OR 2.46 [1.77-3.41], B .030), likewise did other bleedings such as haemorrhage from respiratory passages (OR 2.89 [1.37-6.11], B.036). Falls were more likely in older adults (OR 2.84 [1.77-4.53], B .030), while dizziness was frequent in both age groups. CONCLUSION Our data point to differences in symptoms of ADRs between adults and older individuals, with dangerous drug-associated phenomena in the older adult such as bleedings or falls. Physicians should consider drug-associated origins of symptoms in older adults with an increased risk for serious health problems.
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Affiliation(s)
- Katja S. Just
- Institute of Clinical PharmacologyUniversity Hospital of RWTH AachenAachenGermany
| | | | - Marlen Schurig
- Research DepartmentFederal Institute for Drugs and Medical DevicesBonnGermany
| | - Miriam Böhme
- Research DepartmentFederal Institute for Drugs and Medical DevicesBonnGermany
| | - Michael Steffens
- Research DepartmentFederal Institute for Drugs and Medical DevicesBonnGermany
| | | | - Kristin Ettrich
- Internal Medicine Emergency DepartmentUlm University Medical CentreUlmGermany
| | - Thomas Seufferlein
- Internal Medicine Emergency DepartmentUlm University Medical CentreUlmGermany
| | - Ingo Gräff
- Interdisciplinary Emergency Department (INZ)University Hospital of BonnBonnGermany
| | - Svitlana Igel
- Dr. Margarete Fischer‐Bosch‐Institute of Clinical PharmacologyStuttgartGermany
| | - Severin Schricker
- Department of Internal Medicine, Division of General Internal Medicine and NephrologyRobert‐Bosch‐HospitalStuttgartGermany
| | - Simon U. Jaeger
- Dr. Margarete Fischer‐Bosch‐Institute of Clinical PharmacologyStuttgartGermany
- Department of Clinical PharmacologyUniversity of TuebingenTuebingenGermany
| | - Matthias Schwab
- Dr. Margarete Fischer‐Bosch‐Institute of Clinical PharmacologyStuttgartGermany
- Department of Clinical PharmacologyUniversity of TuebingenTuebingenGermany
- Department of Pharmacy and BiochemistryUniversity of TuebingenTuebingenGermany
| | - Julia C. Stingl
- Institute of Clinical PharmacologyUniversity Hospital of RWTH AachenAachenGermany
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Luley MC, Loleit T, Knopf E, Djukic M, Criée CP, Nau R. Training improves the handling of inhaler devices and reduces the severity of symptoms in geriatric patients suffering from chronic-obstructive pulmonary disease. BMC Geriatr 2020; 20:398. [PMID: 33036566 PMCID: PMC7547456 DOI: 10.1186/s12877-020-01804-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/30/2020] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Elderly patients with impaired vision, cognitive decline or motor/sensory disturbances of their fingers suffering from chronic-obstructive pulmonary disease (COPD) encounter difficulties in handling inhaler devices used as the cornerstones of treatment of pulmonary obstruction. Many elderly patients make severe mistakes which impede adequate drug delivery to the bronchioles. This multimodal training program was designed to reduce the number of handling mistakes of inhaler devices. METHODS From October 1, 2016 to September 30, 2017, a prospective intervention study was conducted in 38 in-patients > 65 years (median age 79 years) with previously diagnosed COPD. The effect of an 8-day intervention comprising daily counselling and video demonstration according to the recommendations of the German Airway League on the frequency of mistakes during handling of inhaler devices, the forced expiratory volume in 1 s (FEV1), the forced vital capacity (FVC) and the perception of symptoms (COPD Assessment Test, CAT) were studied. Measurements on days 1 and 8 were compared by Wilcoxon signed rank test. RESULTS The number of handling mistakes per patient decreased as a consequence of the intervention from 3.0 (0-7) to 0.5 (0-6) [median (minimum-maximum; p < 0.0001)]. The CAT Score decreased from 19.5 (14/24) to 14.5 (10.75/21) [median (25./75. percentile; p < 0.0001) indicating a substantial reduction of clinical symptoms. Conversely, FEV1 and FVC only slightly increased (difference statistically not significant). At study entry, the number of handling mistakes was inversely correlated with the Mini Mental Status Test (MMST) score (p = 0.01). The reduction of the number of handling mistakes during the intervention was not correlated with the MMST. CONCLUSION In COPD, intensive training for 8 days improved the handling of inhalers and reduced clinical symptoms in geriatric patients. Patients with cognitive abnormalities also benefitted from this intervention. TRIAL REGISTRATION German Clinical Trials Registry DRKS00023196 , date of registration September 29, 2020 (retrospectively registered).
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Affiliation(s)
- Marie-Christine Luley
- Department of Geriatrics, Protestant Hospital Göttingen-Weende, An der Lutter 24, 37075, Göttingen, Germany.,Institute of Neuropathology, University Medical Center Göttingen, Göttingen, Germany
| | - Tobias Loleit
- Department of Geriatrics, Protestant Hospital Göttingen-Weende, An der Lutter 24, 37075, Göttingen, Germany
| | - Elmar Knopf
- Department of Geriatrics, Protestant Hospital Göttingen-Weende, An der Lutter 24, 37075, Göttingen, Germany
| | - Marija Djukic
- Department of Geriatrics, Protestant Hospital Göttingen-Weende, An der Lutter 24, 37075, Göttingen, Germany.,Institute of Neuropathology, University Medical Center Göttingen, Göttingen, Germany
| | - Carl-Peter Criée
- Department of Pneumology, Protestant Hospital Göttingen-Weende, Göttingen, Germany
| | - Roland Nau
- Department of Geriatrics, Protestant Hospital Göttingen-Weende, An der Lutter 24, 37075, Göttingen, Germany. .,Institute of Neuropathology, University Medical Center Göttingen, Göttingen, Germany.
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Kim JY, Park IS, Kang DH, Lee YS, Kim KT, Hong SJ. Prediction of Risk Factors after Spine Surgery in Patients Aged >75 Years Using the Modified Frailty Index. J Korean Neurosurg Soc 2020; 63:827-833. [PMID: 32898965 PMCID: PMC7671779 DOI: 10.3340/jkns.2020.0019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 03/11/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Spine surgery is associated with higher morbidity and mortality rates in elderly patients. The modified Frailty Index (mFI) is an evaluation tool to determine the frailty of an individual and how preoperative status may impact postoperative survival and outcomes. This study aimed to determine the usefulness of mFI in predicting postoperative complications in patients aged ≥75 years undergoing surgery with instrumentation. METHODS We retrospectively reviewed the perioperative course of 137 patients who underwent thoracolumbar-instrumentation spine surgery between 2011 and 2016. The preoperative risk factors were the 11 variables of the mFI, as well as body mass index (kg/cm2), preoperative hemoglobin, platelet, albumin, creatinine, anesthesia time, operation time, estimated blood loss, and transfusion amount. The 60-day occurrences of complication rates were used for outcome assessment. RESULTS Major complications after spinal instrumentation surgery occurred in 34 of 138 patients (24.6%). The mean mFI score was 0.18±0.12. When we divided patients into a pre-frail group (mFI, 0.09-0.18; n=94) and a frail group (mFI ≥0.27; n=44), only the rate of sepsis was statistically higher in the frail group than in the pre-frail group. There were significantly more major complications in patients with low albumin levels or in patients with infection or who had experienced trauma. The mFI was a more useful predictor of postoperative complications than the American Society of Anesthesiologists physical status score. CONCLUSION The mFI can successfully predict postoperative morbidity and mortality in patients aged ≥75 years undergoing spine surgery. The mFI improves perioperative risk stratification that provides important information to assist in the preoperative counselling of patients and their families.
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Affiliation(s)
- Ji-Yoon Kim
- Department of Anesthesiology, Pain and Critical Care Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - In Sung Park
- Department of Neurosurgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Dong-Ho Kang
- Department of Neurosurgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Young-Seok Lee
- Department of Neurosurgery, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Kyoung-Tae Kim
- Department of Neurosurgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sung Jin Hong
- Department of Anesthesiology, Pain and Critical Care Medicine, Yeouido St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Korea
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Hsu CH, Hung YM, Chu KA, Chen CF, Yin CH, Lee CC. Prognostic nomogram for elderly patients with acute respiratory failure receiving invasive mechanical ventilation: a nationwide population-based cohort study in Taiwan. Sci Rep 2020; 10:13161. [PMID: 32753615 PMCID: PMC7403322 DOI: 10.1038/s41598-020-70130-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 05/21/2020] [Indexed: 11/13/2022] Open
Abstract
Patients in critical care medicine are ageing. There is limited literature evaluating long-term outcomes and prognostic factors for the growing number of elderly patients with acute respiratory failure (ARF) receiving invasive mechanical ventilation (IMV). Data on elderly patients (≧ 65 years old) with ARF receiving intubation and IMV during 2003–2012 were retrospectively collected from the national health database in Taiwan. We included 7,095 elderly patients. The 28-day mortality was 33%, the 60-day mortality was 47.5%, and the 1-year mortality was 70.4%. Patients were divided into groups: young-old (65–74 years), middle-old (75–84 years), and oldest-old (≧ 85 years). Patients in the oldest-old and middle-old groups had higher 1-year mortality than the young-old group (p < 0.001). The multivariate logistic regression revealed 9 significant factors associated with 1-year mortality, and these factors were used to develop a prognostic nomogram. The present study showed that the long-term prognosis of elderly patients with ARF and IMV is very poor. This nomogram can help physicians estimate the 1-year mortality of elderly patients in the early stage of ARF and assist in clinical decision making.
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Affiliation(s)
- Chun-Hsiang Hsu
- Division of Chest Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yao-Min Hung
- School of Medicine, National Yang Ming University, Taipei, Taiwan.,Department of Emergency Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Yuhing Junior College of Health Care and Management, Kaohsiung, Taiwan.,Kaohsiung Municipal United Hospital, Kaohsiung, Taiwan
| | - Kuo-An Chu
- Division of Chest Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan. .,School of Medicine, National Yang Ming University, Taipei, Taiwan. .,Department of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan.
| | - Chiu-Fan Chen
- Division of Chest Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan. .,Department of Internal Medicine, Taitung Branch, Taipei Veterans General Hospital, Taitung, Taiwan.
| | - Chun-Hao Yin
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Ching-Chih Lee
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Department of Otolaryngology, Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
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Deng R, Zhang J, Chen L, Miao J, Duan J, Qiu Y, Leung D, Chan H, Lee DT. The effectiveness of a modified advance care planning programme. Nurs Ethics 2020; 27:1569-1586. [PMID: 32588743 DOI: 10.1177/0969733020922893] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Frailty is a natural consequence of the aging process. With the increasing aging population in Mainland China, the quality of life and end-of-life care for frail older people need to be taken into consideration. Advance Care Planning has also been used worldwide in long-term facilities, hospitals and communities to improve the quality of end-of-life care, increase patient and family satisfaction, and reduce healthcare costs and hospital admissions in Western countries. However, it has not been practiced in China. RESEARCH OBJECTIVE This study aimed to evaluate the effectiveness of a modified Advance Care Planning intervention in certainty of end-of-life care, preferences for end-of-life care, quality of life concerns, and healthcare utilization among frail older people. RESEARCH DESIGN This study used a quasi-experimental design, with a single-blind, control group, pretest and repeated posttest approach. PARTICIPANTS AND RESEARCH CONTEXT A convenience sample of 74 participates met the eligibility criteria in each nursing home. A total of 148 frail older people were recruited in two nursing homes in Zhejiang Province, China. ETHICAL CONSIDERATIONS The study received ethical approval from the Clinical Research Ethics Committee, the Faculty of Medicine, and The Chinese University of Hong Kong, CREC Ref. No: 2016.059. FINDINGS The results indicated the Advance Care Planning programme was effective at increasing autonomy in decision making on end-of-life care issues, decreasing decision-making conflicts over end-of-life care issues, and increasing their expression about end-of-life care. DISCUSSION This study promoted the participants' autonomy and broke through the inherent custom of avoiding talking about death in China. CONCLUSION The modified Advance Care Planning intervention is effective and recommended to support the frail older people in their end-of-life care decision in Chinese society.
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Affiliation(s)
- Renli Deng
- 26451The Chinese University of Hong Kong, China
| | | | - Liuliu Chen
- 485858The Fifth Affiliated (Zhuhai) Hospital of Zunyi Medical University, China.,26451The Chinese University of Hong Kong, China
| | - Jiarui Miao
- 398625Zunyi Medical University, China.,26451The Chinese University of Hong Kong, China
| | | | - Yeyin Qiu
- 485858The Fifth Affiliated (Zhuhai) Hospital of Zunyi Medical University, China.,26451The Chinese University of Hong Kong, China
| | - Doris Leung
- 26451The Chinese University of Hong Kong, China
| | - Helen Chan
- 26451The Chinese University of Hong Kong, China
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Kawabe A, Nakano K, Kubo S, Asakawa T, Tanaka Y. Differential long-term retention of biological disease-modifying antirheumatic drugs in patients with rheumatoid arthritis by age group from the FIRST registry. Arthritis Res Ther 2020; 22:136. [PMID: 32513309 PMCID: PMC7282084 DOI: 10.1186/s13075-020-02233-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 06/02/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The effectiveness and safety of biological disease-modifying antirheumatic drugs (bDMARDs) by age group (< 65, 65-74, and ≥ 75 years) are uncertain. We examined retention rates reflecting the effectiveness and safety of bDMARDs in actual clinical practice for clarifying optimal therapeutic strategies for rheumatoid arthritis (RA) by age groups. METHODS Data of patients who were treated with tumor necrosis factor inhibitors (TNFi), abatacept (ABA), and tocilizumab (TCZ) between February 2011 and April 2017 were collected from a prospective observational registry of RA patients. A total of 1362 patients were enrolled, of which 695 were aged < 65 years, 402 were aged 65-74 years, and 265 were aged ≥ 75 years. Primary outcome was the drug retention rate in adjusted data using inverse probability of treatment weighting based on generalized propensity scores. RESULTS In patients aged < 65 years, 3-year retention rates of TNFi, ABA, and TCZ were 43%, 47%, and 69%, respectively (ABA versus TCZ, p = 0.017; TNFi versus TCZ, p = 0.002). In patients aged 65-74 years, 3-year retention rates of TNFi, ABA, and TCZ were 44%, 53%, and 60%, respectively (TCZ versus TNFi, p = 0.034). In patients aged ≥ 75 years, 3-year retention rates for TNFi, ABA, and TCZ were 38%, 63%, and 58%, respectively (ABA versus TNFi, p = 0.017). CONCLUSIONS We found that the effectiveness and safety of TCZ were maximal in patients aged < 75 years and that patients aged ≥ 75 years might be suitable candidates for TCZ and ABA therapy. The use of therapeutic strategies appropriate to each age group might improve the outcomes of bDMARD therapy for RA.
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Affiliation(s)
- Akio Kawabe
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi, Kitakyushu, 807-8555, Japan
| | - Kazuhisa Nakano
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi, Kitakyushu, 807-8555, Japan
| | - Satoshi Kubo
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi, Kitakyushu, 807-8555, Japan
| | - Takeshi Asakawa
- Department of Information Systems Center, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi, Kitakyushu, 807-8555, Japan
| | - Yoshiya Tanaka
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi, Kitakyushu, 807-8555, Japan.
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Ebner NC, Ellis DM, Lin T, Rocha HA, Yang H, Dommaraju S, Soliman A, Woodard DL, Turner GR, Spreng RN, Oliveira DS. Uncovering Susceptibility Risk to Online Deception in Aging. J Gerontol B Psychol Sci Soc Sci 2020; 75:522-533. [PMID: 29669133 PMCID: PMC8921760 DOI: 10.1093/geronb/gby036] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Indexed: 11/14/2023] Open
Abstract
OBJECTIVES Fraud in the aged is an emerging public health problem. An increasingly common form of deception is conducted online. However, identification of cognitive and socioemotional risk factors has not been undertaken yet. In this endeavor, this study extended previous work suggesting age effects on susceptibility to online deception. METHODS Susceptibility was operationalized as clicking on the link in simulated spear-phishing emails that young (18-37 years), young-old (62-74 years), and middle-old (75-89 years) Internet users received, without knowing that the emails were part of the study. Participants also indicated for a set of spear-phishing emails how likely they would click on the embedded link (susceptibility awareness) and completed cognitive and socioemotional measures to determine susceptibility risk profiles. RESULTS Higher susceptibility was associated with lower short-term episodic memory in middle-old users and with lower positive affect in young-old and middle-old users. Greater susceptibility awareness was associated with better verbal fluency in middle-old users and with greater positive affect in young and middle-old users. DISCUSSION Short-term memory, verbal fluency, and positive affect in middle-old age may contribute to resilience against online spear-phishing attacks. These results inform mechanisms of online fraud susceptibility and real-life decision-supportive interventions toward fraud risk reduction in aging.
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Affiliation(s)
- Natalie C Ebner
- Department of Psychology, Institute on Aging, University of Florida, Gainesville
- Department of Aging and Geriatric Research, Institute on Aging, University of Florida, Gainesville
- Center for Cognitive Aging and Memory, Department of Clinical and Health Psychology, University of Florida, Gainesville
- Florida Institute for Cybersecurity Research, University of Florida, Gainesville
| | - Donovan M Ellis
- Department of Psychology, Institute on Aging, University of Florida, Gainesville
| | - Tian Lin
- Department of Psychology, Institute on Aging, University of Florida, Gainesville
| | - Harold A Rocha
- Department of Psychology, Institute on Aging, University of Florida, Gainesville
| | - Huizi Yang
- Department of Electrical and Computer Engineering, University of Florida, Gainesville
| | - Sandeep Dommaraju
- Department of Electrical and Computer Engineering, University of Florida, Gainesville
| | - Adam Soliman
- Department of Electrical and Computer Engineering, University of Florida, Gainesville
| | - Damon L Woodard
- Florida Institute for Cybersecurity Research, University of Florida, Gainesville
- Department of Electrical and Computer Engineering, University of Florida, Gainesville
| | - Gary R Turner
- Department of Psychology, York University, Toronto, ON, Canada
| | - R Nathan Spreng
- Laboratory of Brain and Cognition, Montreal Neurological Institute, Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
- Human Neuroscience Institute, Department of Human Development, Cornell University, Ithaca, NY
| | - Daniela S Oliveira
- Florida Institute for Cybersecurity Research, University of Florida, Gainesville
- Department of Electrical and Computer Engineering, University of Florida, Gainesville
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27
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Kim JW, Byun MS, Yi D, Lee JH, Ko K, Jeon SY, Sohn BK, Lee JY, Kim YK, Shin SA, Sohn CH, Lee DY. Association of moderate alcohol intake with in vivo amyloid-beta deposition in human brain: A cross-sectional study. PLoS Med 2020; 17:e1003022. [PMID: 32097439 PMCID: PMC7041799 DOI: 10.1371/journal.pmed.1003022] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 01/17/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND An emerging body of literature has indicated that moderate alcohol intake may be protective against Alzheimer disease (AD) dementia. However, little information is available regarding whether moderate alcohol intake is related to reductions in amyloid-beta (Aβ) deposition, or is protective via amyloid-independent mechanisms in the living human brain. Here we examined the associations of moderate alcohol intake with in vivo AD pathologies, including cerebral Aβ deposition, neurodegeneration of AD-signature regions, and cerebral white matter hyperintensities (WMHs) in the living human brain. METHODS AND FINDINGS The present study was part of the Korean Brain Aging Study for Early Diagnosis and Prediction of Alzheimer's Disease (KBASE), an ongoing prospective cohort study that started in 2014. As of November 2016, 414 community-dwelling individuals with neither dementia nor alcohol-related disorders (280 cognitively normal [CN] individuals and 134 individuals with mild cognitive impairment [MCI]) between 56 and 90 years of age (mean age 70.9 years ± standard deviation 7.8; male, n [%] = 180 [43.5]) were recruited from 4 sites (i.e., 2 university hospitals and 2 public centers for dementia prevention and management) around Seoul, South Korea. All the participants underwent comprehensive clinical assessments comprising lifetime and current histories of alcohol intake and multimodal brain imaging, including [11C] Pittsburgh compound B positron emission tomography (PET), [18F] fluorodeoxyglucose (FDG) PET, and magnetic resonance imaging (MRI) scans. Lifetime and current alcohol intake were categorized as follows: no drinking, <1 standard drink (SD)/week, 1-13 SDs/week, and 14+ SDs/week. A moderate lifetime alcohol intake (1-13 SDs/week) was significantly associated with a lower Aβ positivity rate compared to the no drinking group, even after controlling for potential confounders (odds ratio 0.341, 95% confidence interval 0.163-0.714, p = 0.004). In contrast, current alcohol intake was not associated with amyloid deposition. Additionally, alcohol intake was not related to neurodegeneration of AD-signature regions or cerebral WMH volume. The present study had some limitations in that it had a cross-sectional design and depended on retrospective recall for alcohol drinking history. CONCLUSIONS In this study, we observed in middle- and old-aged individuals with neither dementia nor alcohol-related disorders that moderate lifetime alcohol intake was associated with lower cerebral Aβ deposition compared to a lifetime history of not drinking. Moderate lifetime alcohol intake may have a beneficial influence on AD by reducing pathological amyloid deposition rather than amyloid-independent neurodegeneration or cerebrovascular injury.
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Affiliation(s)
- Jee Wook Kim
- Department of Neuropsychiatry, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Republic of Korea
- Department of Psychiatry, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Min Soo Byun
- Institute of Human Behavioral Medicine, Medical Research Center, Seoul National University, Seoul, Republic of Korea
| | - Dahyun Yi
- Institute of Human Behavioral Medicine, Medical Research Center, Seoul National University, Seoul, Republic of Korea
| | - Jun Ho Lee
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kang Ko
- Department of Geriatric Psychiatry, National Center for Mental Health, Seoul, Republic of Korea
| | - So Yeon Jeon
- Department of Psychiatry, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Bo Kyung Sohn
- Department of Psychiatry, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
| | - Jun-Young Lee
- Department of Neuropsychiatry, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yu Kyeong Kim
- Department of Nuclear Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Seong A Shin
- Department of Nuclear Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Chul-Ho Sohn
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Dong Young Lee
- Institute of Human Behavioral Medicine, Medical Research Center, Seoul National University, Seoul, Republic of Korea
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
- * E-mail:
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Outcomes and failure risks in mid-urethral sling insertion in elderly and old age with urodynamic stress incontinence. Int Urogynecol J 2019; 31:717-726. [PMID: 31832716 DOI: 10.1007/s00192-019-04171-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 10/25/2019] [Indexed: 02/06/2023]
Abstract
INTRODUCTION AND HYPOTHESIS To study the surgical outcomes and risk factors for failure of three types of mid urethral slings(MUS) surgeries in elderly and old age women with urodynamic stress incontinence(USI). METHODS Three different types of MUS surgeries [single incision sling(SIS), trans-obturator tape(TOT), retro-public mid-urethral sling-tension-free vagina tape (TVT)]were performed among three age groups of women (young <64 yr, elderly 65-74 yr and old >75 yr) with USI. They were followed up for 1 year. RESULTS Complete postoperative data was available for 688 women. After 1 year, overall objective cure rate was 88.2% and subjective cure rate was 85.9%. Among the young, elderly, and old age women objective cure rates were 91.0%, 80.6%, 66.7% and subjective cure rates were 89.2%, 77.6%, 58.3% respectively. Urodynamic parameters demonstrated flow rate, higher post-void bladder residual, smaller cystometric capacity, and lower maximum urethral closure pressure were significantly lower among old and elderly group. Subjectively, urinary distress inventory-6 (UDI-6) and incontinence impact questionnaire-7(IIQ-7) improved significantly in all groups with significant changes from baseline only in older women. Intrinsic sphincter deficiency(ISD) was found to be significantly associated with failure in older women. Other preoperative comorbidities were equally distributed among all the three age groups. The operative time, perioperative complications, and length of hospital stay showed no difference between the study groups. CONCLUSIONS MUS surgery is safe for the young and aging patients with USI and demostrated significant improvement in its outcomes, but objective and subjective cure rates decreases with age. ISD was also found to be significantly associated with failure.
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Just KS, Dormann H, Böhme M, Schurig M, Schneider KL, Steffens M, Dunow S, Plank-Kiegele B, Ettrich K, Seufferlein T, Gräff I, Igel S, Schricker S, Jaeger SU, Schwab M, Stingl JC. Personalising drug safety—results from the multi-centre prospective observational study on Adverse Drug Reactions in Emergency Departments (ADRED). Eur J Clin Pharmacol 2019; 76:439-448. [DOI: 10.1007/s00228-019-02797-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 11/12/2019] [Indexed: 12/14/2022]
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30
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Sezgin G, Li L, Wilson R, Westbrook JI, Lindeman R, Vecellio E, Georgiou A. Laboratory Test Utilization and Repeat Testing for Inpatients of Age 80 and Over in Australia: A Retrospective Observational Study. J Appl Lab Med 2019; 4:143-151. [DOI: 10.1373/jalm.2019.029025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 03/12/2019] [Indexed: 02/02/2023]
Abstract
Abstract
Introduction
Repeat laboratory testing is often necessary in hospitals. However, frequent blood draws can be harmful to older patients. The objective of this study was to identify the most frequently ordered laboratory tests and repeat testing rates for these tests among older inpatients.
Methods
A retrospective observational study of inpatients of age 80 years and over in 4 public hospitals in New South Wales, Australia, was conducted between 2008 and 2013. Proportions of laboratory tests and proportions of repeated tests among the most frequently used tests were reported.
Results
There were 42739 patients with 108003 admissions (56.2% women; 43.2% of ages 80–84). Of these admissions, 95.9% had a laboratory test, with 3012577 tests recorded. Five tests accounted for 62% of all tests and were present in 98.5% of admissions: electrolytes urea and creatinine (EUC; 18% of all tests ordered), complete blood count (CBC; 16.7%), calcium magnesium phosphate (CaMgPhos; 10.2%), liver function test (LFT; 9.0%), and C-reactive protein (CRP; 8.0%). Proportions of repeat tests for this group performed outside recommended minimum repeat intervals were 10.3% EUC, 8.9% CBC, 41.5% CRP, 68.2% CaMgPhos, and 65.2% LFT tests. An exponential increase in repeat testing for all 5 tests was observed around 24 h after a previous test.
Conclusion
Compliance with guidelines on repeat testing intervals among older patients is variable. A better understanding of the underlying reasons for repeat testing would allow targeting of interventions, including decision support, to improve laboratory use for older inpatients.
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Affiliation(s)
- Gorkem Sezgin
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Health and Medical Sciences, Macquarie University, New South Wales, Australia
| | - Ling Li
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Health and Medical Sciences, Macquarie University, New South Wales, Australia
| | - Roger Wilson
- New South Wales Health Pathology, Chatswood, New South Wales, Australia
| | - Johanna I Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Health and Medical Sciences, Macquarie University, New South Wales, Australia
| | - Robert Lindeman
- New South Wales Health Pathology, Chatswood, New South Wales, Australia
| | - Elia Vecellio
- New South Wales Health Pathology, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Andrew Georgiou
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Health and Medical Sciences, Macquarie University, New South Wales, Australia
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Omission of adjuvant radiotherapy following breast-conserving surgery for elderly women with early-stage pure mucinous breast carcinoma. Radiat Oncol 2019; 14:190. [PMID: 31685005 PMCID: PMC6829954 DOI: 10.1186/s13014-019-1394-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 10/09/2019] [Indexed: 12/05/2022] Open
Abstract
Background We aimed to ascertain population-based practice patterns and survival outcomes of postoperative radiotherapy following breast conserving-surgery (BCS) in elderly women (aged ≥65 years) with early-stage pure mucinous breast carcinoma (PMBC). Methods Patients aged ≥65 years diagnosed with T1–2N0 and hormone receptor-positive PMBC between 1990 and 2010 were identified from the Surveillance, Epidemiology, and End Results database. Binomial logistic regression, Kaplan-Meier method, Multivariate Cox proportional hazards models, and propensity score matching (PSM) were used for statistical analysis. Results We enrolled 3416 patients, including 1225 (35.9%) and 2191 (64.1%) in the no-radiotherapy and radiotherapy cohorts, respectively. The percentage of patients receiving postoperative radiotherapy following BCS was significantly lower after 2004 (59.5% between 2004 and 2010), relative to that before 2004 (71.1% between 1990 and 2003; P < 0.001). Before PSM, the 10-year breast cancer-specific survival (BCSS) rates were 98.1 and 93.2% for patients with and without postoperative radiotherapy (log-rank test, P < 0.001), respectively. In the PSM cohort, receiving postoperative radiotherapy was associated with better BCSS rates, with 10-year BCSS rates of 97.6 and 94.5% in patients with and without postoperative radiotherapy, respectively (log-rank test, P = 0.001). Multivariate Cox proportional analysis indicated that receiving postoperative radiotherapy was an independent factor associated with better BCSS before (P < 0.001) and after PSM (P = 0.001), relative to those not receiving postoperative radiotherapy. Conclusions This study shows a decreasing utilization of postoperative radiotherapy following BCS of elderly PMBC patients over time. However, postoperative radiotherapy following BCS should be administered for elderly women with PMBC owing to independent association with better survival.
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Huang YH, Lee PC. ROLE OF PROPERTY MANAGEMENT IN SERVICE DEMANDS OF ELDERLY RESIDENTS OF APARTMENT COMPLEXES. INTERNATIONAL JOURNAL OF STRATEGIC PROPERTY MANAGEMENT 2019. [DOI: 10.3846/ijspm.2019.10852] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
An aging population results in an increased demand for services designed to meet the needs of elderly people. To enable elderly individuals to age successfully in their original residence environments, property management companies that provide services to apartment complex residents play an important role as service providers. The purpose of this study was to identify possible services that property management companies can provide to elderly residents of apartment complexes in response to changing demographics. Factor analysis was performed to identify the main areas of service demands or service demand aspects. Cluster analysis and a chi-square test were also used to identify and highlight the varied demographic characteristics and residence conditions of respondents and how they affect the level of importance attributed to each service demand aspect. Results showed seven main service aspects that were of concern to elderly individuals. Specific characteristics of elderly people that led to higher demands for certain other service aspects were also identified. The results of this study can serve as a reference for property management companies to help them provide custom design services for apartment complexes they serve and to expand their business scope and opportunities.
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Affiliation(s)
- Ying-Hua Huang
- Department of Civil and Construction Engineering, National Yunlin University of Science and Technology, Yunlin, Taiwan
| | - Pei-Chen Lee
- Department of Civil and Construction Engineering, National Yunlin University of Science and Technology, Yunlin, Taiwan
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Anjo I, Amaral TF, Afonso C, Borges N, Santos A, Moreira P, Padrão P. Are hypohydrated older adults at increased risk of exhaustion? J Hum Nutr Diet 2019; 33:23-30. [PMID: 31578795 DOI: 10.1111/jhn.12702] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Dehydration appears to affect muscle strength and weakness, although its influence on exhaustion remains unclear. The present study aimed to quantify the association between hydration status and exhaustion among older adults. METHODS A cluster sampling approach was used, representing Portuguese older adults (≥65 years) according to age, sex, education level and region within the Nutrition UP65 cross-sectional study. A 24-h urine sample was collected to estimate free water reserve (FWR), which was categorised into tertiles according to sex. Subjects with incomplete 24-h urine and renal disease were excluded. From a sample size of 1500 subjects, 1143 were eligible. Exhaustion was self-reported according to the Center for Epidemiologic Studies Depression Scale. A logistic regression model was conducted to evaluate the association between FWR and exhaustion. Odds ratios and the respective 95% confidence intervals were calculated by sex and age. RESULTS Free water reserve median (interquartile range) was 0.52 (0.68) L in women and 0.36 (0.77) L in men. Hypohydration affected 11.6% of women and 25.1% of men, whereas exhaustion was reported by 39.3% of women and 25.1% of men. After adjusting for confounders, women ≥80 years classified in the highest tertile of FWR showed a decreased risk of exhaustion (third tertile: odds ratio = 0.38; 95% confidence interval = 0.15-0.96) compared to women in the lowest FWR tertile. No such significant association was observed in women with <80 years and in men. CONCLUSIONS These results show an association between worse hydration status and exhaustion in older women, highlighting the need to implement further studies clarifying this association.
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Affiliation(s)
- I Anjo
- Faculdade de Ciências da Nutrição e Alimentação da, Universidade do Porto, Porto, Portugal
| | - T F Amaral
- Faculdade de Ciências da Nutrição e Alimentação da, Universidade do Porto, Porto, Portugal.,Faculdade de Engenharia, UISPA-IDMEC, Universidade do Porto, Porto, Portugal
| | - C Afonso
- Faculdade de Ciências da Nutrição e Alimentação da, Universidade do Porto, Porto, Portugal.,EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - N Borges
- Faculdade de Ciências da Nutrição e Alimentação da, Universidade do Porto, Porto, Portugal.,CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal
| | - A Santos
- Faculdade de Ciências da Nutrição e Alimentação da, Universidade do Porto, Porto, Portugal.,I3S-Instituto de Investigação e Inovação em Saúde, Porto, Portugal
| | - P Moreira
- Faculdade de Ciências da Nutrição e Alimentação da, Universidade do Porto, Porto, Portugal.,EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Centro de Atividade Física, Saúde e Lazer, Universidade do Porto, Porto, Portugal
| | - P Padrão
- Faculdade de Ciências da Nutrição e Alimentação da, Universidade do Porto, Porto, Portugal.,EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
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Lee CH, Son DW, Lee SH, Lee JS, Sung SK, Lee SW, Song GS. Radiological and Clinical Outcomes of Anterior Cervical Discectomy and Fusion in Older Patients: A Comparative Analysis of Young-Old Patients (Ages 65-74 Years) and Middle-Old Patients (Over 75 Years). Neurospine 2019; 17:156-163. [PMID: 31284342 PMCID: PMC7136094 DOI: 10.14245/ns.1836072.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 02/20/2019] [Indexed: 12/23/2022] Open
Abstract
Objective Anterior cervical discectomy and fusion (ACDF) is the most commonly performed procedure for degenerative cervical spondylosis. Because of its relatively low invasiveness and surgical procedure, old age is not regarded as an exclusion criterion for ACDF. However, very few studies have been conducted on the radiological and clinical outcomes of ACDF in older patients. The purpose of this study was to evaluate the radiological and clinical outcomes of ACDF in older patients.
Methods We retrospectively analyzed 48 patients (> 65 years) who underwent ACDF from January 2011 to December 2015. We divided the patients into 2 groups: young-old age group (65–74 years) and middle-old age group (≥ 75 years). Cervical lateral radiographs taken in the neutral standing position were evaluated preoperatively (PRE), on postoperative day 7 (POST), and at the 1-year follow-up (F/U). The radiological parameters included cervical angle (CA: C2–7 Cobb angle), segmental angle, total intervertebral height, disc height, sagittal vertical axis (SVA), T1 slope (T1s), and range of cervical motion (extension CA minus flexion CA). Postoperative hospital days, comorbidities, complications, and clinical outcomes were also analyzed.
Results We analyzed data from 48 patients (group A: n = 30 patients, 46 segments, mean age, 68.60 ± 3.36 years; group B: n = 18 patients, 23 segments, mean age, 79.22 ± 2.63 years). The surgical levels were as follows: C3/4, 4; C4/5, 7; C5/6, 10; C6/7, 29; and C7/ T1, 6 levels, and there were no significant between-group differences in the distribution. There were no significant between-group differences in the fusion and subsidence rates (fusion rate: group A, 76.2%; group B, 71.4%; p = 0.732; subsidence rate: group A, 34.8%; group B, 26.1%; p = 0.587). There was no longitudinal trend in the repeated-measurements analysis of variance test of the 2 groups of the PRE, POST, and F/U data for each radiological parameter. According to the paired t-test, T1 slope (T1s), SVA, and CA did not differ preoperatively and postoperatively. There was no statistically significant difference in visual analogue scale scores (axial, arm), the Neck Disability Index, or Odom’s criteria between the 2 groups (p = 0.448, p = 0.357, and p = 0.913).
Conclusion There was no significant difference in radiological and clinical outcomes between young-old and middle-old patients. Middle-old age does not seem to be a limitation to ACDF, but larger-scale and longer-term studies are needed to confirm the findings of this study.
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Affiliation(s)
- Chi Hyung Lee
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Department of Neurosurgery, Pusan National University School of Medicine, Yangsan, Korea
| | - Dong Wuk Son
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Department of Neurosurgery, Pusan National University School of Medicine, Yangsan, Korea
| | - Su Hun Lee
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Department of Neurosurgery, Pusan National University School of Medicine, Yangsan, Korea
| | - Jun Seok Lee
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Department of Neurosurgery, Pusan National University School of Medicine, Yangsan, Korea
| | - Soon Ki Sung
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Department of Neurosurgery, Pusan National University School of Medicine, Yangsan, Korea
| | - Sang Weon Lee
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Department of Neurosurgery, Pusan National University School of Medicine, Yangsan, Korea
| | - Geun Sung Song
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Department of Neurosurgery, Pusan National University School of Medicine, Yangsan, Korea
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Orsini C. The mortality effects of changing public funding for home health care: An empirical analysis of Medicare home health care in the United States. HEALTH ECONOMICS 2019; 28:921-936. [PMID: 31237098 DOI: 10.1002/hec.3896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 04/10/2019] [Accepted: 04/11/2019] [Indexed: 06/09/2023]
Abstract
In light of population aging, it is important to understand whether limiting public in-kind transfers to the elderly affects elderly mortality. I focus on home health care-a popular in-kind transfer-and I exploit variation in the Medicare home health care reimbursement that arose in 1997 in the United States to study whether cuts to government coverage of home health care affected elderly mortality. Under the identifying assumptions of the DID model, I find that the cuts affected total mortality for some men but not women, suggesting that changes in home health care can affect elderly mortality and differences in mortality between men and women. For men aged between 65 and 74, the Interim Payment System was associated with an increase in mortality equal to 0.6%, an effect in absolute value comparable to the mortality response to a one percentage point change in unemployment rates and within the range of other estimates of the impact of health insurance on elderly mortality.
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Affiliation(s)
- Chiara Orsini
- Department of Economics, University of Sheffield, Sheffield, UK
- Department of Health Policy, London School of Economics and Political Science, London, UK
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36
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Burch P, Blakeman T, Bower P, Sanders C. Understanding the diagnosis of pre-diabetes in patients aged over 85 in English primary care: a qualitative study. BMC FAMILY PRACTICE 2019; 20:90. [PMID: 31255180 PMCID: PMC6599359 DOI: 10.1186/s12875-019-0981-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 06/18/2019] [Indexed: 12/12/2022]
Abstract
Background The benefit of a “diagnosis” of pre-diabetes in very elderly patients is debated. How clinicians manage pre-diabetic blood results in these patients is unknown. This study aims to understand how clinicians are “diagnosing” older patients with pre-diabetic blood parameters. Methods Semi-structured interviews and focus groups with health care staff (24 total participants) were conducted in the north of England. Interviews and focus groups were recorded, transcribed and analysed thematically. A grounded theory approach was taken with the theory of candidacy being used as a sensitising concept through which questions were framed and results interpreted. Results There is a complex system of competing pressures that influence a clinician in deciding whether, and in what way, to inform a very elderly patient that they have pre-diabetes. The majority of clinicians adjust their management of pre-diabetes to the age and perceived risk/benefit for the patient. Whilst some clinicians choose not to inform certain patients of their blood results, many clinicians maintain, what could be seen as a somewhat paradoxical approach of labeling all older patients with pre-diabetes but downplaying the significance to the patient. The policy, organisational context, workload and professional constraints under which clinicians work, play a significant role in shaping how they deal with pre-diabetic blood results in the very elderly. Conclusion There has been recent acknowledgement of how policy and organisational context frames decision-making, but there is a lack of evidence on how this influences uncertainty and dilemmas in decision-making in practice. These findings add further weight for the argument that treatment burden should be included in clinical guidelines.
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Affiliation(s)
- Patrick Burch
- NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, School of Health Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
| | - Thomas Blakeman
- NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, School of Health Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Peter Bower
- NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, School of Health Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Caroline Sanders
- NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, School of Health Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Ebru TK, Resul K. Comparison of ketamine-propofol mixture (ketofol) and midazolam-meperidine in endoscopic retrograde cholangiopancretography (ERCP) for oldest old patients. Ther Clin Risk Manag 2019; 15:755-763. [PMID: 31417263 PMCID: PMC6592063 DOI: 10.2147/tcrm.s201441] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 05/06/2019] [Indexed: 01/28/2023] Open
Abstract
Background and aim: Endoscopic retrograde cholangiopancreatography (ERCP) requires moderate-to-deep conscious sedation. Combinations of ketamine and propofol (ketofol) and of midazolam and meperidine were analyzed using the bispectral index (BIS). There is no research on the use of ketofol on very elderly patients. The aim of this study is to use BIS and offer insight into the use and safety of ketofol sedation for oldest old patients undergoing ERCP. Materials and methods: For the ERCP procedure, 168 patients aged 85+ years were enrolled in a 2-year retrospective single center study. Seventy-five patients received midazolam-meperidine (MM) sedation in 2016, while 75 patients received ketofol (KP) sedation in 2018. The two groups were compared for patient data, procedure duration, Ramsay Sedation Score (RSS), heart rate (HR), blood pressure (BP), and pulse oximetry (SpO2), BIS, facial pain score (FPS), time to achieve BIS, recovery time, and complications. The total amount of rescue medication was recorded. Results: The two groups did not differ by patient data or procedure duration (p>0.05). Group KP had significantly higher systolic and diastolic BP, HR, and SpO2 values and lower BIS scores than Group MM (p=0.0001). The two groups did not differ by time to achieve BIS scores (p>0.05). Group KP had significantly fewer complications and a shorter recovery time than Group MM (p<0.001). Conclusion: Ketofol induced sedation results in more stable vital signs and fewer complications than the midazolam-meperidine sedation regimen during ERCP in oldest old patients, indicating that ketofol can be an alternative to midazolam-meperidine.
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Affiliation(s)
- Tarıkçı Kılıç Ebru
- Department of Anesthesiology, Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - Kahraman Resul
- Department of Gastroenterology, Ümraniye Training and Research Hospital, İstanbul, Turkey
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Birimoğlu-Okuyan C, Bilgili N. [Determining the Prevalence of Constipation and Relating Factors in Elderly People: A Nursing Home Study]. Florence Nightingale Hemsire Derg 2019; 27:157-165. [PMID: 34267970 PMCID: PMC8127603 DOI: 10.26650/fnjn422104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 12/31/2018] [Indexed: 11/20/2022] Open
Abstract
Amaç Bu çalışma, huzurevinde kalan yaşlılarda Roma II konstipasyon tanılama kriterlerine göre konstipasyon görülme sıklığını ve ilişkili faktörleri belirlemek amacıyla yapılmıştır. Yöntem Kesitsel tipteki bu çalışma Ankara’da bir huzurevinde yaşayan ve araştırmaya dahil edilme kriterlerine uyan 160 yaşlı birey ile gerçekleştirilmiştir. Veriler tanıtıcı özellikler bilgi formu ve Roma II Konstipasyon Tanılama Kriterleri formu ile yüz yüze görüşülerek toplanmıştır. Verilerin analizinde tanımlayıcı istatistikler ile Ki-Kare testi kullanılmıştır. Bulgular Yaşlı bireylerin yaş ortalaması 78±8.1 (min: 65, max: 95) olup, %53.1’i erkektir. Yaşlı bireylerin %51.9’u Roma II konstipasyon tanılama kriterlerine göre konstipasyon sorunu yaşamaktadır. Roma II konstipasyon tanılama kriterleri incelendiğinde yaşlı bireylerin, %44.4’ünün defekasyon yaparken zorlanma/yoğun ıkınma yaşadığı, %29.4’ünün dışkı kıvamının sert olduğu, %53.8’inin yetersiz dışkılama hissi/tam boşalamama problemi olduğu, %30.2’sinin bağırsak hareketinin haftada 2 kez ve daha az olduğu belirlenmiştir. Düzenli fiziksel aktivite yapmayan, günlük 2 litreden az su tüketen ve huzurevinde kalma süresi 11 yılın üzerinde olan yaşlı bireylerde konstipasyon sorununun daha fazla olduğu belirlenmiştir (p<0.05). Sonuç Huzurevinde yaşayan yaşlı bireylerin yarısından biraz fazlasının konstipasyon sorunu yaşadığı belirlenmiştir. Yaşlı bireylerde konstipasyon ve risk faktörlerinin erken dönemde belirlenmesi, düzenli olarak egzersiz yapmalarının desteklenmesi önem taşımaktadır.
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Affiliation(s)
| | - Naile Bilgili
- Gazi Üniversitesi Sağlık Bilimleri Fakültesi, Ankara, Türkiye
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Seo JH, Kim DH, Cho E, Jun CH, Park SY, Cho SB, Park CH, Kim HS, Choi SK, Rew JS. Characteristics and Outcomes of Extreme Elderly Patients With Hepatocellular Carcinoma in South Korea. In Vivo 2019; 33:145-154. [PMID: 30587615 DOI: 10.21873/invivo.11451] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 10/08/2018] [Accepted: 10/09/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND/AIM The number of elderly patients diagnosed with hepatocellular carcinoma (HCC) has been increasing. But there is no proper management based on age stratification in elderly patients. Therefore, we evaluated the clinical characteristics and outcomes of elderly HCC patients more than 75 years old in South Korea. PATIENTS AND METHODS Five hundred and fifty elderly patients with HCC were enrolled and divided into the oldest-old (age ≥85 years), middle-old (age between 80 and 85 years), and young-old groups (age between 75 and 80 years). RESULTS Fifty-one, 153, and 346 patients were included in the oldest-old (mean age: 87 years), middle-old (mean age: 82 years), and young-old groups (mean age: 77 years), respectively. There was a significantly lower rate of alcohol-related and hepatitis B virus-related diseases in the oldest-old group than in the other groups, whereas there was no significant difference in other characteristics. With increasing age, conservative treatment was predominantly performed. Transarterial chemoembolization was the main modality of active treatment in all groups. In multivariate analysis, the performance score, model for end-stage liver disease score, modified Union for International Cancer Control staging, Barcelona Clinic Liver Cancer staging, presence of portal vein tumor thrombosis, ruptured HCC, and active treatment were risk factors of overall survival. CONCLUSION When the therapeutic approach is used in elderly patients with HCC, the patient's performance status, liver function, and stage of cancer should be considered, and its use should not be restricted to those of advanced age.
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Affiliation(s)
- Ji Ho Seo
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
| | - Dong Hyun Kim
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
| | - Eunae Cho
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
| | - Chung Hwan Jun
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
| | - Seon Young Park
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
| | - Sung Bum Cho
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
| | - Chang Hwan Park
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
| | - Hyun Soo Kim
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
| | - Sung Kyu Choi
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
| | - Jong Sun Rew
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
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Naro F, Venturelli M, Monaco L, Toniolo L, Muti E, Milanese C, Zhao J, Richardson RS, Schena F, Reggiani C. Skeletal Muscle Fiber Size and Gene Expression in the Oldest-Old With Differing Degrees of Mobility. Front Physiol 2019; 10:313. [PMID: 30971947 PMCID: PMC6443969 DOI: 10.3389/fphys.2019.00313] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 03/07/2019] [Indexed: 12/22/2022] Open
Abstract
The oldest-old, in the ninth and tenth decades of their life, represent a population characterized by neuromuscular impairment, which often implies a loss of mobility and independence. As recently documented by us and others, muscle atrophy and weakness are accompanied by an unexpected preservation of the size and contractile function of skeletal muscle fibers. This suggests that, while most fibers are likely lost with their respective motoneurons, the surviving fibers are well preserved. Here, we investigated the mechanisms behind this fiber preservation and the relevance of physical activity, by comparing a group of 6 young healthy controls (YG: 22-28 years) with two groups of oldest-old (81-96 years), one able to walk (OW: n = 6, average 86 years) and one confined to a wheelchair (ONW n = 9, average 88 years). We confirmed previous results of fiber preservation and, additionally, observed a shift in fiber type, toward slow predominance in OW and fast predominance in ONW. Myonuclear density was increased in muscles of ONW, compared to YG and OW, potentially indicative of an ongoing atrophy process. We analyzed, by RT-qPCR, the expression of genes relevant for fiber size and type regulation in a biopsy sample from the vastus lateralis. In all oldest-old both myostatin and IGF-1 expression were attenuated compared to YG, however, in ONW two specific IGF-1 isoforms, IGF-1EA and MGF, demonstrated a further significant decrease compared to OW. Surprisingly, atrogenes (MURF1 and atrogin) expression was also significantly reduced compared to YG and this was accompanied by a close to statistically significantly attenuated marker of autophagy, LC3. Among the determinants of the metabolic fiber type, PGC1α was significantly reduced in both OW and ONW compared to YG, while AMPK was down-regulated only in ONW. We conclude that, in contrast to the shift of the balance in favor of pro-atrophy factors found by other studies in older adults (decreased IGF-1, increase of myostatin, increase of atrogenes), in the oldest-old the pro-atrophy factors also appear to be down-regulated, allowing a partial recovery of the proteostasis balance. Furthermore, the impact of muscle activity, as a consequence of lost or preserved walking ability, is limited.
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Affiliation(s)
- Fabio Naro
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Massimo Venturelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Lucia Monaco
- Department of Physiology and Pharmacology, Sapienza University of Rome, Rome, Italy
| | - Luana Toniolo
- Department of Biomedical Sciences, University of Padova, Padua, Italy
| | - Ettore Muti
- Monsignor Arrigo Mazzali Foundation, Mantova, Italy
| | - Chiara Milanese
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Jia Zhao
- Division of Geriatrics, Department of Internal Medicine, The University of Utah, Salt Lake City, UT, United States.,Department of Nutrition and Integrative Physiology, The University of Utah, Salt Lake City, UT, United States.,Geriatric Research, Education, and Clinical Center, George E. Whalen VA Medical Center, Salt Lake City, UT, United States
| | - Russell S Richardson
- Division of Geriatrics, Department of Internal Medicine, The University of Utah, Salt Lake City, UT, United States.,Department of Nutrition and Integrative Physiology, The University of Utah, Salt Lake City, UT, United States.,Geriatric Research, Education, and Clinical Center, George E. Whalen VA Medical Center, Salt Lake City, UT, United States
| | - Federico Schena
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Carlo Reggiani
- Department of Biomedical Sciences, University of Padova, Padua, Italy.,Institute for Kinesiology Research, Science and Research Center of Koper, Koper, Slovenia
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Mentes JC, DeVost MA, Nandy K. Salivary Osmolality, Function, and Hydration Habits in Community-Dwelling Older Adults. SAGE Open Nurs 2019; 5:2377960819826253. [PMID: 33415218 PMCID: PMC7774490 DOI: 10.1177/2377960819826253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 11/06/2018] [Accepted: 12/23/2018] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to examine the relationship between hydration status as
measured by salivary osmolality and personal hydration habits, selected demographic
characteristics, and performance on a walking and balance test in older community-dwelling
adults. This study used a descriptive observational design in a convenience sample of
multiethnic, community-dwelling older adults (N = 53). We collected
saliva for analysis on 3 days both in the morning and early afternoon, along with a
hydration habit questionnaire, get up and go test and demographic information. An
exploratory factor analysis of the hydration habit questionnaire revealed a two-factor
solution including physical barriers and psychological barriers to drinking fluids. A
linear mixed-model approach revealed that time of day (p < .01), race
(p = .015), mobility (p < .01), and cognitive
barriers (p = .023) are all significant predictors of salivary osmolality
among noninstitutionalized seniors. There is also a significant interaction between
psychological barriers to drinking fluids and time of day (p < .01).
Average salivary osmolality was higher in this group of older adults than has been
reported in younger adults. Controlling for all other variables, salivary osmolality is
higher in the morning than in the afternoon, lower among Black or African American seniors
than among White or Caucasian seniors, and higher among seniors with decreased mobility.
An interaction between psychological barriers and salivary osmolality showed that those
participants with more psychological barriers to drinking had higher salivary osmolality
in the morning and an inverse relationship in the afternoon.
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Affiliation(s)
- Janet C Mentes
- School of Nursing, University of California, Los Angeles, CA, USA
| | | | - Karabi Nandy
- Department of Biostatistics and Epidemiology, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
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Abnormalities of functional cortical source connectivity of resting-state electroencephalographic alpha rhythms are similar in patients with mild cognitive impairment due to Alzheimer's and Lewy body diseases. Neurobiol Aging 2019; 77:112-127. [PMID: 30797169 DOI: 10.1016/j.neurobiolaging.2019.01.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 01/15/2019] [Accepted: 01/16/2019] [Indexed: 02/01/2023]
Abstract
Previous evidence has shown different resting-state eyes-closed electroencephalographic delta (<4 Hz) and alpha (8-10.5 Hz) source connectivity in subjects with dementia due to Alzheimer's (ADD) and Lewy body (DLB) diseases. The present study tested if the same differences may be observed in the prodromal stages of mild cognitive impairment (MCI). Here, clinical and resting-state eyes-closed electroencephalographic data in age-, gender-, and education-matched 30 ADMCI, 23 DLBMCI, and 30 healthy elderly (Nold) subjects were available in our international archive. Mini-Mental State Evaluation (MMSE) score was matched in the ADMCI and DLBMCI groups. The eLORETA freeware estimated delta and alpha source connectivity by the tool called lagged linear connectivity (LLC). Area under receiver operating characteristic curve (AUROCC) indexed the classification accuracy among individuals. Results showed that widespread interhemispheric and intrahemispheric LLC solutions in alpha sources were abnormally lower in both MCI groups compared with the Nold group, but with no differences were found between the 2 MCI groups. AUROCCs of LLC solutions in alpha sources exhibited significant accuracies (0.72-0.75) in the discrimination of Nold versus ADMCI-DLBMCI individuals, but not between the 2 MCI groups. These findings disclose similar abnormalities in ADMCI and DLBMCI patients as revealed by alpha source connectivity. It can be speculated that source connectivity mostly reflects common cholinergic impairment in prodromal state of both AD and DLB, before a substantial dopaminergic derangement in the dementia stage of DLB.
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Fullen MC, Granello DH, Richardson VE, Granello PF. Using Wellness and Resilience to Predict Age Perception in Older Adulthood. JOURNAL OF COUNSELING AND DEVELOPMENT 2018. [DOI: 10.1002/jcad.12224] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Factors Affecting Inpatient Mortality in Elderly People with Acute Kidney Injury. ScientificWorldJournal 2018; 2018:2142519. [PMID: 29853800 PMCID: PMC5960515 DOI: 10.1155/2018/2142519] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 01/30/2018] [Accepted: 03/25/2018] [Indexed: 11/18/2022] Open
Abstract
Background Acute Kidney Injury (AKI) is common in elderly people (EP). There is paucity of data on predictor of mortality in EP with AKI. Objective This study was done to know more about factors associated with inpatient mortality in EP with AKI. Methods We retrospectively reviewed medical records of patients aged 65 years or above hospitalized with a diagnosis of AKI at Aga Khan University Hospital, Karachi, between January 2005 and December 2010. Binary logistic regression models were constructed to identify factors associated with mortality in EP with AKI. Results 431 patients had AKI, with 341 (79.1%) having stage I AKI, 56 (13%) having stage II AKI, and 34 (7.9%) having stage III AKI. Out of 431 patients, 142 (32.9%) died. Mortality increased with increasing severity of AKI. Mortality was 50% (17/34) in AKI stage III, 44.6% (25/56) in AKI stage II, and 29.3% (100/341) in AKI stage I. Factors associated with increased inpatients mortality were presence of stage III AKI (OR: 3.20, P = 0.04, 95% CI: 1.05-9.72), presence of oliguria (OR: 3.42, P = 0.006, 95% CI: 1.42-8.22), and need for vasopressors (OR: 6.90, P < 0.001, 95% CI: 2.42-19.65). Median bicarbonate 18 versus 17 between those who survived and those who died was associated with less mortality (OR: 0.94, P = 0.02, 95% CI: 0.89-0.99). History of hypertension (OR: 0.49, P = 0.03, 95% CI: 0.25-0.95) and high admission creatinine (OR: 0.68, P = 0.01, 95% CI: 0.50-0.91) were also associated with less mortality. Conclusion Mortality in EP increases with increasing severity of AKI. Presence of stage III AKI, oliguria, and hemodynamic instability needing vasopressor are associated with increased mortality. Increased median bicarbonate, presence of hypertension, and high admission creatinine were various factors associated with decreased inpatient mortality. Increasing age and need for dialysis did not increase mortality in elderly population.
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Neuro-Cognitive Effects of Acute Tyrosine Administration on Reactive and Proactive Response Inhibition in Healthy Older Adults. eNeuro 2018; 5:eN-NWR-0035-17. [PMID: 30094335 PMCID: PMC6084775 DOI: 10.1523/eneuro.0035-17.2018] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 03/01/2018] [Accepted: 03/24/2018] [Indexed: 01/02/2023] Open
Abstract
The aging brain is characterized by altered dopamine signaling. The amino acid tyrosine, a catecholamine precursor, is known to improve cognitive performance in young adults, especially during high environmental demands. Tyrosine administration might also affect catecholamine transmission in the aging brain, thereby improving cognitive functioning. In healthy older adults, impairments have been demonstrated in two forms of response inhibition: reactive inhibition (outright stopping) and proactive inhibition (anticipatory response slowing) under high information load. However, no study has directly compared the effects of a catecholamine precursor on reactive and load-dependent proactive inhibition. In this study we explored the effects of tyrosine on reactive and proactive response inhibition and signal in dopaminergically innervated fronto-striatal regions. Depending on age, tyrosine might lead to beneficial or detrimental neurocognitive effects. We aimed to address these hypotheses in 24 healthy older human adults (aged 61-72 years) using fMRI in a double blind, counterbalanced, placebo-controlled, within-subject design. Across the group, tyrosine did not alter reactive or proactive inhibition behaviorally but did increase fronto-parietal proactive inhibition-related activation. When taking age into account, tyrosine affected proactive inhibition both behaviorally and neurally. Specifically, increasing age was associated with a greater detrimental effect of tyrosine compared with placebo on proactive slowing. Moreover, with increasing age, tyrosine decreased fronto-striatal and parietal proactive signal, which correlated positively with tyrosine's effects on proactive slowing. Concluding, tyrosine negatively affected proactive response slowing and associated fronto-striatal activation in an age-dependent manner, highlighting the importance of catecholamines, perhaps particularly dopamine, for proactive response inhibition in older adults.
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Guaraldi G, Malagoli A, Calcagno A, Mussi C, Celesia BM, Carli F, Piconi S, De Socio GV, Cattelan AM, Orofino G, Riva A, Focà E, Nozza S, Di Perri G. The increasing burden and complexity of multi-morbidity and polypharmacy in geriatric HIV patients: a cross sectional study of people aged 65 - 74 years and more than 75 years. BMC Geriatr 2018; 18:99. [PMID: 29678160 PMCID: PMC5910563 DOI: 10.1186/s12877-018-0789-0] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 04/12/2018] [Indexed: 02/06/2023] Open
Abstract
Background Geriatric Patients Living with HIV/AIDS (GEPPO) is a new prospective observational multicentre cohort consisting of all the HIV-positive geriatric patients being treated at 10 clinics in Italy, and HIV-negative controls attending a single geriatric clinic. The aim of this analysis of the GEPPO cohort was to compare prevalence and risk factors of individual non-communicable diseases (NCD), multi-morbidity (MM) and polypharmacy (PP) amongst HIV positive and HIV negative controls at enrolment into the GEPPO cohort. Methods This cross-sectional study was conducted between June 2015 and May 2016. The duration of HIV infection was subdivided into three intervals: < 10, 10–20 and > 20 years. The NCD diagnoses were based on guidelines defined criteria, including cardiovascular disease, hypertension, type 2 diabetes, chronic kidney disease, dyslipidaemia, chronic obstructive pulmonary disease. MM was classified as the presence of two or more co-morbidities. The medications prescribed for the treatment of comorbidities were collected in both HIV positive and HIV negative group from patient files and were categorized using the Anatomical Therapeutic Chemical (ATC) classification. PP was defined as the presence of five or more drug components other than anti-retroviral agents. Results The study involved a total of 1573 patient: 1258 HIV positive and 315 HIV negative). The prevalence of individual comorbidities was similar in the two groups with the exception of dyslipidaemia, which was more frequent in the HIV-positive patients (p < 0.01). When the HIV-positive group was stratified based on the duration of HIV infection, most of the co-morbidities were significantly more frequent than in control patients, except for hypertension and cardiovascular disease, while COPD was more prevalent in the control group. MM and PP were both more prevalent in the HIV-positive group, respectively 64% and 37%. Conclusions MM and PP burden in geriatric HIV positive patients are related to longer duration of HIV-infection rather than older age per se.
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Affiliation(s)
- G Guaraldi
- Infectious Disease Clinic, Department of Medical and Surgical Sciences for Children & Adults, University of Modena and Reggio Emilia, Modena, Italy.
| | - A Malagoli
- Infectious Disease Clinic, Department of Medical and Surgical Sciences for Children & Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - A Calcagno
- Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, Turin, Italy
| | - C Mussi
- Centre of Gerontological Evaluation and Research, University of Modena and Reggio Emilia, Modena, Italy
| | - B M Celesia
- Department of Clinical and Molecular Biomedicine, Division of Infectious Diseases, University of Catania, ARNAS Garibaldi, Catania, Italy
| | - F Carli
- Infectious Disease Clinic, Department of Medical and Surgical Sciences for Children & Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - S Piconi
- First Division of Infectious Diseases Unit, University of Milan, Ospedale L. Sacco, Milan, Italy
| | - G V De Socio
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria di Perugia, Perugia, Italy
| | - A M Cattelan
- Unit of Infectious Diseases, Department of Internal Medicine, Azienda Ospedaliera-Universitaria di Padova, Padua, Italy
| | - G Orofino
- Unit of Infectious Diseases, Division A, Ospedale Amedeo di Savoia, ASLTO2, Turin, Italy
| | - A Riva
- Third Division of Infectious Diseases, University of Milan, Ospedale L. Sacco, Milan, Italy
| | - E Focà
- Unit of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy
| | - S Nozza
- Department of Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy
| | - G Di Perri
- Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, Turin, Italy
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Ballas SK. Comorbidities in aging patients with sickle cell disease. Clin Hemorheol Microcirc 2018; 68:129-145. [DOI: 10.3233/ch-189003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Samir K. Ballas
- Cardeza Foundation for Hematologic Research, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
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Willshire C, Bron AJ, Gaffney EA, Pearce EI. Basal Tear Osmolarity as a metric to estimate body hydration and dry eye severity. Prog Retin Eye Res 2018; 64:56-64. [PMID: 29476817 DOI: 10.1016/j.preteyeres.2018.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 02/02/2018] [Accepted: 02/20/2018] [Indexed: 01/28/2023]
Abstract
The osmolarities of various bodily fluids, including tears, saliva and urine, have been used as indices of plasma osmolality, a measure of body hydration, while tear osmolarity is used routinely in dry eye diagnosis, the degree of tear hyperosmolarity providing an index of disease severity. Systemic dehydration, due to inadequate water intake or excessive water loss is common in the elderly population, has a high morbidity and may cause loss of life. Its diagnosis is often overlooked and there is a need to develop a simple, bedside test to detect dehydration in this population. We hypothesize that, in the absence of tear evaporation and with continued secretion, mixing and drainage of tears, tear osmolarity falls to a basal level that is closer to that of the plasma than that of a tear sample taken in open eye conditions. We term this value the Basal Tear Osmolarity (BTO) and propose that it may be measured in tear samples immediately after a period of evaporative suppression. This value will be particular to an individual and since plasma osmolarity is controlled within narrow limits, it is predicted that it will be stable and have a small variance. It is proposed that the BTO, measured immediately after a defined period of eye closure, can provide a new metric in the diagnosis of systemic dehydration and a yardstick against which to gauge the severity of dry eye disease.
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Affiliation(s)
- C Willshire
- Vision and Eye Research Unit, Anglia Ruskin University, Cambridge, UK
| | - A J Bron
- Vision and Eye Research Unit, Anglia Ruskin University, Cambridge, UK; Nuffield Department of Clinical Neurosciences and Nuffield Laboratory of Ophthalmology, University of Oxford, UK.
| | - E A Gaffney
- Wolfson Centre of Mathematical Biology, Mathematical Institute, University of Oxford, UK
| | - E Ian Pearce
- School of Health and Life Sciences, Glasgow Caledonian University, UK
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Tolvaptan should be used very carefully in very elderly patients. Anatol J Cardiol 2018; 19:79. [PMID: 29339706 PMCID: PMC5864796 DOI: 10.14744/anatoljcardiol.2017.8195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Garcia IFF, Tiuganji CT, Simões MDSMP, Santoro IL, Lunardi AC. Systemic effects of chronic obstructive pulmonary disease in young-old adults' life-space mobility. Int J Chron Obstruct Pulmon Dis 2017; 12:2777-2785. [PMID: 29026295 PMCID: PMC5627755 DOI: 10.2147/copd.s146041] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The objective was to assess whether dyspnea, peripheral muscle strength and the level of physical activity are correlated with life-space mobility of older adults with COPD. PATIENTS AND METHODS Sixty patients over 60 years of age (40 in the COPD group and 20 in the control group) were included. All patients were evaluated for lung function (spirometry), life-space mobility (University of Alabama at Birmingham Study of Aging Life-Space Assessment), dyspnea severity (Modified Dyspnea Index), peripheral muscle strength (handgrip dynamometer), level of physical activity and number of daily steps (accelerometry). Groups were compared using unpaired t-test. Pearson's correlation was used to test the association between variables. RESULTS Life-space mobility (60.41±16.93 vs 71.07±16.28 points), dyspnea (8 [7-9] vs 11 [10-11] points), peripheral muscle strength (75.16±14.89 vs 75.50±15.13 mmHg), number of daily steps (4,865.4±2,193.3 vs 6,146.8±2,376.4 steps), and time spent in moderate to vigorous activity (197.27±146.47 vs 280.05±168.95 minutes) were lower among COPD group compared to control group (p<0.05). The difference was associated with the lower mobility of COPD group in the neighborhood. CONCLUSION Life-space mobility is decreased in young-old adults with COPD, especially at the neighborhood level. This impairment is associated to higher dyspnea, peripheral muscle weakness and the reduced level of physical activity.
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Affiliation(s)
| | - Carina Tiemi Tiuganji
- Master’s and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo
| | | | - Ilka Lopes Santoro
- Respiratory Division, Pulmonary Rehabilitation Center, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Adriana Claudia Lunardi
- Master’s and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo
- Department of Physical Therapy, School of Medicine, University of Sao Paulo
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