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Xu Q, Xu L, Tao J, Chen X, Zhang Y, Jiang S, Dong C. Adaptation and validation of the Abrams geriatric self-neglect assessment scale among older Chinese people admitted to the hospital. Int J Older People Nurs 2023; 18:e12569. [PMID: 37574788 DOI: 10.1111/opn.12569] [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: 01/01/2023] [Revised: 06/07/2023] [Accepted: 08/03/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVES Elder self-neglect is a global public health problem, and older people admitted to the hospital may have a higher risk of self-neglect due to their deteriorating health conditions. This study aimed to translate, adapt and validate the Abrams geriatric self-neglect assessment scale (AGSS) among older Chinese people admitted to the hospital. METHODS Data were derived from a cross-sectional survey of a convenience sample of 452 older people admitted to a general hospital. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to examine the structural validity of the AGSS. Content validity, criterion validity, internal consistency reliability, and test-retest reliability were also conducted to assess the psychometric properties of the scale. RESULTS EFA yielded a 6-item one-factor model, which was supported by CFA and explained 44.74% of the total variance. The internal consistency was acceptable (Cronbach α = 0.740), and the test-retest reliability with a 14-day interval was good (intraclass correlation coefficient, ICC = 0.966). Significantly positive correlations with the caregiver-rated elder self-neglect assessment scale (r = 0.648) supported the concurrent validity of the scale. Significant differences in scores between respondents with different ages, marital statuses, educational levels and numbers of chronic diseases demonstrated the discriminative validity. CONCLUSION The Chinese version of the AGSS is an easy-to-use, reliable and valid measure with satisfactory psychometric properties. Future studies should recruit a more representative sample of older people in China to verify the applicability of the scale. IMPLICATIONS FOR PRACTICE The Chinese version of the AGSS enables clinical staff to accurately screen for and assess elder self-neglect upon hospital admission, which can inform the development of specific interventions and assignment of additional guardianship to those at risk of elder self-neglect.
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Affiliation(s)
- Qiongying Xu
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Liuqing Xu
- School of Nursing, Wenzhou Medical University, Wenzhou, China
- Ningbo Medical Center Lihuili Hospital, Ningbo, China
| | - Jingrui Tao
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Xuewei Chen
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Yao Zhang
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Sisi Jiang
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Chaoqun Dong
- School of Nursing, Wenzhou Medical University, Wenzhou, China
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Dong L, Sun L. Self-neglect among older adults with disabilities in Liaoning Province during the COVID-19 outbreak: A cross-sectional study. Front Psychol 2022; 13:1072110. [PMID: 36619127 PMCID: PMC9817287 DOI: 10.3389/fpsyg.2022.1072110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022] Open
Abstract
Background Self-neglect among older adults is a well-recognized public health issue. During the novel coronavirus disease 2019 (COVID-19), older adults with disabilities may be at increased risk for self-neglect. This study aimed to assess the prevalence of self-neglect and associated factors among older adults with disabilities in Liaoning Province during the COVID-19 outbreak. Methods A cross-sectional study was conducted from January 2021 to April 2021. A convenience sample of 230 older adults with disabilities filled out questionnaires that collected data on socioeconomic and demographic characteristics alongside data using the Barthel Index (BI), the Elder Self-Neglect Assessment (ESNA), the Geriatric Depression Scale-Short Form (GDS-SF), the Multidimensional Scale of Perceived Social Support (MSPSS), and the Mini-Mental State Examination (MMSE). Results The overall self-neglect rate was 86%. The study revealed that self-neglect correlates positively with the degree of disability (p < 0.001) and depressive symptoms (p < 0.001). In contrast, monthly income (p = 0.002) and perceived social support (p = 0.001) were negatively associated with self-neglect. Conclusion During the COVID-19 outbreak, self-neglect has been a serious public health problem among older adults with disabilities. Lower monthly income, decreased physical function, depressive symptoms, and perceptions of poor social support contributed to self-neglect among older adults with disabilities.
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Affiliation(s)
- Li Dong
- Department of Nursing, The Second People's Hospital of Yibin, Yibin, China
| | - Longfeng Sun
- Department of Geriatrics, The First Hospital of China Medical University, Shenyang, China,*Correspondence: Longfeng Sun ✉
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Liu PJ, Hernandez Chilatra JA, Phelan A. Examining nurses' role in Adult Protective Services related to safeguarding older people. J Adv Nurs 2021; 77:2481-2497. [PMID: 33606282 PMCID: PMC8048587 DOI: 10.1111/jan.14792] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 12/08/2020] [Accepted: 01/23/2021] [Indexed: 12/22/2022]
Abstract
Aim To examine the role of Adult Protective Services' (APS's) nurses in helping abused, neglected and exploited older people, this study investigated how nurses' contribution differs from social workers. Though the majority of APS' workforce is staffed by social workers, some programmes also employ nurses. Design Secondary data analysis using convergent parallel mixed‐method design was conducted. Methods Using survey data from the National Adult Protective Services Association, 99 nurses' responses between October 2014 and August 2015 were analysed to examine their agency characteristics, training and qualities, job responsibilities and interprofessional collaboration. Results The majority of nurses work with social workers or other professionals using a multidisciplinary team (MDT) approach. Among those carrying a caseload, 69% (49 out of 71) of nurses work in conjunction with social workers. Out of all nurses, 64% (63 out of 99) indicated participation in at least one MDT. While the responsibilities nurses provided were similar to social workers, nurses were also able to provide healthcare related services, in their professional competencies, without referral. Conclusion Nurses in APS are in a privileged position to investigate mistreatment and provide/coordinate direct care for victims. Impact Not much was known about nurses who directly investigate elder mistreatment and provide services to victims. This study was the first to highlight the nursing workforce in APS, and described the nurses' unique contribution to the field. Nurses functioned as both social workers and healthcare professionals in APS. Since victims of elder mistreatment often suffer from negative physical, psychological and social consequences, having nurses in APS benefits victims to receive and the programmes in providing better care and services.
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Affiliation(s)
- Pi-Ju Liu
- School of Nursing and Center on Aging and the Life Course, Purdue University, West Lafayette, IN, USA
| | | | - Amanda Phelan
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
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İlhan B, Bahat G, Saka F, Kılıç C, Merve Oren M, Karan MA. A new screening tool for self-neglect in community-dwelling older adults: IMSelf-neglect questionnaire. Aging Male 2020; 23:388-395. [PMID: 30289016 DOI: 10.1080/13685538.2018.1499083] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE We aimed to develop a new screening tool for self-neglect in community-dwelling self-sufficient older adults. METHODS Istanbul Medical School Elder Self-Neglect questionnaire (IMSelf-neglect) was developed as a screening tool. Community-dwelling, self-sufficient older adults were recruited in a geriatric outpatient clinic (n = 226, 142 female, 84 male). Construct validity was based on social-worker's interview as a gold-standard method. The cut-off threshold for IMSelf-neglect questionnaire was calculated from ROC-analysis using cut-off values that predicted social-worker's opinion whether the older adult has self-neglect. RESULTS Mean age was 74 ± 6.5 years. The inter-rater and test-retest reliability were excellent (r = 0.887, p < .05; r = 0.942, p < .05, respectively). The internal consistency was good (Cronbach's alpha: 0.708). Cut-off threshold for IM Self-neglect questionnaire was calculated as 7 with 92.1% sensitivity and 70.7% specificity. Positive predictive value and negative predictive value of IMSelf-neglect questionnaire were 38.9% and 97.8%, respectively. There was significant moderate agreement between social worker's assessment and results of IMSelf-neglect questionnaire (κ = 0.407, p < .001). The social worker confirmed 16.8% of the participants have self-neglect by the gold-standard clinical interview. Participants with self-neglect had decreased functionality, worse quality of life and tended to have more depression compared with participants without self-neglect. DISCUSSION/CONCLUSION We developed the IMSelf-neglect questionnaire as a valid and reliable tool to screen self-neglect in outpatient clinics complementary to comprehensive geriatric assessment.
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Affiliation(s)
- Birkan İlhan
- Department of Internal Medicine, Division of Geriatrics, Dr. Ersin Arslan Training and Research Hospital, Gaziantep, Turkey
| | - Gülistan Bahat
- Istanbul Medical School, Department of Internal Medicine, Division of Geriatrics, Istanbul University, Istanbul, Turkey
| | - Filiz Saka
- Istanbul Medical School, Department of Internal Medicine, Division of Geriatrics, Istanbul University, Istanbul, Turkey
| | - Cihan Kılıç
- Istanbul Medical School, Department of Internal Medicine, Division of Geriatrics, Istanbul University, Istanbul, Turkey
| | - Meryem Merve Oren
- Erzurum Provincial Health Directorate, Public Health Services Presidency, Erzurum, Turkey
| | - Mehmet Akif Karan
- Istanbul Medical School, Department of Internal Medicine, Division of Geriatrics, Istanbul University, Istanbul, Turkey
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Lee JL, Burnett J, Xia R, Smith SM, Dyer CB. Feasibility of intervention in elder self-neglecters: Setting the stage for future research. J Elder Abuse Negl 2018; 30:223-235. [PMID: 29565762 DOI: 10.1080/08946566.2018.1450172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Interventions are critical to improving clinical outcomes in elder self-neglecters. This study assessed feasibility of a randomized controlled trial of oral vitamin D in Adult Protective Services-substantiated self-neglect clients ≥65 years. METHODS Participants were directly observed to consume ergocalciferol 50,000 IU (treatment) or ergocalciferol 400 IU (control), once a month, for 10 months. For months 6-10, half the control group randomly crossed into the treatment group (crossover). Intervention feasibility was measured by number of potential participants who agreed to participate and by retention rates during the study. RESULTS Ninety-four referrals were received and 59 (63%) agreed to participate. Forty-nine participants were enrolled after prescreening and 35 completed the two-phase trial for a 72% retention rate. The participants' average age was 75.2 ± 6.8 years, mainly female (59%), African-American (47%), and living alone (41%). DISCUSSION Despite assumptions that self-neglecters are resistant to care, we have successfully conducted the first clinical intervention in this vulnerable population.
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Affiliation(s)
- Jessica L Lee
- a Division of Geriatric and Palliative Medicine; Texas Elder Abuse and Mistreatment (TEAM) Institute; and UTHealth Consortium on Aging , The University of Texas Health Science Center at Houston (UTHealth)
| | - Jason Burnett
- a Division of Geriatric and Palliative Medicine; Texas Elder Abuse and Mistreatment (TEAM) Institute; and UTHealth Consortium on Aging , The University of Texas Health Science Center at Houston (UTHealth)
| | - Rui Xia
- b UTHealth Division of Geriatric and Palliative Medicine ; TEAM Institute
| | - Scott M Smith
- c Human Health and Performance Directorate , NASA Lyndon B. Johnson Space Center
| | - Carmel B Dyer
- a Division of Geriatric and Palliative Medicine; Texas Elder Abuse and Mistreatment (TEAM) Institute; and UTHealth Consortium on Aging , The University of Texas Health Science Center at Houston (UTHealth)
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Li J, Zhao D, Dong B, Yu D, Ren Q, Chen J, Qin Q, Bi P, Sun Y. Frailty index and its associations with self-neglect, social support and sociodemographic characteristics among older adults in rural China. Geriatr Gerontol Int 2018; 18:987-996. [DOI: 10.1111/ggi.13280] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/12/2017] [Accepted: 01/24/2018] [Indexed: 12/22/2022]
Affiliation(s)
- Jie Li
- Department of Epidemiology and Health Statistics, School of Public Health; Anhui Medical University; Hefei China
| | - Dongdong Zhao
- Department of Epidemiology and Health Statistics, School of Public Health; Anhui Medical University; Hefei China
| | - Bao Dong
- Department of Epidemiology and Health Statistics, School of Public Health; Anhui Medical University; Hefei China
| | - Dandan Yu
- Department of Epidemiology and Health Statistics, School of Public Health; Anhui Medical University; Hefei China
| | - Qiongqiong Ren
- Department of Epidemiology and Health Statistics, School of Public Health; Anhui Medical University; Hefei China
| | - Jian Chen
- Ma’anshan Center for Disease Control and Prevention; Ma’anshan China
| | - Qirong Qin
- Ma’anshan Center for Disease Control and Prevention; Ma’anshan China
| | - Peng Bi
- Department of Epidemiology and Health Statistics, School of Public Health; Anhui Medical University; Hefei China
- The University of Adelaide, School of Public Health; Adelaide South Australia Australia
| | - Yehuan Sun
- Department of Epidemiology and Health Statistics, School of Public Health; Anhui Medical University; Hefei China
- Center for Evidence-Based Practice; Anhui Medical University; Hefei China
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Hansen MC, Flores DV, Coverdale J, Burnett J. Correlates of depression in self-neglecting older adults: A cross-sectional study examining the role of alcohol abuse and pain in increasing vulnerability. J Elder Abuse Negl 2016; 28:41-56. [PMID: 26716386 DOI: 10.1080/08946566.2015.1136252] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Self-neglect among older adults results in increased morbidity and mortality rates. Depression is strongly linked to self-neglect and when untreated, severely complicates management of health and functional outcomes. The study aims to identify factors correlated with depression to inform approaches to service recruitment and retention that improve long-term outcomes. The sample included urban community-dwelling older adults (n = 96) 65 years of age and older with Adult Protective Services-substantiated self-neglect. All participants completed a range of validated cognitive, functional, and self-report demographic and clinical measures around health and mental health functioning. A secondary data analysis using multivariable logistic regression revealed that a positive screen for alcohol abuse, low self-rated health, and higher self-reported pain were associated with significantly higher odds of self-reported depression. Further research is needed to understand the temporality between these correlates and depression and to inform prevention and intervention practices for self-neglecting older adults.
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Affiliation(s)
- Marissa C Hansen
- a School of Social Work , California State University, Long Beach , Long Beach , California , USA.,b Texas Elder Abuse and Mistreatment (TEAM) Institute , Houston , Texas , USA
| | - David V Flores
- b Texas Elder Abuse and Mistreatment (TEAM) Institute , Houston , Texas , USA
| | - John Coverdale
- b Texas Elder Abuse and Mistreatment (TEAM) Institute , Houston , Texas , USA.,c Baylor College of Medicine , Houston , Texas , USA.,d Harris Health System , Houston , Texas , USA
| | - Jason Burnett
- b Texas Elder Abuse and Mistreatment (TEAM) Institute , Houston , Texas , USA.,d Harris Health System , Houston , Texas , USA.,e Division of Geriatric and Palliative Medicine , UTHealth , Houston , Texas , USA.,f Division of Health Promotion and Behavioral Sciences, School of Public Health , UTHealth , Houston , Texas , USA
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8
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Ernst JS, Ramsey-Klawsnik H, Schillerstrom JE, Dayton C, Mixson P, Counihan M. Informing evidence-based practice: a review of research analyzing adult protective services data. J Elder Abuse Negl 2015; 26:458-94. [PMID: 24965804 DOI: 10.1080/08946566.2013.832605] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The mission of Adult Protective Services (APS) is to protect older and vulnerable adults from abuse, neglect, and exploitation. The complexity of APS cases and the potential for life-changing interventions point to the need for research that examines and evaluates APS practices. A literature review identified 50 studies published during a 16-year period that used APS agencies, clients, data, or resources to test hypotheses regarding elder abuse. The analysis revealed promising efforts toward knowledge development about elder mistreatment and self-neglect. This article provides an overview of salient findings, notes the scarcity of studies that analyze the effectiveness of APS, and highlights the need for additional research. Lessons learned are described, and APS practitioners and researchers are urged to work collaboratively to develop key practice-related questions about APS processes and outcomes that can be tested with appropriate research methodologies.
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Affiliation(s)
- Joy Swanson Ernst
- a Department of Sociology and Social Work , Hood College , Frederick , Maryland , USA
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Abstract
This article is based on the lecture for the 2014 American Geriatrics Society Outstanding Scientific Achievement for Clinical Investigation Award. Elder abuse is a global public health and human rights problem. Evidence suggests that elder abuse is prevalent, predictable, costly, and sometimes fatal. This review will highlight the global epidemiology of elder abuse in terms of its prevalence, risk factors, and consequences in community populations. The global literature in PubMed, MEDLINE, PsycINFO, BIOSIS, Science Direct, and Cochrane Central was searched. Search terms included elder abuse, elder mistreatment, elder maltreatment, prevalence, incidence, risk factors, protective factors, outcomes, and consequences. Studies that existed only as abstracts, case series, or case reports or recruited individuals younger than 60; qualitative studies; and non-English publications were excluded. Tables and figures were created to highlight the findings: the most-detailed analyses to date of the prevalence of elder abuse according to continent, risk and protective factors, graphic presentation of odds ratios and confidence intervals for major risk factors, consequences, and practical suggestions for health professionals in addressing elder abuse. Elder abuse is common in community-dwelling older adults, especially minority older adults. This review identifies important knowledge gaps, such as a lack of consistency in definitions of elder abuse; insufficient research with regard to screening; and etiological, intervention, and prevention research. Concerted efforts from researchers, community organizations, healthcare and legal professionals, social service providers, and policy-makers should be promoted to address the global problem of elder abuse.
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Affiliation(s)
- Xin Qi Dong
- Rush Institute for Healthy Aging; Rush University Medical Center; Chicago Illinois
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10
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Hildebrand C, Taylor M, Bradway C. Elder self-neglect: The failure of coping because of cognitive and functional impairments. J Am Assoc Nurse Pract 2014; 26:452-462. [DOI: 10.1002/2327-6924.12045] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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11
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Homocysteine, antioxidant micronutrients and late onset dementia. Eur J Nutr 2013; 53:277-85. [DOI: 10.1007/s00394-013-0526-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 04/15/2013] [Indexed: 10/26/2022]
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12
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Boscatto EC, Duarte MDFDS, Coqueiro RDS, Barbosa AR. Nutritional status in the oldest elderly and associated factors. Rev Assoc Med Bras (1992) 2013; 59:40-7. [PMID: 23440141 DOI: 10.1590/s0104-42302013000100010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Accepted: 07/24/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To verify factors associated with nutritional status in an oldest elderly communitydwelling population in Southern Brazil. METHODS This cross-sectional epidemiological and household-based study involved all subjects (n = 134) aged > 80 years who were living in Antônio Carlos (Santa Catarina state, Brazil). Nutritional status was assessed by body mass index (BMI < 22.0 kg/m², underweight; BMI > 27.0 kg/m², overweight). Explanatory variables in the study were: gender (women/ men), literacy (knows how to write and read - yes/no), living conditions (lives alone/with company), cognitive function (normal/altered), eating difficulty (yes/no), medication use (none to two/three or more), morbidity (none to two/three or more diseases), alimentary pattern (adequate/inadequate), alcohol consumption (none to one day a week, two or more days a week), cigarette smoking (never/current or former smoker), physical activity level (< 150 min/week; > 150 min/week), and sitting time (< 4 hours/day; > 4 hours but < 6 hours/ day; > 6 hours/day). RESULTS Prevalence of underweight was 27.3% in men and 12.8% in women (p < 0.01), and was positively associated with altered cognitive function (OR: 3.52) and inversely related with greater medication use (OR: 0.34). Overweight affected 25.5% of men and 53.8% of women. It was negatively associated with illiteracy (OR: 0.12) and positively associated with female gender (OR: 2.58). CONCLUSION There are differences between men and women regarding nutritional status. The factors associated to nutritional status of the oldest elderly from Antônio Carlos are specific to the vulnerability condition (underweight and overweight).
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Affiliation(s)
- Elaine Caroline Boscatto
- Postgraduate Program in Physical Education, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
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13
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Burnett J, Achenbaum WA, Hayes L, Flores DV, Hochschild AE, Kao D, Halphen JM, Dyer CB. Increasing surveillance and prevention efforts for elder self-neglect in clinical settings. ACTA ACUST UNITED AC 2012. [DOI: 10.2217/ahe.12.67] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Elder self-neglect is a growing public health problem characterized by a complex network of biopsychosocial risk factors and predictors. The lack of reliable and valid assessment criteria for identifying elder self-neglect during brief clinical visits often results in missed opportunities for reducing or preventing the negative health outcomes commonly associated with this geriatric syndrome. Knowing the most salient risk factors and predictors of self-neglect in older patients may help clinicians and other healthcare providers appropriately identify and prevent self-neglect and the associated negative health outcomes. This article discusses the salient factors that contribute to elder self-neglect and how they can be used to improve clinical surveillance and guide intervention and prevention efforts.
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Affiliation(s)
- Jason Burnett
- UT Health, Division of Geriatric & Palliative Medicine, Houston, TX 77030, USA
| | - W Andrew Achenbaum
- The University of Houston, Graduate College of Social Work, 4800 Calhoun Rd, Houston, TX 77004, USA
| | - Leslie Hayes
- Faculty of Health Sciences, Staffordshire University, Staffordshire, UK
| | - David V Flores
- UT Health, Division of Geriatric & Palliative Medicine, Houston, TX 77030, USA
- Texas Elder Abuse and Mistreatment Institute (TEAM), 3601 N. MacGregor Way (CREST Office), Houston, TX 77004, USA
- Harris Health System, TX, USA
| | - Ann E Hochschild
- UT Health, Division of Geriatric & Palliative Medicine, Houston, TX 77030, USA
- Texas Elder Abuse and Mistreatment Institute (TEAM), 3601 N. MacGregor Way (CREST Office), Houston, TX 77004, USA
- Harris Health System, TX, USA
| | - Dennis Kao
- The University of Houston, Graduate College of Social Work, 4800 Calhoun Rd, Houston, TX 77004, USA
| | - John M Halphen
- UT Health, Division of Geriatric & Palliative Medicine, Houston, TX 77030, USA
- Texas Elder Abuse and Mistreatment Institute (TEAM), 3601 N. MacGregor Way (CREST Office), Houston, TX 77004, USA
- Harris Health System, TX, USA
| | - Carmel B Dyer
- UT Health, Division of Geriatric & Palliative Medicine, Houston, TX 77030, USA
- Texas Elder Abuse and Mistreatment Institute (TEAM), 3601 N. MacGregor Way (CREST Office), Houston, TX 77004, USA
- Harris Health System, TX, USA
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Morgan JLL, Zwart SR, Heer M, Ploutz-Snyder R, Ericson K, Smith SM. Bone metabolism and nutritional status during 30-day head-down-tilt bed rest. J Appl Physiol (1985) 2012. [DOI: 10.115210.1152/japplphysiol.01064.2012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Bed rest studies provide an important tool for modeling physiological changes that occur during spaceflight. Markers of bone metabolism and nutritional status were evaluated in 12 subjects (8 men, 4 women; ages 25–49 yr) who participated in a 30-day −6° head-down-tilt diet-controlled bed rest study. Blood and urine samples were collected twice before, once a week during, and twice after bed rest. Data were analyzed using a mixed-effects linear regression with a priori contrasts comparing all days to the second week of the pre-bed rest acclimation period. During bed rest, all urinary markers of bone resorption increased ∼20% ( P < 0.001), and serum parathyroid hormone decreased ∼25% ( P < 0.001). Unlike longer (>60 days) bed rest studies, neither markers of oxidative damage nor iron status indexes changed over the 30 days of bed rest. Urinary oxalate excretion decreased ∼20% during bed rest ( P < 0.001) and correlated inversely with urinary calcium ( R = −0.18, P < 0.02). These data provide a broad overview of the biochemistry associated with short-duration bed rest studies and provide an impetus for using shorter studies to save time and costs wherever possible. For some effects related to bone biochemistry, short-duration bed rest will fulfill the scientific requirements to simulate spaceflight, but other effects (antioxidants/oxidative damage, iron status) do not manifest until subjects are in bed longer, in which case longer studies or other analogs may be needed. Regardless, maximizing research funding and opportunities will be critical to enable the next steps in space exploration.
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Affiliation(s)
- Jennifer L. L. Morgan
- Oak Ridge Associated Universities/NASA Post-Doctoral Fellow, NASA Johnson Space Center, Houston, Texas
| | - Sara R. Zwart
- Universities Space Research Association and NASA, NASA Johnson Space Center, Houston, Texas
| | - Martina Heer
- Department of Nutrition and Food Science, Nutritional Physiology, University of Bonn, Bonn, Germany
- Profil Institute for Metabolic Research, Neuss, Germany
| | - Robert Ploutz-Snyder
- Universities Space Research Association and NASA, NASA Johnson Space Center, Houston, Texas
| | - Karen Ericson
- Department of Chemistry, Indiana University-Purdue University Fort Wayne, Fort Wayne, Indiana; and
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15
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Morgan JLL, Zwart SR, Heer M, Ploutz-Snyder R, Ericson K, Smith SM. Bone metabolism and nutritional status during 30-day head-down-tilt bed rest. J Appl Physiol (1985) 2012; 113:1519-29. [PMID: 22995395 PMCID: PMC3524659 DOI: 10.1152/japplphysiol.01064.2012] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 09/18/2012] [Indexed: 11/22/2022] Open
Abstract
Bed rest studies provide an important tool for modeling physiological changes that occur during spaceflight. Markers of bone metabolism and nutritional status were evaluated in 12 subjects (8 men, 4 women; ages 25-49 yr) who participated in a 30-day -6° head-down-tilt diet-controlled bed rest study. Blood and urine samples were collected twice before, once a week during, and twice after bed rest. Data were analyzed using a mixed-effects linear regression with a priori contrasts comparing all days to the second week of the pre-bed rest acclimation period. During bed rest, all urinary markers of bone resorption increased ~20% (P < 0.001), and serum parathyroid hormone decreased ~25% (P < 0.001). Unlike longer (>60 days) bed rest studies, neither markers of oxidative damage nor iron status indexes changed over the 30 days of bed rest. Urinary oxalate excretion decreased ~20% during bed rest (P < 0.001) and correlated inversely with urinary calcium (R = -0.18, P < 0.02). These data provide a broad overview of the biochemistry associated with short-duration bed rest studies and provide an impetus for using shorter studies to save time and costs wherever possible. For some effects related to bone biochemistry, short-duration bed rest will fulfill the scientific requirements to simulate spaceflight, but other effects (antioxidants/oxidative damage, iron status) do not manifest until subjects are in bed longer, in which case longer studies or other analogs may be needed. Regardless, maximizing research funding and opportunities will be critical to enable the next steps in space exploration.
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Affiliation(s)
- Jennifer L L Morgan
- Oak Ridge Associated Universities, NASA Johnson Space Center, 2101 NASA Parkway, Houston, TX 77030, USA
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Lauder W, Roxburgh M. Self-neglect consultation rates and comorbidities in primary care. Int J Nurs Pract 2012; 18:454-61. [DOI: 10.1111/j.1440-172x.2012.02065.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- William Lauder
- School of Nursing, Midwifery and Health; University of Stirling; Stirling; UK
| | - Michelle Roxburgh
- School of Nursing, Midwifery and Health; University of Stirling; Stirling; UK
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17
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Abstract
Self-neglect is characterized by the inability to perform essential self-care tasks threatening a person's health and safety. The exact prevalence of self-neglect in a community-based aged population is not known. Cognitive impairment is the most important predisposing factor of self-neglect. There are also a number of other predisposing factors such as psychiatric diseases, pre-morbid personality, alcohol abuse, poor physical ability, lack of social support and a low socioeconomic situation. Self-neglect has a number of serious consequences. It is an independent risk factor for early mortality among the aged. It commonly causes malnutrition, frailty and the deterioration of physical ability, therefore, increasing the risk of falls and fractures. Untreated medical conditions result in emergency visits and acute hospitalization. The neglect of housekeeping and financial affairs seriously affects the domestic environment. Diagnosis and treatment of self-neglect should be based on the medical and psychosocial assessment of a patient. Patients require multidisciplinary support at home or in hospital, and sometimes long-term care is inevitable. There is no sufficient scientific evidence to support the benefits of early intervention in self-neglect. Controlled studies are needed, especially to show whether early diagnosis followed by increased social support and tailored health care services have an effect on the outcome.
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Saturation diving alters folate status and biomarkers of DNA damage and repair. PLoS One 2012; 7:e31058. [PMID: 22347427 PMCID: PMC3274529 DOI: 10.1371/journal.pone.0031058] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Accepted: 12/31/2011] [Indexed: 11/19/2022] Open
Abstract
Exposure to oxygen-rich environments can lead to oxidative damage, increased body iron stores, and changes in status of some vitamins, including folate. Assessing the type of oxidative damage in these environments and determining its relationships with changes in folate status are important for defining nutrient requirements and designing countermeasures to mitigate these effects. Responses of humans to oxidative stressors were examined in participants undergoing a saturation dive in an environment with increased partial pressure of oxygen, a NASA Extreme Environment Mission Operations mission. Six participants completed a 13-d saturation dive in a habitat 19 m below the ocean surface near Key Largo, FL. Fasting blood samples were collected before, twice during, and twice after the dive and analyzed for biochemical markers of iron status, oxidative damage, and vitamin status. Body iron stores and ferritin increased during the dive (P<0.001), with a concomitant decrease in RBC folate (P<0.001) and superoxide dismutase activity (P<0.001). Folate status was correlated with serum ferritin (Pearson r = −0.34, P<0.05). Peripheral blood mononuclear cell poly(ADP-ribose) increased during the dive and the increase was significant by the end of the dive (P<0.001); γ-H2AX did not change during the mission. Together, the data provide evidence that when body iron stores were elevated in a hyperoxic environment, a DNA damage repair response occurred in peripheral blood mononuclear cells, but double-stranded DNA damage did not. In addition, folate status decreases quickly in this environment, and this study provides evidence that folate requirements may be greater when body iron stores and DNA damage repair responses are elevated.
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Abstract
Elder mistreatment encompasses a range of behaviors including emotional, financial, physical, and sexual abuse, neglect by other individuals, and self-neglect. This article discusses the range of elder mistreatment in community-living older adults, associated factors, and consequences. Although self-neglect is not considered a type of abuse in many research definitions, it is the most commonly reported form of elder mistreatment and is associated with increased morbidity and mortality. The case on which this article is based describes a 70-year-old woman who neglects herself and dies despite multiple contacts with the medical community. Despite significant gaps in research, enough is known to guide clinical practice. This article presents the practical approaches a health care professional can take when a reasonable suspicion of elder mistreatment arises. Public health and interdisciplinary team approaches are needed to manage what is becoming an increasing problem as the number of older adults around the world increases.
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Affiliation(s)
- Laura Mosqueda
- Department of Family Medicine, School of Medicine, University of California, Irvine, 101 The City Dr S, Bldg 200, Ste 512, Rt 81, Orange, CA 92868, USA.
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20
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Serum 25-OH vitamin D concentrations are linked with various clinical aspects in patients with systemic sclerosis: a retrospective cohort study and review of the literature. Autoimmun Rev 2011; 10:490-4. [PMID: 21320645 DOI: 10.1016/j.autrev.2011.02.002] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2011] [Accepted: 01/05/2011] [Indexed: 01/13/2023]
Abstract
Low vitamin D serum concentrations have been reported in several autoimmune conditions. The study's aim was to explore such a relationship in a large multinational population of patients with systemic sclerosis (SSc) and to pursue possible clinical and laboratory correlates with vitamin D concentrations. 327 sera samples of European patients with SSc and 141 samples of compatible healthy controls were studied for vitamin D concentrations using the commercial kit LIAISON 25-OH vitamin D assay (Diasorin). Additionally, clinical parameters including the Rodnan skin score, diffusing lung capacity for carbon monoxide (DLCO), systolic pulmonary artery pressure (sPAP), forced vital capacity (FVC), and nailfold video capillaroscopic, erythrocyte sedimentation rate (ESR), anti-nuclear antibodies (ANA and scl70), rheumatoid factor (RF) were investigated. Vitamin D serum concentration was 13.5 ± 9.0 ng/ml (mean ± standard deviation) in patients with SSc compared to 21.6 ± 9.7 ng/ml in a control group (p<0.001). A negative correlation between patients' age and vitamin D concentration (r = -0.2, p<0.05, n = 96) was observed. An inverse relationship was found between skin involvement and vitamin D serum concentrations; Patients with a Rodnan skin score of 10 or lower (n = 11) had a mean vitamin D concentration of 17.7 ± 10.4 ng/ml compared to patients with a score above 10 (n = 28) 8 ± 10.1 ng/ml (p=0.02, by the Mann-Whitney test). In conclusion, Patients with SSc have significantly lower serum vitamin D concentrations compared to healthy controls; moreover fibrosis of the cutaneous tissue is inversely related to the vitamin D concentration.
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21
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Dong XQ, Simon M, Evans D. Cross-sectional study of the characteristics of reported elder self-neglect in a community-dwelling population: findings from a population-based cohort. Gerontology 2009; 56:325-34. [PMID: 19786733 DOI: 10.1159/000243164] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2008] [Accepted: 04/20/2009] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Elder self-neglect is an important public health issue. However, little is known about the characteristics of self-neglect and its association with social factors among community-dwelling populations. OBJECTIVES (1) To examine the sociodemographic, health-related and psychosocial characteristics of reported elder self-neglect; (2) to examine the association of social network and social engagement with reported self-neglect. METHODS Population-based study conducted from 1993 to 2005 of community-dwelling subjects (n = 9,056) participating in the Chicago Health and Aging Project (CHAP). Subsets of the CHAP subjects (n = 1,812) were identified for suspected self-neglect by the social services agency, which also assessed the severity. This reported group was compared with the unreported group in the CHAP across the sociodemographic, health-related and psychosocial variables. Logistical regressions were used to assess the association of social factors and self-neglect. RESULTS Older age, women, African-Americans, and those with lower education or lower income were more likely to be reported for self-neglect. Those reported for self-neglect were more likely to have lower levels of cognitive and physical function, nutritional status, psychosocial function and a higher number of medical comorbidities. After adjusting for confounders, lower levels of social network and social engagement were significantly associated with an increased risk of reported self-neglect. Among the reported cases of self-neglect, the study found increased trends of older age, women, African-American, lower income, lower cognitive and physical function, lower social engagement and a higher number of chronic medical conditions with self-neglect severity. CONCLUSION Reported self-neglect elders have multiple sociodemographic, health- related and psychosocial characteristics that are different than elders not reported. Lower levels of social network and social engagement were associated with increased risk of self-neglect.
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Affiliation(s)
- Xin-Qi Dong
- Department of Internal Medicine, Rush University Medical Center, Chicago, Ill., USA.
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22
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Zwart SR, Crawford GE, Gillman PL, Kala G, Rodgers AS, Rogers A, Inniss AM, Rice BL, Ericson K, Coburn S, Bourbeau Y, Hudson E, Mathew G, DeKerlegand DE, Sams CF, Heer MA, Paloski WH, Smith SM. Effects of 21 days of bed rest, with or without artificial gravity, on nutritional status of humans. J Appl Physiol (1985) 2009; 107:54-62. [PMID: 19074571 PMCID: PMC4073965 DOI: 10.1152/japplphysiol.91136.2008] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2008] [Accepted: 12/01/2008] [Indexed: 11/22/2022] Open
Abstract
Spaceflight and bed rest models of microgravity have profound effects on physiological systems, including the cardiovascular, musculoskeletal, and immune systems. These effects can be exacerbated by suboptimal nutrient status, and therefore it is critical to monitor nutritional status when evaluating countermeasures to mitigate negative effects of spaceflight. As part of a larger study to investigate the usefulness of artificial gravity as a countermeasure for musculoskeletal and cardiovascular deficits during bed rest, we tested the hypothesis that artificial gravity would have an effect on some aspects of nutritional status. Dietary intake was recorded daily before, during, and after 21 days of bed rest with artificial gravity (n = 8) or bed rest alone (n = 7). We examined body composition, hematology, general blood chemistry, markers of oxidative damage, and blood levels of selected vitamins and minerals before, during, and after the bed rest period. Several indicators of vitamin status changed in response to diet changes: serum alpha- and gamma-tocopherol and urinary 4-pyridoxic acid decreased (P < 0.001) and plasma beta-carotene increased (P < 0.001) in both groups during bed rest compared with before bed rest. A decrease in hematocrit (P < 0.001) after bed rest was accompanied by a decrease in transferrin (P < 0.001), but transferrin receptors were not changed. These data provide evidence that artificial gravity itself does not negatively affect nutritional status during bed rest. Likewise, artificial gravity has no protective effect on nutritional status during bed rest.
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Affiliation(s)
- S. R. Zwart
- Universities Space Research Association, Houston; Enterprise Advisory Services, Inc., Houston; University of Texas Medical Branch, Galveston, Texas; Department of Chemistry, Indiana University-Purdue University Fort Wayne, Fort Wayne, Indiana; JES Tech, Houston; Human Adaptation and Countermeasures Division, National Aeronautics and Space Administration Johnson Space Center, Houston, Texas; and German Aerospace Center-Institute of Aerospace Medicine, Linder Hoehe, Cologne, Germany
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Sachs-Ericsson N, Corsentino E, Cougle JR. Problems meeting basic needs predict cognitive decline in community-dwelling Hispanic older adults. J Aging Health 2009; 21:848-63. [PMID: 19571183 DOI: 10.1177/0898264309340689] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives. Indices of low socioeconomic status (SES) have been found to predict negative health outcomes. However, problems meeting basic needs (e.g., not having enough money for health care, adequate food, etc.) may be a more potent measure of negative health outcomes than other more typically assessed indices of SES, such as income. This article examined the association between problems meeting basic needs and cognitive decline in a sample of community-dwelling Hispanic older adults (N = 1,964). Method. The authors used a prospective design to study the influence of problems meeting basic needs on cognitive functioning. Analyses controlled for demographics, health problems, and depressive symptoms. Results. The authors found problems meeting basic needs to be a more potent predictor of cognitive decline than income. Discussion. Interventions focused on providing older adults with resources for meeting basic needs, such as adequate food and health care, may substantially reduce the subsequent level of stress and health problems in this population.
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Lauder W, Roxburgh M, Harris J, Law J. Developing self-neglect theory: analysis of related and atypical cases of people identified as self-neglecting. J Psychiatr Ment Health Nurs 2009; 16:447-54. [PMID: 19538601 DOI: 10.1111/j.1365-2850.2009.01397.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Self-neglect is a complex, relatively common and as yet not fully understood phenomenon. People who self-neglect often do not undertake those activities which are judged necessary to maintain a socially accepted standard of personal and household hygiene or to maintain their health status. This may be explained by a variety of factors of which psychopathology, culture, social class and poverty all play a role in the construction of this phenomenon. The self-neglect literature overwhelmingly presents professional views and focuses on the most severe cases. This paper explores some core issues in relation to self-neglect theory through in-depth interviews with atypical (related) cases. These cases allow the boundaries of what is and is not self-neglect to be tested. Analysis of these cases suggests that self-neglect remains a useful concept but contains a far wide range of presentations than previously reported.
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Affiliation(s)
- W Lauder
- School of Nursing and Midwifery, University of Stirling, Stirling, UK.
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25
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Paveza G, Vandeweerd C, Laumann E. Elder self-neglect: a discussion of a social typology. J Am Geriatr Soc 2008; 56 Suppl 2:S271-5. [PMID: 19016971 DOI: 10.1111/j.1532-5415.2008.01980.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This article presents a theoretical framework for the study of social and behavioral factors associated with elder self-neglect. The model presented reflects the authors' beliefs that a risk-vulnerability model offers a useful framework from which to study all forms of elder mistreatment, as well as elder self-neglect. This model has particular utility, because it can begin to define the elements of risk and vulnerability that may be addressed using preventative measures as opposed to solely addressing intervention, which is often the case when addressing elder mistreatment and self-neglect. The authors then address a method for using the Consortium for Research in Elder Self-neglect of Texas data as currently constructed and adding to that database to effectively study risks and vulnerabilities in the elder self-neglect population. These additional data would greatly expand the scope of the study. The discussant adds his perspective to the ideas proposed by the authors.
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Affiliation(s)
- Gregory Paveza
- University of South Florida Lakeland, Lakeland, Florida, USA.
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26
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Naik AD, Burnett J, Pickens-Pace S, Dyer CB. Impairment in instrumental activities of daily living and the geriatric syndrome of self-neglect. THE GERONTOLOGIST 2008; 48:388-93. [PMID: 18591364 PMCID: PMC2856595 DOI: 10.1093/geront/48.3.388] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE We sought to characterize self-neglect definitively as a geriatric syndrome by identifying an association with functional impairment. DESIGN AND METHODS We performed a cross-sectional home evaluation of 100 community-living older adults referred by Adult Protective Services for geriatric self-neglect and 100 matched adults from a community geriatrics clinic. We made our assessments by using two manual muscle tests, a timed-gait test, a modified Physical Performance Test (mPPT), and the Kohlman Evaluation of Living Skills (KELS). RESULTS Participants in the self-neglect group had impaired mPPT (p <.077) and KELS (p <.001) scores compared with community-controls. Using analysis of covariance models, we found that self-neglect referral explained a significant proportion of the variance in KELS scores (32%; p <.001) but not in mPPT scores (22%; p =.49). IMPLICATIONS The geriatric syndrome of self-neglect is associated with increased morbidity and mortality and appears to be independently associated with impairments in instrumental activities of daily living. The evaluation and treatment of geriatric self-neglect should be consistent with that of other geriatric syndromes.
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Affiliation(s)
- Aanand D Naik
- Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX 77030, USA
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27
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Smith SM, Zwart SR, Heer M, Lee SMC, Baecker N, Meuche S, Macias BR, Shackelford LC, Schneider S, Hargens AR. WISE-2005: supine treadmill exercise within lower body negative pressure and flywheel resistive exercise as a countermeasure to bed rest-induced bone loss in women during 60-day simulated microgravity. Bone 2008; 42:572-81. [PMID: 18249055 DOI: 10.1016/j.bone.2007.11.015] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2007] [Revised: 11/16/2007] [Accepted: 11/29/2007] [Indexed: 11/19/2022]
Abstract
Bone loss associated with disuse during bed rest (BR), an analog of space flight, can be attenuated by exercise. In previous studies, the efficacy of either aerobic or resistive exercise countermeasures has been examined separately. We hypothesized that a regimen of combined resistive and aerobic exercise during BR would prevent bone resorption and promote bone formation. After a 20-day ambulatory adaptation to controlled confinement and diet, 16 women participated in a 60-day, 6 degrees head-down-tilt BR and were assigned randomly to one of the two groups. Control subjects (CON, n=8) performed no countermeasure. Exercise subjects (EX, n=8) participated in an exercise program during BR, alternating between supine treadmill exercise within lower body negative pressure (3-4 d wk(-1)) and flywheel resistive exercise (2-3 d wk(-1)). By the last week of BR, excretion of helical peptide (CON, 79%+/-44 increase; EX, 64%+/-50, mean+/-SD) and N-terminal cross-linking telopeptide (CON, 51%+/-34; EX, 43%+/-56), markers of bone resorption, were greater than they were before BR in both groups (P<0.05). However, serum concentrations of the bone formation marker procollagen type I N propeptide were greater in EX than CON throughout and after bed rest (P<0.05), while concentrations of the bone formation marker bone alkaline phosphatase tended to be greater in EX than CON. Dual-energy X-ray absorptiometry results indicated that the exercise treatment significantly (P<0.05) attenuated loss of hip and leg bone mineral density in EX compared to CON. The combination of resistive and aerobic exercise did not prevent bone resorption but did promote bone formation, and helped mitigate the net bone loss associated with simulated microgravity.
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Affiliation(s)
- Scott M Smith
- Human Adaptation and Countermeasures Division, National Aeronautics and Space Administration Lyndon B. Johnson Space Center, Houston, TX 77058, USA.
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Abstract
BACKGROUND Vitamin D deficiency is common in elders. However, little is known about the implications of vitamin D deficiency in elder self-neglect. SPECIFIC AIMS To characterize a group of self-neglecting elders with vitamin D deficiency based on clinical, cognitive, and functional status. Participants. Forty-four self-neglecting elders referred by the Adult Protective Services. METHODS Vitamin D status of the self-neglecting elders was based upon serum levels of 25-hydroxyvitamin D (25-OHD). Demographics, cognitive, and functional characteristics of vitamin D deficient self-neglecting elders were described and compared to those without vitamin D deficiency. RESULTS Vitamin D deficiency (25-OHD < 25 nmol/L) was detected in 16 out of 44 self-neglecting elders (36%). Self-neglecting elders with vitamin D deficiency had lower scores in the Physical Performance Test and higher scores in the Kohlman Evaluation of Living Skills, compared with those who were not vitamin D deficient (p = 0.014 and p = 0.018 respectively). CONCLUSIONS Vitamin D deficiency is common in elder self-neglect. Self-neglecting elders with vitamin D deficiency have impaired physical performance and inadequate living skills, which can be potentially improved by treating vitamin D deficiency.
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Abstract
BACKGROUND Research in elder self-neglect has lagged behind that of other forms of mistreatment, despite the fact that self-neglect is the most common allegation reported to Adult Protective Service agencies throughout the US. The lack of a gold standard to measure self-neglect has hampered efforts to study this phenomenon. METHODS Researchers designed the Self-Neglect Severity Scale (SSS) based on interviews with Adult Protective Service workers and a national expert panel. The SSS is based on observation and interview and is administered in the home to include an environmental assessment. It was piloted, extensively field tested and then revised. RESULTS The CREST SSS was developed using survey data and consultation with experts in the field. This instrument utilizes observer ratings, interview responses, and assesses subjects' physical and environmental domains. It also assesses functional status as it relates to health and safety issues. After field and pilot testing, the SSS was finalized and is currently undergoing reliability and validity testing. CONCLUSIONS The CREST SSS was developed as a state scale to provide a common language for describing cases of self-neglect. It is the first self-neglect severity scale available to researchers. If found to be both reliable and valid, it may be used in future intervention studies.
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Abstract
Historically, the view of elder mistreatment in the United States has been similar to that of child abuse and has been detrimental to the understanding of elder mistreatment. Until recently, there was little understanding of the complexity of elder mistreatment and the legal system lacked appropriate laws with which to handle this growing problem. Over the last two decades, legislation, laws, and criminal codes of conduct have been developed to tackle the problem of elder mistreatment. However, little knowledge or understanding of the public health problems and legal implications related to the most common form of elder mistreatment referred to Adult Protective Services (APS), elder self-neglect, is available. The growth of this national problem has expanded the role of the legal system and pushed the development of interdisciplinary research with the intent of defining and understanding the problem of self-neglect and with the ultimate goal of expanding intervention strategies. The Consortium for Research in Elder Self-Neglect of Texas (CREST) is the leader in this field and the pilot study suggests numerous medical and legal implications for both intervention and future research.
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