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Pedersen LT, Ipsen JA, Bruun IH, Egebæk HK, Andersen PT, Viberg B. Association between patient activation level and functional outcomes in older adults with hip fractures. Arch Gerontol Geriatr 2024; 124:105472. [PMID: 38728823 DOI: 10.1016/j.archger.2024.105472] [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: 02/26/2024] [Revised: 04/26/2024] [Accepted: 05/02/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Hip fractures can significantly impact older adults' mobility and function. Effective rehabilitation is crucial to help them regain independence and quality of life. However, little is known about the association between patient activation and hip fracture rehabilitation. This study aims to assess the association between the PAM-13 scores and the level of physical function, mobility, and activities of daily living in older adults following a hip fracture rehabilitation program. METHOD An exploratory outcome study from a cluster-randomized stepped-wedge clinical controlled trial. Two hundred thirty-nine patients were classified into four Patient Activation Measure-Levels (PAM-13) according to their PAM-13 scores, reflecting their confidence and preparedness to manage their health. Level 1 represents the lowest level of confidence. The patient's mobility, function, and daily activities were evaluated at discharge and after 12 and 24 weeks. RESULTS The cohort had a median age of 78; 67% were female, and 50% lived alone. There were no significant differences in demographics between the PAM-Levels. PAM-Level 1 patients had longer hospital stays and lower mobility scores than PAM-Level 4 patients. However, all patients improved over time, and higher initial PAM levels resulted in better outcomes. PAM-Level 1 patients improved in Time Up and Go score from a median score of 54 seconds to 14 seconds at 24 weeks, while PAM-Level 4 patients improved from 26 to 9 seconds. CONCLUSION Our study found an association between PAM levels and functional outcomes in hip fracture rehabilitation. Patients with higher activation levels had better mobility and functional outcomes.
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Affiliation(s)
- Lars Tobiesen Pedersen
- Department of Physical Therapy and Occupational Therapy, Lillebaelt Hospital - University Hospital of Southern Denmark, Kolding, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; Department of Health Education, University College South Denmark Esbjerg, Denmark.
| | - Jonas Ammundsen Ipsen
- Department of Physical Therapy and Occupational Therapy, Lillebaelt Hospital - University Hospital of Southern Denmark, Kolding, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Inge H Bruun
- Department of Physical Therapy and Occupational Therapy, Lillebaelt Hospital - University Hospital of Southern Denmark, Kolding, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Heidi Klakk Egebæk
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, The Capital Region, Denmark; Department of Exercise Epidemiology, Institute for Sports Science and Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Pernille Tanggaard Andersen
- Department of Public Health, Unit for Health Promotion, University of Southern Denmark, Odense & Esbjerg, Denmark
| | - Bjarke Viberg
- Department of Orthopedic Surgery and Traumatology, Lillebaelt Hospital - University Hospital of Southern Denmark, Kolding, Denmark; Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
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Wertman E. Essential New Complexity-Based Themes for Patient-Centered Diagnosis and Treatment of Dementia and Predementia in Older People: Multimorbidity and Multilevel Phenomenology. J Clin Med 2024; 13:4202. [PMID: 39064242 PMCID: PMC11277671 DOI: 10.3390/jcm13144202] [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: 06/10/2024] [Revised: 07/12/2024] [Accepted: 07/13/2024] [Indexed: 07/28/2024] Open
Abstract
Dementia is a highly prevalent condition with devastating clinical and socioeconomic sequela. It is expected to triple in prevalence by 2050. No treatment is currently known to be effective. Symptomatic late-onset dementia and predementia (SLODP) affects 95% of patients with the syndrome. In contrast to trials of pharmacological prevention, no treatment is suggested to remediate or cure these symptomatic patients. SLODP but not young onset dementia is intensely associated with multimorbidity (MUM), including brain-perturbating conditions (BPCs). Recent studies showed that MUM/BPCs have a major role in the pathogenesis of SLODP. Fortunately, most MUM/BPCs are medically treatable, and thus, their treatment may modify and improve SLODP, relieving suffering and reducing its clinical and socioeconomic threats. Regrettably, the complex system features of SLODP impede the diagnosis and treatment of the potentially remediable conditions (PRCs) associated with them, mainly due to failure of pattern recognition and a flawed diagnostic workup. We suggest incorporating two SLODP-specific conceptual themes into the diagnostic workup: MUM/BPC and multilevel phenomenological themes. By doing so, we were able to improve the diagnostic accuracy of SLODP components and optimize detecting and favorably treating PRCs. These revolutionary concepts and their implications for remediability and other parameters are discussed in the paper.
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Affiliation(s)
- Eli Wertman
- Department of Neurology, Hadassah University Hospital, The Hebrew University, Jerusalem 9190500, Israel;
- Section of Neuropsychology, Department of Psychology, The Hebrew University, Jerusalem 9190500, Israel
- Or’ad: Organization for Cognitive and Behavioral Changes in the Elderly, Jerusalem 9458118, Israel
- Merhav Neuropsychogeriatric Clinics, Nehalim 4995000, Israel
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Su D, Liu Y, Su Y, Zhang X, Chan P. Cognitive impairment is a risk factor for decreased physical performance in the elderly. Heliyon 2024; 10:e32132. [PMID: 38867948 PMCID: PMC11168380 DOI: 10.1016/j.heliyon.2024.e32132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 05/21/2024] [Accepted: 05/28/2024] [Indexed: 06/14/2024] Open
Abstract
Background This study aimed to show a 3-year trajectory of physical performance among Chinese elderly in Beijing communities and explore the associations between new adverse events during the 3-year follow-up period and decreased physical performance. Methods A longitudinal observational study included baseline data and transitional information of physical performance from 456 community elders (mean age 67.3 ± 4.9 years, female 43.2 %) at a 3-year follow-up. The Mini-Mental State Examination (MMSE) and the Short Physical Performance Battery (SPPB) were used to measure cognition and physical performance, respectively. The number of chronic diseases, cognitive impairment, malnutrition, depression, knee pain, falls, and frailty were the principal independent variables in multivariate logistic regression analysis. Results The proportion of the elderly with poor physical performance (26.97 %) increased to 42.11 % and the proportion of those with good physical performance (44.96 %) dropped to 30.48 % after the three-year follow-up. As for physical performance transitions, 39.47 % of the elderly progressed to a worsening physical status. After adjustment for covariates, only new onset cognitive impairment (OR: 5.17; 95%CI: 2.01-14.54; P = 0.001) was associated with physical performance deterioration. Conclusion Cognitive impairment is an independent risk factor for decreased physical performance in elderly people. Active interventions targeted at cognitive impairment could help promote healthy aging.
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Affiliation(s)
- Dan Su
- Department of Geriatrics, Liangxiang Hospital of Beijing Fangshan District, Beijing, 102400, China
- Department of Geriatrics, National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital of Capital Medical University, Beijing, 100053, China
| | - Ying Liu
- Department of Neurology, Beijing Shunyi Hospital, Beijing, Beijing, 101300, China
| | - Yangling Su
- Department of Geriatrics, Liangxiang Hospital of Beijing Fangshan District, Beijing, 102400, China
| | - Xiaojun Zhang
- Department of Geriatrics, National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital of Capital Medical University, Beijing, 100053, China
- Department of Internal Medicine, Beijing Massage Hospital, Beijing, 100021, China
| | - Piu Chan
- Department of Geriatrics, National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital of Capital Medical University, Beijing, 100053, China
- Clinical Center for Parkinson's Disease, Parkinson Disease Center of Beijing Institute for Brain Disorders, Beijing, 100053, China
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Communicating Patient Safety Information Through Video and Oral Formats-A Comparison. J Patient Saf 2023; 19:137-142. [PMID: 36729426 DOI: 10.1097/pts.0000000000001086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE One way to decrease adverse events is to increase patient participation in their own care. Sahlgrenska University Hospital has introduced a patient safety advisory, consisting of an animated video and structured oral information. This article investigates how the animated video and structured oral information regarding was perceived by the patients and determines which communication method the patients preferred. METHOD In this study, we compared patients' attitudes toward patient safety information delivered in video or oral format. Data were collected after intervention through a survey consisting of 5 questions. RESULTS One hundred thirty-four patients were recruited to the study. Ninety-two patients either watched the video or received oral information. Forty-two patients were given both oral information and viewed the video. Information received by the patients was rated as good or very good by 90% of those viewing the video and by 100% who received the oral presentation ( P = 0.007). Of the 42 participants who received both formats, 74% preferred the oral presentation ( P < 0.001). CONCLUSIONS The patients thought the patient safety information to be good and beneficial. An informative video can complement the oral information, but not replace, when informing patients about patient safety. Providing patients with information in a manner they prefer may increase patient's involvement in their care and possibly reduce the risk of adverse events.
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Older patients with EGFR mutation-positive non-small cell lung cancer treated with afatinib in clinical practice: A subset analysis of the non-interventional GIDEON study. J Geriatr Oncol 2023; 14:101394. [PMID: 36323612 DOI: 10.1016/j.jgo.2022.10.009] [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: 05/12/2022] [Revised: 08/22/2022] [Accepted: 10/12/2022] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Lung cancer is most common in older patients; despite this, older patients are historically under-represented in clinical studies. Here we present data from GIDEON, a study undertaken in Germany in patients with epidermal growth factor receptor mutation-positive (EGFRm+) non-small cell lung cancer (NSCLC) receiving first-line afatinib. GIDEON enrolled a high proportion of patients aged ≥70 years, providing an opportunity to study afatinib use in older patients. MATERIALS AND METHODS In GIDEON (NCT02047903), a prospective non-interventional study, patients with EGFRm+ NSCLC received first-line afatinib in routine clinical practice until disease progression, death or intolerable adverse events. Key objectives were twelve-month progression-free survival (PFS) rate and objective response rate (ORR). Overall survival (OS) and safety were also assessed. This post hoc analysis explores outcomes of patients grouped by age (≥70 and <70 years). RESULTS In the 152 patients enrolled in GIDEON (69.7% female, 64.5%/22.4%/13.2% with Del19/L858R/other exon 18-21 mutations, 33.6% with brain metastases), the median age was 67 years (range 38-89) and 43.4% were aged ≥70 years. In the ≥70 years age group and the <70 years age group, twelve-month PFS rate was 58.9% and 43.9%, median PFS was 17.2 months and 10.6 months, ORR was 72.0% and 76.5%, twelve-month OS rate was 79.1% and 79.2%, 24-month OS rate was 52.0% and 61.7%, and median OS was 30.4 months and 27.4 months, respectively. In the ≥70 years age group and the <70 years age group, grade ≥3 adverse drug reactions (ADRs) were observed in 34.8% and 40.7% of patients, respectively; the most common were diarrhea (13.6% and 14.0%), acneiform dermatitis (7.6% and 7.0%), stomatitis (1.5% and 4.7%) and maculopapular rash (1.5% and 4.7%). DISCUSSION Patients with EGFRm+ NSCLC aged ≥70 years showed clinical benefit from first-line afatinib with no unexpected safety signals, supporting the use of afatinib in this setting.
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Beltz S, Gloystein S, Litschko T, Laag S, van den Berg N. Multivariate analysis of independent determinants of ADL/IADL and quality of life in the elderly. BMC Geriatr 2022; 22:894. [PMID: 36418975 PMCID: PMC9682836 DOI: 10.1186/s12877-022-03621-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 11/14/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND This study evaluated the determinants of disability and quality of life in elderly people who participated at the multi-centred RubiN project (Regional ununterbrochen betreut im Netz) in Germany. METHODS Baseline data of the subjects aged 70 years and older of the RubiN project were used and only subjects with complete data sets were considered for the ensuing analysis (complete case analysis (CCA)). Disability was examined using the concepts of ADL (activities of daily living) and IADL (instrumental activities of daily living). Subjects exhibiting one or more deficiencies in ADL respectively IADL were considered as ADL respectively IADL disabled. Quality of life was assessed using the WHOQOL-BREF and the WHOQOL-OLD. Applying multivariate analysis, sociodemographic factors, psychosocial characteristics as well as the functional, nutritional and cognitive status were explored as potential determinants of disability and quality of life in the elderly. RESULTS One thousand three hundred seventy-five subjects from the RubiN project exhibited data completeness regarding baseline data. ADL and IADL disability were both associated with the respective other construct of disability, sex, a reduced cognitive and functional status as well as domains of the WHOQOL-BREF. Furthermore, ADL disability was related to social participation, while IADL disability was linked to age, education and social support. Sex, ADL and IADL disability, income, social support and social participation as well as the functional status were predictors of the domain 'Physical Health' (WHOQOL-BREF). The facet 'Social Participation' (WHOQOL-OLD) was affected by both ADL and IADL disability, income, social participation, the nutritional and also the functional status. CONCLUSIONS Several potential determinants of disability and quality of life were identified and confirmed in this study. Attention should be drawn to prevention schemes as many of these determinants appear to be at least partly modifiable.
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Affiliation(s)
- Sebastian Beltz
- grid.5603.0Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald, Greifswald, Germany
| | - Simone Gloystein
- grid.5603.0Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald, Greifswald, Germany
| | - Thomas Litschko
- grid.5603.0Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald, Greifswald, Germany
| | - Sonja Laag
- Department for Product Strategy/Development, BARMER Health Insurance, Wuppertal, Germany
| | - Neeltje van den Berg
- grid.5603.0Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald, Greifswald, Germany
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Dong PTX, Pham VTT, Dinh CT, Le AV, Tran HTH, Nguyen HTL, Hua S, Li SC. Implementation and Evaluation of Clinical Pharmacy Services on Improving Quality of Prescribing in Geriatric Inpatients in Vietnam: An Example in a Low-Resources Setting. Clin Interv Aging 2022; 17:1127-1138. [PMID: 35903286 PMCID: PMC9314755 DOI: 10.2147/cia.s368871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/02/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Geriatric inpatients generally have a high risk of drug-related problems (DRP) in prescribing following hospital admission, which are likely to cause negative clinical consequences. This is particularly evident in developing countries such as Vietnam. Therefore, clinical pharmacy service (CPS) aims to identify and resolve these DRPs to improve the quality use of medicines in the older population following hospital admission. Patients and Methods The study was conducted as a prospective, single-center study implemented at a general public hospital in Hanoi. Patients aged ≥60 years with at least three chronic diseases admitted to the Internal Medicine Department between August 2020 and December 2020 were eligible to be enrolled. A well-trained clinical pharmacist provided a structured CPS to identify any DRP in prescribing for each patient in the study. Clinical pharmacist interventions were then proposed to the attending physicians and documented in the DRP reporting system. Results A total of 255 DRP were identified in 185 patients during the study period. The most frequent types of DRP were underuse (21.2%), dose too high (12.2%), and contraindication (11.8%). There was a very high rate of approval and uptake by the physicians regarding the interventions proposed by the clinical pharmacist (82.4% fully accepted and 12.5% partially accepted). Of the interventions, 73.4% were clinically relevant (pADE score ≥0.1). In general, 9 out of 10 physicians agreed that CPS has significant benefits for both patients and physicians. Conclusion Improving clinical pharmacy services can potentially have a positive impact on the quality of prescribing in elderly inpatients. These services should officially be implemented to optimize the quality use of medicines in this population group in Vietnam.
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Affiliation(s)
- Phuong Thi Xuan Dong
- Department of Clinical Pharmacy, Hanoi University of Pharmacy, Hanoi, Vietnam.,School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - Van Thi Thuy Pham
- Department of Clinical Pharmacy, Hanoi University of Pharmacy, Hanoi, Vietnam.,Department of Pharmacy, Friendship Hospital, Hanoi, Vietnam
| | - Chi Thi Dinh
- Department of Pharmacy, Friendship Hospital, Hanoi, Vietnam
| | - Anh Van Le
- Department of Pharmacy, Friendship Hospital, Hanoi, Vietnam
| | - Ha Thi Hai Tran
- Department of Internal Cardiology, Friendship Hospital, Hanoi, Vietnam
| | | | - Susan Hua
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - Shu Chuen Li
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
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Incidence and Predictive Factors of Functional Decline in Older People Living in Nursing Homes: A Systematic Review. J Am Med Dir Assoc 2022; 23:1815-1825.e9. [DOI: 10.1016/j.jamda.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/26/2022] [Accepted: 05/01/2022] [Indexed: 11/23/2022]
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Wettstein M, Kornadt AE, Wahl HW. Awareness of Age-Related Changes Among Middle-Aged and Older Adults: Longitudinal Trajectories, and the Role of Age Stereotypes and Personality Traits. Front Psychiatry 2022; 13:902909. [PMID: 35693951 PMCID: PMC9174521 DOI: 10.3389/fpsyt.2022.902909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 04/26/2022] [Indexed: 12/03/2022] Open
Abstract
Awareness of Age-Related Change (AARC) describes to what extent people become aware of changes which they attribute to getting older. So far little is known regarding how different AARC dimensions change over time, to what extent these changes in different domains of AARC gains and losses are interrelated, and which predictors account for inter-individual differences in within-person longitudinal trajectories. Specifically, the extent to which individuals perceive age-related gains and losses might be shaped by their chronological age, their personality as well as by their general views on aging (i.e., their age stereotypes). We investigated changes in global and domain-specific AARC gains and losses over about five years in a sample of originally N = 423 participants aged 40 to 98 years at baseline. We analyzed the role of personality traits and age stereotypes for levels and changes of AARC, taking into account participants' age at baseline and controlling for gender, education, and subjective health. Based on longitudinal multilevel regression models, we observed mean-level declines in most AARC gain domains. In contrast, perceived general AARC losses, as well as AARC losses in health and physical functioning, in cognitive functioning and in social-cognitive/socio-emotional functioning remained, on average, stable over time. Baseline scores on AARC gains (global scale) were higher among individuals with higher neuroticism, openness, conscientiousness and more positive age stereotypes. Additionally, the association of higher neuroticism with higher AARC gain scores was stronger among individuals with more positive age stereotypes. Higher neuroticism and more negative age stereotypes also predicted higher baseline scores on AARC losses (global scale). At the same time, higher neuroticism was associated with a steeper decrease in AARC loss perceptions over time. Most of the intercorrelations within the intercepts and within the intra-individual trajectories of the different AARC domains were positive, but small in size. Our findings show the importance of considering trajectories of age-related gains and losses in parallel and across multiple developmental domains when investigating the subjective perception of the aging process. They also suggest that personality traits and general age stereotypes are related with individual experiences of aging.
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Affiliation(s)
- Markus Wettstein
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Psychology, Heidelberg University, Heidelberg, Germany
| | - Anna E. Kornadt
- Department of Cognitive and Behavioral Sciences, University of Luxembourg, Luxembourg, Luxembourg
| | - Hans-Werner Wahl
- Department of Psychology, Heidelberg University, Heidelberg, Germany
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Uche IE, Akinbami AA, Bamiro AR, Suleiman MA, Benjamin A, Kareem OA, Odebiyi AH, Oduniyi AO. Assessment of megaloblastic anemia in geriatrics in Lagos State, Nigeria. THE EGYPTIAN JOURNAL OF HAEMATOLOGY 2022. [DOI: 10.4103/ejh.ejh_64_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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11
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Segmental ureterectomy vs. radical nephroureterectomy in older patients treated for upper tract urothelial carcinoma. Clin Genitourin Cancer 2022; 20:381-387. [DOI: 10.1016/j.clgc.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 12/27/2021] [Accepted: 01/08/2022] [Indexed: 11/23/2022]
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Mental Health and Social Connectedness Across the Adult Lifespan in the Context of the COVID-19 Pandemic. Can J Aging 2021. [DOI: 10.1017/s0714980821000477] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
AbstractThe coronavirus disease (COVID-19) pandemic has had profound consequences on collective mental health and well-being, and yet, older adults appear better off than younger adults. The current study examined mental health impacts of the pandemic across adult age groups in a large sample (n = 5,320) of Canadians using multiple hierarchical regression analyses. Results suggest older adults are experiencing better mental health and more social connectedness relative to younger adults. Loneliness predicted negative mental health outcomes across all age groups, while the negative association between social support and mental health was only significant at average and high levels of loneliness in the 65–69 age group. Results point towards differential mental health impacts of the pandemic across adult age groups and indicate that loneliness and social support may be key intervention targets during the COVID-19 pandemic. Future research should further examine mechanisms of resiliency among older Canadian adults during the pandemic.
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Calderón-Larrañaga A, Hu X, Haaksma M, Rizzuto D, Fratiglioni L, Vetrano DL. Health trajectories after age 60: the role of individual behaviors and the social context. Aging (Albany NY) 2021; 13:19186-19206. [PMID: 34383709 PMCID: PMC8386565 DOI: 10.18632/aging.203407] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 08/02/2021] [Indexed: 11/25/2022]
Abstract
Background: This study aimed to detect health trajectories after age 60, and to explore to what extent individual and social factors may contribute to healthier aging. Methods: Twelve-year health trajectories were identified in subjects from the Swedish National Study on Aging and Care in Kungsholmen (N=3108), integrating five indicators of disease, physical and cognitive function, and disability through nominal response models. Growth mixture models were applied to explore health trajectories in terms of rate and pattern of change. Baseline information about health-related behaviors and the social context was collected through standardized questionnaires. The strength of the associations was estimated using logistic regression, and their impact through population attributable fractions (PAF). Results: Three trajectories were identified grouping 78%, 18%, and 4% of people with respectively increasing rates of health decline. Compared to the best trajectory, subjects in the middle and worst trajectories became functionally dependent 12.0 (95% CI: 11.4-12.6) and 12.1 (95% CI: 11.5-12.7) years earlier, respectively. Insufficient physical activity (OR: 3.38, 95% CI: 2.58-4.42), financial strain (OR: 2.76, 95% CI: 1.77-4.30), <12 years education (OR: 1.53, 95% CI: 1.14-2.04), low social connections (OR: 1.45, 95% CI: 1.09-1.94), low social participation (OR: 1.39, 95% CI: 1.06-1.83) and a body mass index ≥25 (OR: 1.34, 95% CI: 1.03-1.75) were associated with belonging to the middle/worst trajectories. The highest PAFs were observed for insufficient physical activity (27.1%), low education (19.3%) and low social participation (15.9%); a total PAF of 66.1% was obtained. Conclusions: Addressing the social determinants of health in its broadest sense, complementarily considering life-long factors belonging to the socioeconomic, psychosocial, and behavioral dimensions, should be central to any strategy aimed at fostering health in older age.
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Affiliation(s)
- Amaia Calderón-Larrañaga
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Sweden
| | - Xiaonan Hu
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Sweden
| | - Miriam Haaksma
- Department of Public Health and Primary Care, Leiden University Medical Center, The Netherlands
| | - Debora Rizzuto
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Sweden.,Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Sweden.,Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Davide L Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Sweden.,Centro di Medicina dell'Invecchiamento, IRCCS Fondazione Policlinico "A. Gemelli", and Catholic University of Rome, Rome, Italy
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Ansah JP, Chiu CT, Wei-Yan AC, Min TLS, Matchar DB. Trends in functional disability and cognitive impairment among the older adult in China up to 2060: estimates from a dynamic multi-state population model. BMC Geriatr 2021; 21:380. [PMID: 34157986 PMCID: PMC8218480 DOI: 10.1186/s12877-021-02309-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 04/07/2021] [Indexed: 12/02/2022] Open
Abstract
Background Available evidence suggests that cognitive impairment (CI), which leads to deficits in episodic memory, executive functions, visual attention, and language, is associated with difficulties in the capacity to perform activities of daily living. Hence any forecast of the future prevalence of functional disability should account for the likely impact of cognitive impairment on the onset of functional disability. Thus, this research aims to address this gap in literature by projecting the number of older adults in China with functional disability and cognitive impairment while accounting for the impact of cognitive impairment on the onset of functional disability. Methods We developed and validated a dynamic multi-state population model which simulates the population of China and tracks the transition of Chinese older adults (65 years and older) from 2010 to 2060, to and from six health states—(i) active older adults without cognitive impairment, (ii) active older adults with cognitive impairment, (iii) older adults with 1 to 2 ADL limitations, (iv) older adults with cognitive impairment and 1 to 2 ADL limitations, (v) older adults with 3 or more ADL limitations, and (vi) older adults with cognitive impairment and 3 or more ADL limitations. Results From 2015 to 2060, the number of older adults 65 years and older in China is projected to increase, of which the number with impairment (herein referred to as individuals with cognitive impairment and/or activity of daily living limitations) is projected to increase more than fourfold from 17·9 million (17·8–18·0) million in 2015 to 96·2 (95·3–97·1) million by 2060. Among the older adults with impairment, those with ADL limitations only is projected to increase from 3·7 million (3·6–3·7 million) in 2015 to 23·9 million (23·4–24·6 million) by 2060, with an estimated annual increase of 12·2% (12·1–12·3); while that for cognitive impairment only is estimated to increase from 11·4 million (11·3–11·5 million) in 2015 to 47·8 million (47·5–48·2 million) by 2060—this representing an annual growth of 7·07% (7·05–7·09). Conclusion Our findings suggest there will be an increase in demand for intermediate and long-term care services among the older adults with functional disability and cognitive impairment. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02309-4.
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Affiliation(s)
| | - Chi-Tsun Chiu
- Institute of European and American Studies Academia Sinica, Taipei, Taiwan
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15
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Jacobs JM, Marcus EL, Stessman J. Prolonged Mechanical Ventilation: Symptomatology, Well-Being, and Attitudes to Life. J Am Med Dir Assoc 2021; 22:1242-1247. [PMID: 32907755 PMCID: PMC7474963 DOI: 10.1016/j.jamda.2020.07.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/24/2020] [Accepted: 07/24/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Although prolonged mechanical ventilation (PMV) is increasingly common, little is known concerning patient symptom burden or attitudes toward PMV. This study aims to describe the mood, well-being, distressing symptoms, and attitudes toward prolonged ventilation among PMV patients treated either at home or long-term acute care (LTAC). DESIGN An observational study. SETTING AND PARTICIPANTS 62 communicative participants treated with PMV, aged ≥18 years, insurees of a single HMO, treated at home hospital or LTAC specializing in ventilation in Jerusalem. MEASURES Sociodemographic characteristics; chronic conditions; functional status; symptom burden measured by revised Edmonton Symptomatic Assessment System (r-ESAS); attitudes toward PVM. RESULTS Participants were aged 61.7 ± 20.7 years, commonly suffered progressive neuromuscular disease (43.5%) or chronic lung disease (29%), were functionally dependent, treated at home (64.5%) or LTAC (35.5%), and had a mean PMV duration of 36.6 months (interquartile range 10.8-114.1). The 5-item, short Geriatric Depression Scale identified depression among 38% of participants, and was less at home vs LTAC (34% vs 44%, P < .001). Mean revised Edmonton Symptom Assessment System score was 24.5 ± 14.8 (maximum severity = 100), and participants reported severe or distressing symptoms for tiredness (27%/20%), pain (10%/25%), anxiety (16%/14%), depression (9%/21%), drowsiness (12%/17%), shortness of breath (9%/15%), poor appetite (7%/9%), and nausea (0%/10%). Impaired general well-being was reported as severe, moderate, mild, or none among 15%, 40%, 30%, and 15%, respectively. Only 1 patient had advance directives concerning ventilation prior to intubation, and when asked if they had to choose again today, 85% of patients would again opt for ventilation. CONCLUSIONS AND IMPLICATIONS Few PMV patients reported distressing symptoms, and 85% would choose ventilation if asked again. These findings might be useful in clinical practice to assist in decision making concerning prolonged ventilation.
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Affiliation(s)
- Jeremy M Jacobs
- Institute of Geriatric Medicine, Clalit Health Services, Jerusalem, Israel; Department of Geriatrics and Geriatric Rehabilitation, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Institute for Aging Research, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Esther-Lee Marcus
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel; Chronic Ventilator-Dependent Division, Herzog Medical Center, Jerusalem, Israel
| | - Jochanan Stessman
- Institute of Geriatric Medicine, Clalit Health Services, Jerusalem, Israel; Department of Geriatrics and Geriatric Rehabilitation, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Institute for Aging Research, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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16
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Alabraba E, Gomez D. Systematic Review of Treatments for Colorectal Metastases in Elderly Patients to Guide Surveillance Cessation Following Hepatic Resection for Colorectal Liver Metastases. Am J Clin Oncol 2021; 44:210-223. [PMID: 33710135 DOI: 10.1097/coc.0000000000000803] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although included in surveillance programmes for colorectal cancer (CRC) metastases, elderly patients are susceptible to declines in health and quality of life that may render them unsuitable for further surveillance. Deciding when to cease surveillance is challenging. METHODS There are no publications focused on surveillance of elderly patients for CRC metastases. A systematic review of studies reporting treatment outcomes for CRC metastases in elderly patients was performed to assess the risk-benefit balance of the key objectives of surveillance; detecting and treating CRC metastases. RESULTS Sixty-eight eligible studies reported outcomes for surgery and chemotherapy in the elderly. Liver resections and use of chemotherapy, including biologics, are more conservative and have poorer outcomes in the elderly compared with younger patients. Selected studies demonstrated poorer quality-of-life (QoL) following surgery and chemotherapy. Studies of ablation in elderly patients are limited. DISCUSSION The survival benefit of treating CRC metastases with surgery or chemotherapy decreases with advancing age and QoL may decline in the elderly. The relatively lower efficacy and detrimental QoL impact of multimodal therapy options for detected CRC metastases in the elderly questions the benefit of surveillance in some elderly patients. Care of elderly patients should thus be customized based on their preference, formal geriatric assessment, natural life-expectancy, and the perceived risk-benefit balance of treating recurrent CRC metastases. Clinicians may consider surveillance cessation in patients aged 75 years and above if geriatric assessment is unsatisfactory, patients decline surveillance, or patient fitness deteriorates catastrophically.
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Affiliation(s)
- Edward Alabraba
- Department of Hepatobiliary Surgery and Pancreatic Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust
| | - Dhanny Gomez
- Department of Hepatobiliary Surgery and Pancreatic Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust
- NIHR Nottingham Digestive Disease Biomedical Research Unit, University of Nottingham, Nottingham, UK
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Papaioannou AI, Bartziokas K, Hillas G, Fouka E, Dimakou K, Kallieri M, Tsikrika S, Papadaki G, Papathanasiou E, Papaporfyriou A, Apollonatou V, Verykokou G, Mplizou M, Papakosta D, Manali ED, Papiris S, Loukides S. Device use errors among patients with asthma and COPD and the role of training: a real-life study. Postgrad Med 2021; 133:524-529. [PMID: 33689545 DOI: 10.1080/00325481.2021.1902188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background and objectives: Administration of inhaled medication for asthma and COPD is often difficult and incorrect device use is associated with unfavorable outcomes. We aimed to evaluate device use errors in asthma and COPD patients and to associate incorrect use with the patient's characteristics and medical history.Methods: Demographics and medical history were recorded. The use of each prescribed device was evaluated according to predefined steps.Results: 607 patients (49.9% male, median age (IQR) 63 (51, 70) years performed 663 demonstrations (56 patients were using 2 different types of devices). 51.4% were treated for asthma and 48.6% for COPD. 79.6% of demonstrations were performed using DPIs. Errors were documented on 41.2% of demonstrations and were associated with the type of device, p < 0.001. Elderly patients were less frequently using their devices correctly compared to younger patients, 50.8% vs 62.2%, respectively, p = 0.007. Correct demonstrations were more among asthmatics compared to COPD patients 63.1% vs 54.5%, p = 0.024. Incorrect use was associated with more acute exacerbations in the preceding year [median(IQR), 1(0, 2) vs 1(0, 1)], for incorrect and correct use, respectively, p < 0.001. Upon demonstration, 15.5% of patients have never been trained (i.e., undergone actual demonstrations and observation while using their device) by anyone. Errors occurred more frequently among patients who reported not to be trained compared to those who were trained, 67.0% vs 14.6%, respectively, p < 0.001. The commonest error was associated with the inspiration maneuver and accounted for the 48.3% of errors in the DPIs and 53.0% of errors in the MDIs.Conclusion: Device use errors are common and associated with unfavorable outcomes. Trained patients were more likely to use the device correctly.
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Affiliation(s)
| | | | - Georgios Hillas
- 5th Respiratory Medicine Department Sotiria Chest Hospital, Athens, Greece
| | - Evangelia Fouka
- Respiratory Medicine Department, Aristotle University of Thessaloniki, G Papanikolaou Hospital, Thessaloniki, Greece
| | - Katerina Dimakou
- 5th Respiratory Medicine Department Sotiria Chest Hospital, Athens, Greece
| | - Maria Kallieri
- 2 Respiratory Medicine Department, "Attikon" University Hospital, Athens, Greece
| | | | - Georgia Papadaki
- 2 Respiratory Medicine Department, "Attikon" University Hospital, Athens, Greece
| | | | | | - Vasiliki Apollonatou
- 2 Respiratory Medicine Department, "Attikon" University Hospital, Athens, Greece
| | - Galateia Verykokou
- 2 Respiratory Medicine Department, "Attikon" University Hospital, Athens, Greece
| | - Myrto Mplizou
- 2 Respiratory Medicine Department, "Attikon" University Hospital, Athens, Greece
| | - Despina Papakosta
- Respiratory Medicine Department, Aristotle University of Thessaloniki, G Papanikolaou Hospital, Thessaloniki, Greece
| | - Effrosyni D Manali
- 2 Respiratory Medicine Department, "Attikon" University Hospital, Athens, Greece
| | - Spyridon Papiris
- 2 Respiratory Medicine Department, "Attikon" University Hospital, Athens, Greece
| | - Stelios Loukides
- 2 Respiratory Medicine Department, "Attikon" University Hospital, Athens, Greece
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18
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Jacobs JM, Maaravi Y, Stessman J. Optimism and longevity beyond age 85. J Gerontol A Biol Sci Med Sci 2021; 76:1806-1813. [PMID: 33609364 DOI: 10.1093/gerona/glab051] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Optimism is associated with health benefits and improved survival among adults aged >65. Whether or not optimism beyond age 85 continues to confer survival benefits is poorly documented. We examine the hypothesis that being optimistic at ages 85 and 90 is associated with improved survival. METHODS The Jerusalem Longitudinal Study (1990-2020) assessed comorbidity, depression, cognition, social and functional status, and 5-year mortality among a representative community sample, born 1920-1921, at age 85 (n=1096) and age 90 (n=533). Overall optimism (Op-Total) was measured using a validated 7-item score from the Scale of Subjective Wellbeing for Older Persons. The four questions concerning positive future expectations (Op-Future) and three questions concerning positive experiences (Op-Happy) were also analyzed separately. We determined unadjusted mortality Hazards Ratios, and also adjusted for gender, financial difficulty, marital status, educational status, ADL dependence, physical activity, diabetes mellitus, hypertension, ischemic heart disease, cognitive impairment and depression. RESULTS Between ages 85-90 and 90-95 years, 33.2% (364/1096) and 44.3% (236/533) people died respectively. All mean optimism scores declined from age 85 to 90, with males significantly more optimistic than females throughout. All measures of optimism (Op-Total, Op-Future, Op-Happy) at age 85 and 90 were significantly associated with improved 5-year survival from age 85-90 and 90-95 respectively, in both unadjusted and adjusted models. Findings remained unchanged after separately excluding depressed subjects, cognitively impaired subjects, and subjects dying within 6 months from baseline. CONCLUSIONS These finding support the hypothesis that being optimistic continues to confer a survival benefit irrespective of advancing age.
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Affiliation(s)
- Jeremy M Jacobs
- The Jerusalem Institute of Aging Research, Faculty of Medicine, Hebrew University of Jerusalem, Israel.,Department of Geriatric Rehabilitation and the Center for Palliative Care, Hadassah Medical Center, Mt Scopus, Jerusalem, Israel
| | - Yoram Maaravi
- The Jerusalem Institute of Aging Research, Faculty of Medicine, Hebrew University of Jerusalem, Israel.,Department of Geriatric Rehabilitation and the Center for Palliative Care, Hadassah Medical Center, Mt Scopus, Jerusalem, Israel
| | - Jochanan Stessman
- The Jerusalem Institute of Aging Research, Faculty of Medicine, Hebrew University of Jerusalem, Israel.,Department of Geriatric Rehabilitation and the Center for Palliative Care, Hadassah Medical Center, Mt Scopus, Jerusalem, Israel
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Wettstein M, Spuling SM, Cengia A, Nowossadeck S, Tesarz J. Associations of Age and Pain With 9-Year Functional Health Trajectories. GEROPSYCH 2020. [DOI: 10.1024/1662-9647/a000221] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract. We investigated whether information-processing speed and accommodative coping moderate associations of age and pain with 9-year functional health trajectories. Our sample consisted of 5,254 participants of the German Ageing Survey aged 40 years and older ( M = 62.33 years) who participated in up to four measurement occasions. After controlling for sex, chronic diseases, and education, our longitudinal multilevel regression models revealed that the association of older age and higher pain severity with lower functional health was weaker in individuals with higher processing speed. The relationship between pain and functional health was weaker in individuals with higher scores on accommodative coping. Our findings suggest that processing speed and accommodative coping may be important compensatory resources buffering negative associations of age and pain with functional health.
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Affiliation(s)
| | | | - Anja Cengia
- German Centre of Gerontology, Berlin, Germany
| | | | - Jonas Tesarz
- Medical Hospital, Heidelberg University, Heidelberg, Germany
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20
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Effects of Age on Long-Term Functional Recovery in Patients with Stroke. ACTA ACUST UNITED AC 2020; 56:medicina56090451. [PMID: 32906615 PMCID: PMC7558871 DOI: 10.3390/medicina56090451] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 08/28/2020] [Accepted: 09/02/2020] [Indexed: 01/08/2023]
Abstract
Background and objectives: Age might be a determinant that limits functional recovery in patients with stroke. Here, we investigated the effect of age on functional recovery within 30 months after stroke onset. Materials and Methods: This retrospective longitudinal study enrolled 111 patients with first-ever stroke. Functional recovery was assessed at 2 weeks and at 1, 6, and 30 months after stroke onset using the modified Barthel Index (MBI), modified Rankin Score (mRS), functional ambulation category (FAC), muscle strength, and Mini-Mental State Examination (MMSE). A generalized estimating equation analysis was performed. Results: With the MBI, function improved until 6 months after stroke onset in patients aged <70 years and until 1 month after stroke onset in patients ≥70 years. At 30 months after stroke, there was no significant change of MBI in patients aged <70 years, whereas there was a significant decline in older patients. With the mRS and FAC, function improved until 30 months after stroke onset in patients aged <70 years and until 1 month after stroke onset in older patients. Motor deficit, assessed using the Medical Research Council (MRC), improved significantly until 6 months after stroke onset in patients aged <70 years. There was a significant improvement in cognition (assessed using the MMSE) until 6 months after stroke onset in patients aged <70 years and until 1 month after stroke onset in older patients. Conclusions: Long-term functional recovery occurred for up to 30 months after stroke. Patients aged ≥70 years showed functional decline between 6 and 30 months after onset. These findings could be useful when measuring functional recovery after stroke.
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21
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Santoni G, Calderón-Larrañaga A, Vetrano DL, Welmer AK, Orsini N, Fratiglioni L. Geriatric Health Charts for Individual Assessment and Prediction of Care Needs: A Population-Based Prospective Study. J Gerontol A Biol Sci Med Sci 2020; 75:131-138. [PMID: 30517610 PMCID: PMC6909908 DOI: 10.1093/gerona/gly272] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 11/30/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Geriatric health charts that are similar to pediatric growth charts could facilitate monitoring health changes and predicting care needs in older adults. We aimed to validate an existing composite score (Health Assessment Tool [HAT]) and provide provisional age-specific reference curves for the general older population. METHODS Data came from the Swedish National study on Aging and Care in Kungsholmen (N = 3,363 participants aged 60 years and over examined clinically at baseline and 3 years later). HAT was validated by exploring its relationship with health indicators (logistic regression) and comparing its ability to predict care consumption with that of two of its components, morbidity and disability (receiver operating characteristic curve areas). A flowchart was developed to obtain individual-level HAT scores (nominal response method). Sex-specific health charts were derived by graphing seven percentile curves of age-related HAT change (logistic quantile regression). RESULTS HAT scores above the age- and sex-specific median were related to good performance in chair-stand tests (odds ratio [OR] = 2.62, 95% confidence interval [CI]: 2.07-3.31), balance and grip tests (interaction balance grip test, OR = 1.15, 95% CI: 1.05-1.25), and good self-rated health (OR = 2.19, 95% CI: 1.77-2.71). Receiver operating characteristic curve areas (HAT vs number of chronic disorders) were formal care, 0.76 versus 0.58 (p value < .001); informal care, 0.74 versus 0.59 (p value < .001); hospital admission, 0.70 versus 0.66 (p value < .001); primary care visits, 0.71 versus 0.69 (p value > .05); and specialty care visits, 0.62 versus 0.65 (p value < .001). HAT consistently predicted medical and social care service use better than disability. CONCLUSIONS HAT is a valid tool that predicts care consumption well and could be useful in developing geriatric health charts to better monitor health changes in older populations.
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Affiliation(s)
- Giola Santoni
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm
| | - Amaia Calderón-Larrañaga
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden
| | - Davide L Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden.,Department of Geriatrics, Catholic University of Rome, Italy
| | - Anna-Karin Welmer
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden.,Karolinska University Hospital, Solna.,Stockholm Gerontology Research Center, Karolinska Institutet, Stockholm, Sweden
| | - Nicola Orsini
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden.,Stockholm Gerontology Research Center, Karolinska Institutet, Stockholm, Sweden
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Peak expiratory flow, walking speed and survival in older adults: An 18-year longitudinal population-based study. Exp Gerontol 2020; 135:110941. [PMID: 32243991 DOI: 10.1016/j.exger.2020.110941] [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] [Received: 01/15/2020] [Revised: 03/28/2020] [Accepted: 03/28/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Peak expiratory flow (PEF) and walking speed (WS) have been proposed as indicators of robustness and are independent predictors of health-related outcomes. We aimed to investigate how the co-occurrence of respiratory and physical impairments changes as a function of age, and to quantify the association of the combination of low PEF and slow WS on survival in older people. METHODS This prospective study analyzes data from 2656 community-dwelling participants (age ≥ 60 years) from the SNAC-K study. At baseline, we assessed: (1) sociodemographic, lifestyle and medical data; (2) respiratory function, estimated through PEF and expressed as standardized residual (SR) percentile; and (3) WS at usual pace, categorized as no (>1.2 m/s), mild (0.8-1.2 m/s) and moderate-to-severe (<0.8 m/s) walking impairment. Participants' vital status over an 18-year follow-up was derived from registers. The association of different combinations of PEF and WS on median survival time was estimated through Laplace regression adjusted for potential confounders. RESULTS Respiratory and walking impairments co-occurred more frequently with increasing age. Among individuals with PEF SR-percentiles < 10th, the percentage of moderate-to-severe walking impairment was 12.1% in sexagenarians, 35.7% in septuagenarians, and 75-80% in the oldest old. The greatest reduction in median survival time (-5.4 [95%CI: -6.4; -4.4] years, p < 0.001) was observed among people with combined respiratory and moderate-to-severe walking impairments, compared with those with no dysfunctions, who had a median survival time of 17.4 (95%CI: 17.0; 17.8) years. CONCLUSIONS Impaired PEF and WS co-occur more frequently with advancing age, and their co-occurrence is associated with shorter survival.
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Altintas B, Anderson NL, Pitta R, Buckley PS, Bhatia S, Provencher MT, Millett PJ. Repair of Rotator Cuff Tears in the Elderly: Does It Make Sense? A Systematic Review. Am J Sports Med 2020; 48:744-753. [PMID: 31038992 DOI: 10.1177/0363546519834574] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The indications and outcomes for rotator cuff repair (RCR) among patients ≥70 years old are not widely reported. Many active patients in this age range desire a joint-preserving option, and several small series reported successful clinical outcomes after RCR among patients aged ≥70 years. PURPOSE To systematically review the literature on the outcomes of RCR among patients ≥70 years old. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A systematic review of the literature was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The electronic databases of PubMed and Cochrane were used for the literature search. The quality of the included studies was evaluated according to the Coleman Methodology Score. Studies in English evaluating repair of full-thickness rotator cuff tears among patients aged ≥70 years were included. RESULTS Eleven studies were reviewed, including 680 patients (694 shoulders) who were treated with arthroscopic and/or open RCR with a mean follow-up of 24.2 months (range, 12-40.8 months). Forty patients were lost to follow-up, leaving 654 shoulders with outcome data. This age group demonstrated a significant increase in clinical and functional outcomes after RCR with high satisfaction. American Shoulder and Elbow Surgeons scores showed an improvement from 44.2 (range, 35.4-56) preoperatively to 87.9 (range, 84-90.3) postoperatively, while Constant scores improved from 41.7 (range, 22.6-53.6) to 70.8 (range, 58.6-76). Postoperative imaging evaluation was performed on 513 shoulders, revealing a retear rate of 27.1% (139 shoulders). There were 45 retears after open repair and 94 after arthroscopic repair. The difference in retear rate among patients receiving arthroscopic repairs was not significantly different than open repairs (P = .831). Pain according to a visual analog scale improved from 5.5 (range, 4.6-6.4) preoperatively to 1.3 (range, 0.5-2.3) postoperatively. CONCLUSION RCR among patients ≥70 years old shows high clinical success rates with good outcomes and overall excellent pain relief. Although patients in this age group have a high potential for retear or persistent defects on imaging studies, RCR offers a joint-preserving option with significant functional and clinical improvement for the appropriately indicated patient.
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Affiliation(s)
- Burak Altintas
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA.,Department of Orthopaedic Surgery, School of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | | | - Rafael Pitta
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Patrick S Buckley
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
| | - Sanjeev Bhatia
- Department of Orthopaedics, Northwestern Medicine, Warrenville, Illinois, USA
| | - Matthew T Provencher
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
| | - Peter J Millett
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
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Wettstein M, Eich W, Bieber C, Tesarz J. Pain Intensity, Disability, and Quality of Life in Patients with Chronic Low Back Pain: Does Age Matter? PAIN MEDICINE 2019; 20:464-475. [PMID: 29701812 PMCID: PMC6387985 DOI: 10.1093/pm/pny062] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objective Nonspecific chronic low back pain (CLBP) is a frequent medical condition among middle-aged and older adults. Its detrimental consequences for functional ability and quality of life are well known. However, less is known about associations of chronological age with disability and well-being among CLBP patients. Coping with pain may be harder with advancing age due to additional age-associated losses of physical, sensory, and other resources, resulting in higher disability and lower quality of life. Alternatively, older patients may feel less impaired and report higher quality of life than younger patients because the experience of chronic pain may be better anticipated and more “normative” in old age. Methods We investigated an age-heterogeneous sample of 228 CLBP patients (mean age = 59.1 years, SD = 10.2 years, range 41–82 years). Our outcomes were pain intensity, pain disability (as assessed by self-reported activity restrictions and performance-based tests), and measures of quality of life (health-related quality of life: SF-12 physical and mental health; well-being: anxiety, depression, perceived control over life, affective distress). Results Although older patients had higher performance-based disability, they scored higher on mental health and on most measures of well-being than younger patients. Conclusions Our findings provide evidence for a “paradoxical” pattern of age effects in CLBP patients and are thus in line with other studies based on nonclinical samples: Although disability in CLBP patients increases with advancing age, indicators of quality of life are equal or even higher in older patients.
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Affiliation(s)
- Markus Wettstein
- Department of General Internal Medicine and Psychosomatics, Medical Hospital, Heidelberg University, Heidelberg, Germany.,German Centre of Gerontology, Berlin, Germany
| | - Wolfgang Eich
- Department of General Internal Medicine and Psychosomatics, Medical Hospital, Heidelberg University, Heidelberg, Germany
| | - Christiane Bieber
- Department of General Internal Medicine and Psychosomatics, Medical Hospital, Heidelberg University, Heidelberg, Germany
| | - Jonas Tesarz
- Department of General Internal Medicine and Psychosomatics, Medical Hospital, Heidelberg University, Heidelberg, Germany
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Altomare D, Ferrari C, Caroli A, Galluzzi S, Prestia A, van der Flier WM, Ossenkoppele R, Van Berckel B, Barkhof F, Teunissen CE, Wall A, Carter SF, Schöll M, Choo ILH, Grimmer T, Redolfi A, Nordberg A, Scheltens P, Drzezga A, Frisoni GB. Prognostic value of Alzheimer's biomarkers in mild cognitive impairment: the effect of age at onset. J Neurol 2019; 266:2535-2545. [PMID: 31267207 DOI: 10.1007/s00415-019-09441-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 05/16/2019] [Accepted: 06/21/2019] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The aim of this study is to assess the impact of age at onset on the prognostic value of Alzheimer's biomarkers in a large sample of patients with mild cognitive impairment (MCI). METHODS We measured Aβ42, t-tau, hippocampal volume on magnetic resonance imaging (MRI) and cortical metabolism on fluorodeoxyglucose-positron emission tomography (FDG-PET) in 188 MCI patients followed for at least 1 year. We categorised patients into earlier and later onset (EO/LO). Receiver operating characteristic curves and corresponding areas under the curve (AUCs) were performed to assess and compar the biomarker prognostic performances in EO and LO groups. Linear Model was adopted for estimating the time-to-progression in relation with earlier/later onset MCI groups and biomarkers. RESULTS In earlier onset patients, all the assessed biomarkers were able to predict cognitive decline (p < 0.05), with FDG-PET showing the best performance. In later onset patients, all biomarkers but t-tau predicted cognitive decline (p < 0.05). Moreover, FDG-PET alone in earlier onset patients showed a higher prognostic value than the one resulting from the combination of all the biomarkers in later onset patients (earlier onset AUC 0.935 vs later onset AUC 0.753, p < 0.001). Finally, FDG-PET showed a different prognostic value between earlier and later onset patients (p = 0.040) in time-to-progression allowing an estimate of the time free from disease. DISCUSSION FDG-PET may represent the most universal tool for the establishment of a prognosis in MCI patients and may be used for obtaining an onset-related estimate of the time free from disease.
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Affiliation(s)
- Daniele Altomare
- Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, Geneva, Switzerland.,Memory Clinic, University Hospital of Geneva, Geneva, Switzerland
| | - Clarissa Ferrari
- Service of Statistics, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, via Pilastroni 4, 25125, Brescia, Italy.
| | - Anna Caroli
- Medical Imaging Unit, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Samantha Galluzzi
- Laboratory of Alzheimer's Neuroimaging and Epidemiology (LANE), IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Annapaola Prestia
- Laboratory of Alzheimer's Neuroimaging and Epidemiology (LANE), IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Wiesje M van der Flier
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Epidemiology and Biostatistics, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Rik Ossenkoppele
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Bart Van Berckel
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Institute of Neurology, UCL, London, UK.,Institute of Healthcare Engineering, UCL, London, UK
| | - Charlotte E Teunissen
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Anders Wall
- Section of Nuclear Medicine and PET, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Stephen F Carter
- Alzheimer Neurobiology Center, Karolinska Institutet, Stockholm, Sweden.,Wolfson Molecular Imaging Centre, University of Manchester, Manchester, UK
| | - Michael Schöll
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden.,Wallenberg Centre for Molecular and Translational Medicine, Department of Psychiatry and Neurochemistry, University of Gothenburg, Gothenburg, Sweden.,Dementia Research Centre, Department of Neurodegenerative Disease, Queen Square Institute of Neurology, University College London, London, UK
| | - I L Han Choo
- Alzheimer Neurobiology Center, Karolinska Institutet, Stockholm, Sweden.,Department of Neuropsychiatry, School of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Timo Grimmer
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Alberto Redolfi
- Laboratory of Alzheimer's Neuroimaging and Epidemiology (LANE), IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Agneta Nordberg
- Center for Alzheimer Research, Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Aging Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Philip Scheltens
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Alexander Drzezga
- Department of Nuclear Medicine, University of Cologne, Cologne, Germany
| | - Giovanni B Frisoni
- Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, Geneva, Switzerland.,Laboratory of Alzheimer's Neuroimaging and Epidemiology (LANE), IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.,Memory Clinic, University Hospital of Geneva, Geneva, Switzerland
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Lornstad MT, Aarøen M, Bergh S, Benth JŠ, Helvik AS. Prevalence and persistent use of psychotropic drugs in older adults receiving domiciliary care at baseline. BMC Geriatr 2019; 19:119. [PMID: 31023243 PMCID: PMC6485106 DOI: 10.1186/s12877-019-1126-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 04/02/2019] [Indexed: 12/03/2022] Open
Abstract
Background Little is known about the use of psychotropic drugs in older adults receiving domiciliary care. The first aim was to describe the prevalence and persistency of use of psychotropic drugs in older adults (≥ 70 years) with and without dementia receiving domiciliary care. Furthermore, the second aim was to explore factors associated with persistent drug use at two consecutive time-points. Lastly, we aimed to examine if use of psychotropic drugs changed after admission to a nursing home. Methods In total, 1001 community-dwelling older adults receiving domiciliary care at inclusion participated in the study. Information about psychotropic drug use was collected at baseline, after 18 months and after 36 months. The participants’ cognitive function, neuropsychiatric symptoms (NPS) and physical health were assessed at the same assessments. Participants were evaluated for dementia based on all gathered information. Formal level of care (domiciliary care or in a nursing home) was registered at the follow-up assessments. Results Prevalence and persistent use of psychotropic drugs in older adults receiving domiciliary care was high. Participants with dementia more often used antipsychotics and antidepressants than participants without dementia. The majority of the participants using antipsychotic drugs used traditional antipsychotics. Younger age was associated with higher odds for persistent use of antipsychotics and antidepressants, and lower odds for persistent use of sedatives. Severity of NPS was associated with persistent use of antidepressants. The odds for use of antipsychotics and antidepressants were higher in those admitted to a nursing home as compared to the community-dwelling participants at the last follow-up. Conclusion There was a high prevalence and persistency of use of psychotropic drugs. The prevalence of use of traditional antipsychotics was surprisingly high, which is alarming. Monitoring the effect and adverse effects of psychotropic drugs is an important part of the treatment, and discontinuation should be considered when possible due to the odds for severe adverse effects of such drugs in people with dementia. Electronic supplementary material The online version of this article (10.1186/s12877-019-1126-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marie Turmo Lornstad
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Postbox 8905, N-7491, Trondheim, Norway.
| | - Marte Aarøen
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Postbox 8905, N-7491, Trondheim, Norway
| | - Sverre Bergh
- Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway; Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, University of Oslo, Norway; Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway; Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway
| | - Anne-Sofie Helvik
- General Practice Research Unit, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; St Olavs University Hospital, Trondheim, Norway; Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
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Associations of local-area walkability with disparities in residents' walking and car use. Prev Med 2019; 120:126-130. [PMID: 30695718 DOI: 10.1016/j.ypmed.2019.01.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 12/18/2018] [Accepted: 01/24/2019] [Indexed: 11/20/2022]
Abstract
Research has examined spatial distribution of physical activity, mostly focusing on between-area differences by examining associations of area-level walkability measures with physical activity. Within-area distribution is also relevant, since larger disparities in physical activity within an area can contribute to greater inequalities in health. However, associations of within-area disparity in walking and walkability have been examined only at a large geographical scale (city level). This cross-sectional study examined associations of local-area walkability measures with within-area disparities in residents' walking and car use, using data collected in the 2009 South-East Queensland Travel Survey in Australia. For each Statistical Area 2 (SA2), we calculated disparity indices of the duration of walking and car use among participants aged 18-84 years, using Gini coefficients. Linear regression examined associations of the disparity measures with population density, street connectivity, and Walk Score. Analyses were conducted for 196 SA2s, which contained 15,895 participants. Higher walkability was associated with lower levels of disparity in walking and higher levels of disparity in car use, regardless of the measures used. Each one-SD increment in Walk Score was associated with a 0.64 lower SD in walking disparity and a 0.50 higher SD in car-use disparity, after adjusting for covariates. The associations remained significant after further adjusting for car ownership. Higher walkability is known to be associated with more walking and less car use. This study extends previous knowledge by showing that higher local-area walkability can be associated with less inequality in residents' walking and higher diversity in their car use.
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Soleimani R, Shokrgozar S, Fallahi M, Kafi H, Kiani M. An investigation into the prevalence of cognitive impairment and the performance of older adults in Guilan province. J Med Life 2018; 11:247-253. [PMID: 30364719 PMCID: PMC6197520 DOI: 10.25122/jml-2018-0017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Introduction: The escalating rate of old people with a functional impairment in Iran and the weakness of the family support due to the diminishing of family size have increased the demand for long-term care for the elderly with cognitive impairment (CI). Objective: The purpose of this research is to explore the frequency of cognitive impairment in the elderly and its association with their daily functional impairment and disability. Method: This is a cross-sectional and descriptive-analytic study conducted in 2016-2017. The study sample consisted of 393 elderly people who were 60 years old or older who live in of Guilan different counties. Samples were selected by using multi-stage cluster sampling. Subsequently, data were analyzed by using the Chi-square test and correlation and regression analysis conducted in SPSS 22. Results: It was observed that 4.3, 28.6, and 37% of the subjects suffered from severe, moderate, and mild cognitive impairment, respectively. Cognitive impairment had a significant relationship with daily functioning and activities requiring special tools. Moreover, cognitive impairment in women, people with low education, and those over 70 years old was more common, and the difference between them was significant (p <0.001). Also, disability was significantly greater in the elderly with cognitive impairment. Conclusion: Many old people need to be cared for after the appearance of cognitive impairment. Therefore, appropriate screening of cognitive impairments is conducive to early diagnosis and prevention of executive functioning problems.
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Affiliation(s)
- Robabeh Soleimani
- Psychiatry Department, Kavosh Cognitive Behaviour Sciences and Addiction Research Center, Shafa educational - remedial Hospital, Associate Professor, Guilan University of Medical Sciences, Rasht, Iran
| | - Somayeh Shokrgozar
- Psychiatry Department, Kavosh Cognitive Behaviour Sciences and Addiction Research Center, Shafa educational - remedial Hospital, Assistant Professor, Guilan University of Medical Sciences, Rasht, Iran
| | - Mahnaz Fallahi
- Vice-chancellor for health, Guilan University of Medical Sciences, Rasht, Iran
| | - Hashem Kafi
- Guilan University of Medical Sciences, Rasht, Iran
| | - Maryam Kiani
- Guilan University of Medical Sciences, Rasht, Iran
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Deviating from IDSA treatment guidelines for non-purulent skin infections increases the risk of treatment failure in emergency department patients. Epidemiol Infect 2018; 147:e68. [PMID: 30516120 PMCID: PMC6518578 DOI: 10.1017/s0950268818003291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The Infectious Disease Society of America (IDSA) publishes guidelines regularly for the management of skin and soft tissue infections; however, the extent to which practice patterns follow these guidelines and if this can affect treatment failure rates is unknown. We observed the treatment failure rates from a multicentre retrospective ambulatory cohort of adult emergency department patients treated for a non-purulent skin infection. We used multivariable logistic regression to examine the role of IDSA classification and whether adherence to IDSA guidelines reduced treatment failure. A total of 759 ambulatory patients were included in the cohort with 17.4% failing treatment. Among all patients, 56.0% had received treatments matched to the IDSA guidelines with 29.1% over-treated, and 14.9% under-treated based on the guidelines. After adjustment for age, gender, infection location and medical comorbidities, patients with a moderate infection type had three times increased risk of treatment failure (adjusted risk ratio (aRR) 2.98; 95% confidence interval (CI) 1.15–7.74) and two times increased risk with a severe infection type (aRR 2.27; 95% CI 1.25–4.13) compared with mild infection types. Patients who were under-treated based on IDSA guidelines were over two times more likely to fail treatment (aRR 2.65; 95% CI 1.16–6.05) while over-treatment was not associated with treatment failure. Patients ⩾70 years of age had a 56% increased risk of treatment failure (aRR 1.56; 95% CI 1.04–2.33) compared with those <70 years. Following the IDSA guidelines for non-purulent SSTIs may reduce the treatment failure rates; however, older adults still carry an increased risk of treatment failure.
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Vilpert S, Monod S, Jaccard Ruedin H, Maurer J, Trueb L, Yersin B, Büla C. Differences in triage category, priority level and hospitalization rate between young-old and old-old patients visiting the emergency department. BMC Health Serv Res 2018; 18:456. [PMID: 29907110 PMCID: PMC6003168 DOI: 10.1186/s12913-018-3257-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 05/30/2018] [Indexed: 11/18/2022] Open
Abstract
Background Emergency Department (ED) are challenged by the increasing number of visits made by the heterogeneous population of elderly persons. This study aims to 1) compare chief complaints (triage categories) and level of priority; 2) to investigate their association with hospitalization after an ED visit; 3) to explore factors explaining the difference in hospitalization rates among community-dwelling older adults aged 65–84 vs 85+ years. Methods All ED visits of patients age 65 and over that occurred between 2005 and 2010 to the University of Lausanne Medical Center were analyzed. Associations of hospitalization with triage categories and level of priority using regressions were compared between the two age groups. Blinder-Oaxaca decomposition was performed to explore how much age-related differences in prevalence of priority level and triage categories contributed to predicted difference in hospitalization rates across the two age groups. Results Among 39′178 ED visits, 8′812 (22.5%) occurred in 85+ patients. This group had fewer high priority and more low priority conditions than the younger group. Older patients were more frequently triaged in “Trauma” (20.9 vs 15.0%) and “Home care impossible” (10.1% vs 4.2%) categories, and were more frequently hospitalized after their ED visit (69.1% vs 58.5%). Differences in prevalence of triage categories between the two age groups explained a quarter (26%) of the total age-related difference in hospitalization rates, whereas priority level did not play a role. Conclusions Prevalence of priority level and in triage categories differed across the two age groups but only triage categories contributed moderately to explaining the age-related difference in hospitalization rates after the ED visit. Indeed, most of this difference remained unexplained, suggesting that age itself, besides other unmeasured factors, may play a role in explaining the higher hospitalization rate in patients aged 85+ years. Electronic supplementary material The online version of this article (10.1186/s12913-018-3257-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sarah Vilpert
- FORS Swiss Centre of Expertise in Social Sciences, University of Lausanne, Géopolis, 1015, Lausanne, Switzerland.
| | - Stéfanie Monod
- Public Health Department of the Canton of Vaud, Av. des Casernes 2, Lausanne, 1014, Switzerland
| | - Hélène Jaccard Ruedin
- Réseau Santé Nord Broye, Center for Community Geriatrics, Av. des Sciences 1, 1400, Yverdon-les-Bains, Switzerland
| | - Jürgen Maurer
- Department of Economics, University of Lausanne, Internef, 1015, Lausanne, Switzerland
| | - Lionel Trueb
- Service of Emergency Medicine, University of Lausanne Medical Center (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Bertrand Yersin
- Service of Emergency Medicine, University of Lausanne Medical Center (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Christophe Büla
- Service of Geriatric Medicine and Geriatric Rehabilitation, University of Lausanne Medical Center (CHUV), Mont-Paisible 16, 1011, Lausanne, Switzerland
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Wettstein M, Wahl HW, Heyl V. Four-year reciprocal relationships between personality and functional ability in older adults with and without sensory impairment: focus on neuroticism and agreeableness. Aging Ment Health 2018; 22:834-843. [PMID: 28447472 DOI: 10.1080/13607863.2017.1318259] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Personality traits have been found to influence health and functional ability (FA) via multiple pathways. However, personality traits may also change in reaction to constraints in FA, particularly in more vulnerable individuals with high risk of decline in independent functioning in daily life (e.g. older adults with sensory impairment). Therefore, conceptually anchored in the World Health Organization's International Classification of Functioning, Disability and Health (ICF model), this study investigated reciprocal relationships between personality, focusing on neuroticism and agreeableness, and indicators of FA (i.e. activities of daily living and subjective autonomy) as well as the potentially moderating role of sensory impairment status. METHOD The study sample consisted of 387 older adults (mean age at T1: M = 82.50 years, SD = 4.71 years) who were either sensory impaired (SI; i.e. visually or hearing impaired) or sensory unimpaired (UI). A total of 168 individuals were reassessed four years later. RESULTS Depending on sensory status, personality acted both as predictor and as outcome of FA. Neuroticism was more strongly related with later FA outcomes in SI than in UI individuals. FA variables, in turn, were significant predictors of later neuroticism in UI older adults only and of later agreeableness in SI individuals only. CONCLUSION These findings suggest that the late-life personality-FA interplay needs to be considered bidirectional, and the direction of associations varies systematically as a function of sensory impairment status.
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Affiliation(s)
- Markus Wettstein
- a Department of Psychological Aging Research , Heidelberg University , Germany
| | - Hans-Werner Wahl
- a Department of Psychological Aging Research , Heidelberg University , Germany
| | - Vera Heyl
- b Institute of Special Education, University of Education , Heidelberg , Germany
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Bolano D, Berchtold A, Bürge E. The Heterogeneity of Disability Trajectories in Later Life: Dynamics of Activities of Daily Living Performance Among Nursing Home Residents. J Aging Health 2018; 31:1315-1336. [DOI: 10.1177/0898264318776071] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: This study investigated the variability in activities of daily living (ADL) trajectories among 6,155 nursing home residents using unique and rich observational data. Method: The impairment in ADL performance was considered as a dynamic process in a multi-state framework. Using an innovative mixture model, such states were not defined a priori but inferred from the data. Results: The process of change in functional health differed among residents. We identified four latent regimes: stability or slight deterioration, relevant change, variability, and recovery. Impaired body functions and poor physical performance were main risk factors associated with degradation in functional health. Discussion: The evolution of disability in later life is not completely gradual or homogeneous. Steep deterioration in functional health can be followed by periods of stability or even recovery. The current condition can be used to successfully predict the evolution of ADL allowing to set and target different care priorities and practices.
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Affiliation(s)
| | | | - Elisabeth Bürge
- University of Applied Sciences, Western Switzerland, Geneva, Switzerland
- Deceased on June 8, 2015
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Foscolou A, Magriplis E, Tyrovolas S, Soulis G, Bountziouka V, Mariolis A, Piscopo S, Valacchi G, Anastasiou F, Gotsis E, Metallinos G, Tyrovola D, Polystipioti A, Polychronopoulos E, Matalas AL, Lionis C, Zeimbekis A, Tur JA, Sidossis LS, Panagiotakos D. Lifestyle determinants of healthy ageing in a Mediterranean population: The multinational MEDIS study. Exp Gerontol 2018; 110:35-41. [PMID: 29763722 DOI: 10.1016/j.exger.2018.05.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 04/25/2018] [Accepted: 05/11/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND To evaluate modifiable, lifestyle risk factors of cardiovascular disease (CVD) among older adults, across ageing, in the Mediterranean area. METHODS During 2005-2017, 3131 individuals from 26 Mediterranean islands of 5 countries, ≥65 years of age, were voluntarily enrolled. Anthropometrical, clinical and socio-demographic characteristics, dietary habits, lifestyle parameters were measured through standard procedures. Analyses were performed by year and across consecutive age groups of the participants. RESULTS A decrease in the prevalence of current smoking (p < 0.001), engagement in physical activities (p = 0.001) and participation in social events (p = 0.001) for every year increase in age was found. Moderate alcohol drinking increased through ageing (p = 0.008), whereas adherence to Mediterranean diet remained stable, but adequate (p = 0.90). Trend analysis also revealed that a quadratic (U-shape) function better characterized the association between ageing and total cardiometabolic risk factors burden (p for trend <0.001). CONCLUSIONS The gaps in the understanding of factors affecting longevity and healthy ageing remain; public health authorities and stakeholders should focus on the lifestyle determinants of healthy ageing, that seems to be an effective mean for improving older peoples' health.
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Affiliation(s)
- Alexandra Foscolou
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Emmanuella Magriplis
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Stefanos Tyrovolas
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece; Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona, Spain
| | - George Soulis
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Vassiliki Bountziouka
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Anargiros Mariolis
- Health Center of Areopolis, General Hospital of Sparta, Aeropolis, Greece
| | - Suzanne Piscopo
- University of Malta, Nutrition, Family and Consumer Studies Office, Msida, Malta
| | - Giuseppe Valacchi
- Department of Life Sciences and Biotechnology, University of Ferrara, Ferrara, Italy
| | - Foteini Anastasiou
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Efthimios Gotsis
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - George Metallinos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Dimitra Tyrovola
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Anna Polystipioti
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Evangelos Polychronopoulos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Antonia-Leda Matalas
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Christos Lionis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Akis Zeimbekis
- Health Center of Kalloni, General Hospital of Mitilini, Mitilini, Greece
| | - Josep-Antoni Tur
- Research Group on Community Nutrition and Oxidative Stress, Universitat de les Illes Balears & CIBERobn, Guillem Colom Bldg, Campus, E-07122 Palma de Mallorca, Spain
| | - Labros S Sidossis
- Department of Kinesiology and Health, School of Arts and Sciences, Rutgers University, NJ, USA
| | - Demosthenes Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece; Department of Kinesiology and Health, School of Arts and Sciences, Rutgers University, NJ, USA.
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Social Context and Geographic Space: An Ecological Study about Hospitalizations of Older Persons. Value Health Reg Issues 2018; 17:8-13. [PMID: 29544112 DOI: 10.1016/j.vhri.2017.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 10/28/2017] [Accepted: 12/01/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To identify the diseases that lead older persons to hospitalizations in the public health system in the state of Rio de Janeiro and, through a study of spatial distribution among hospitalization rates of the municipal districts, discuss the social contexts involved in the hospitalization of the elderly. METHODS An ecological cross-sectional study using secondary data from the Brazilian hospital information system from the period 2009 to 2015 was performed. The hospitalization rates of people 60 years and older, residing in 92 municipalities in the state of Rio de Janeiro, were calculated. The municipal districts were grouped according to the similarity of such rates using K-means nonhierarchical clustering analysis. RESULTS Diseases of the circulatory and respiratory systems, endocrine disorders, illnesses of the genitourinary system or the digestive tract, and certain infectious and parasitic diseases were the most discriminatory diseases for cluster composition. The first cluster, the municipal districts with the lowest hospitalization rates, which were more urbanized and had greater access to social and health services, was named Access and Inclusion. The second group, which had the highest hospitalization rates, was named Isolation and Vulnerability. CONCLUSIONS The primary care-sensitive conditions are the main causes of hospitalization of the elderly in the state, with greater intensity in the municipalities that are geographically rugged and remote. These outcomes reinforce the importance of valuing geographical knowledge, the guidelines of the unified health system concerning equity and regionalization, and the determinants and social determinations involved in the process of health and disease.
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Jacobs JM, Hammerman-Rozenberg A, Stessman J. Frequency of Leaving the House and Mortality from Age 70 to 95. J Am Geriatr Soc 2017; 66:106-112. [PMID: 29164595 DOI: 10.1111/jgs.15148] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine the association between frequency of leaving the house and mortality. DESIGN Prospective follow-up of an age-homogenous, representative, community-dwelling birth cohort (born 1920-21) from the Jerusalem Longitudinal Study (1990-2015). SETTING Home. PARTICIPANTS Individuals aged 70 (n = 593), 78 (n = 973), 85 (n = 1164), and 90 (n = 645), examined in 1990, 1998, 2005, and 2010, respectively. MEASUREMENTS Frequency of leaving the house, defined as daily (6-7/week), often (2-5/week), and rarely (≤1/week); geriatric assessment; all-cause mortality (2010-15). Kaplan-Meier survival charts and proportional hazards models adjusted for social (sex, marital status, financial status, loneliness), functional (sex, self-rated health, fatigue, depression, physical activity, activity of daily living difficulty), and medical (sex, chronic pain, visual impairment, hearing impairment, diabetes mellitus, hypertension, ischemic heart disease, chronic kidney disease) covariates. RESULTS At ages 70, 78, 85, and 90, frequency of going out daily was 87.0%, 80.6%, 65.6%, and 48.4%; often was 6.4%, 9.5%, 17.4%, and 11.3%; and rarely was 6.6%, 10.0%, 17.0%, and 40.3% respectively. Decreasing frequency of going out was associated with negative social, functional, and medical characteristics. Survival rates were lowest among those leaving rarely and highest among those going out daily throughout follow-up. Similarly, compared with rarely leaving the house, unadjusted mortality hazard ratios (HRs) were lowest among subjects leaving daily and remained significant after adjustment for social, functional and medical covariates. Among subjects leaving often, unadjusted HRs showed a similar effect of smaller magnitude, with attenuation of significance after adjustment in certain models. Findings were unchanged after excluding subjects dying within 6 months of follow-up. CONCLUSION In community-dwelling elderly adults aged 70 to 90, leaving the house daily was associated with lower mortality risk, independent of social, functional, or medical status.
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Affiliation(s)
- Jeremy M Jacobs
- Jerusalem Institute of Aging Research, Hadassah-Hebrew University Medical Center, and Hebrew University-Hadassah Medical School, Jerusalem, Israel.,Department of Geriatrics and Rehabilitation, Hadassah-Hebrew University Medical Center, and Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Aliza Hammerman-Rozenberg
- Jerusalem Institute of Aging Research, Hadassah-Hebrew University Medical Center, and Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Jochanan Stessman
- Jerusalem Institute of Aging Research, Hadassah-Hebrew University Medical Center, and Hebrew University-Hadassah Medical School, Jerusalem, Israel.,Department of Geriatrics and Rehabilitation, Hadassah-Hebrew University Medical Center, and Hebrew University-Hadassah Medical School, Jerusalem, Israel
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Santoni G, Marengoni A, Calderón-Larrañaga A, Angleman S, Rizzuto D, Welmer AK, Mangialasche F, Orsini N, Fratiglioni L. Defining Health Trajectories in Older Adults With Five Clinical Indicators. J Gerontol A Biol Sci Med Sci 2017; 72:1123-1129. [PMID: 28329788 PMCID: PMC5861965 DOI: 10.1093/gerona/glw204] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 09/23/2016] [Indexed: 11/13/2022] Open
Abstract
Background: People age differently, challenging the identification of those more at risk of rapid health deterioration. This study aimed to explore the heterogeneity in the health of older adults by using five clinical indicators to detect age-related variation and individual health trajectories over time. Methods: Health of 3,363 people aged 60+ from the Swedish National study on Aging and Care-Kungsholmen (SNAC-K) assessed at baseline and at 3- and 6-year follow-ups. Number of chronic diseases, physical and cognitive performance, personal and instrumental activities of daily living were integrated in a health assessment tool (HAT). Interindividual health differences at baseline and follow-ups were assessed with logistic quantile regression. Intraindividual health trajectories were traced with quantile mixed-effect models. Results: The HAT score ranges from 0 (poor health) to 10 (good health); each score corresponds to a specific clinical profile. HAT was reliable over time and accurately predicted adverse health outcomes (receiver-operating characteristic areas: hospitalization = 0.78; 95% confidence interval = 0.74–0.81; mortality = 0.85; 95% confidence interval = 0.83–0.87; similar areas obtained for gait speed). Before age 85, at least 90% of participants were free of severe disability, and at least 50% were functionally independent despite chronic disorders. Age- and sex-related variation and high heterogeneity in health were detected at baseline and confirmed by intraindividual health trajectories. Conclusions: This study provides a positive picture of the health status of people 60+. Despite the complexity and heterogeneity of health in this age group, we could identify age- and sex-specific health trajectories using an integrated HAT. HAT is potentially useful in clinical practice and public health interventions.
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Affiliation(s)
- Giola Santoni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, and Stockholm University, Sweden
| | - Alessandra Marengoni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, and Stockholm University, Sweden.,Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Amaia Calderón-Larrañaga
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, and Stockholm University, Sweden.,EpiChron Research Group on Chronic Diseases, Aragon Health Sciences Institute, Sweden
| | - Sara Angleman
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, and Stockholm University, Sweden
| | - Debora Rizzuto
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, and Stockholm University, Sweden
| | - Anna-Karin Welmer
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, and Stockholm University, Sweden.,Stockholm Gerontology Research Center, Sweden
| | - Francesca Mangialasche
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, and Stockholm University, Sweden
| | - Nicola Orsini
- Department of Public Health Sciences, Karolinska Institutet, Solna, Sweden
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, and Stockholm University, Sweden.,Stockholm Gerontology Research Center, Sweden
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Paque K, Goossens K, Elseviers M, Van Bogaert P, Dilles T. Autonomy and social functioning of recently admitted nursing home residents. Aging Ment Health 2017; 21:910-916. [PMID: 27177229 DOI: 10.1080/13607863.2016.1181711] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES This paper examines recently admitted nursing home residents' practical autonomy, their remaining social environment and their social functioning. METHOD In a cross-sectional design, 391 newly admitted residents of 67 nursing homes participated. All respondents were ≥65 years old, had mini-mental state examination ≥18 and were living in the nursing home for at least 1 month. Data were collected using a structured questionnaire and validated measuring tools. RESULTS The mean age was 84, 64% were female, 23% had a partner, 80% children, 75% grandchildren and 59% siblings. The mean social functioning score was 3/9 (or 33%) and the autonomy and importance of autonomy score 6/9 (or 67%). More autonomy was observed when residents could perform activities of daily living more independently, and cognitive functioning, quality of life and social functioning were high. Residents with depressive feelings scored lower on autonomy and social functioning compared to those without depressive feelings. Having siblings and the frequency of visits positively correlated with social functioning. In turn, social functioning correlated positively with quality of life. Moreover, a higher score on social functioning lowered the probability of depression. CONCLUSION Autonomy or self-determination and maintaining remaining social relationships were considered to be important by the new residents. The remaining social environment, social functioning, quality of life, autonomy and depressive feelings influenced each other, but the cause--effect relation was not clear.
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Affiliation(s)
- Kristel Paque
- a Faculty of Medicine and Health Sciences, Department of Nursing Science , Centre For Research and Innovation in Care (CRIC), University of Antwerp , Wilrijk , Belgium.,d VTI Institute of Nursing , Hasselt , Belgium
| | | | - Monique Elseviers
- a Faculty of Medicine and Health Sciences, Department of Nursing Science , Centre For Research and Innovation in Care (CRIC), University of Antwerp , Wilrijk , Belgium.,c Heymans Institute of Pharmacology , University of Ghent , Ghent , Belgium
| | - Peter Van Bogaert
- a Faculty of Medicine and Health Sciences, Department of Nursing Science , Centre For Research and Innovation in Care (CRIC), University of Antwerp , Wilrijk , Belgium
| | - Tinne Dilles
- a Faculty of Medicine and Health Sciences, Department of Nursing Science , Centre For Research and Innovation in Care (CRIC), University of Antwerp , Wilrijk , Belgium.,b Department of Nursing and Midwifery , Thomas More University College , Lier , Belgium
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Nyman SR, Innes A, Heward M. Social care and support needs of community-dwelling people with dementia and concurrent visual impairment. Aging Ment Health 2017; 21:961-967. [PMID: 27215277 DOI: 10.1080/13607863.2016.1186151] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES This study explored the social care and support needs of people with dementia and visual impairment, and the barriers and facilitators for meeting these needs. METHOD Twenty-six semi-structured interviews were conducted: 21 joint and 5 individual interviews with the person with dementia and visual impairment (n=4) or their family/paid carer (n=1). Interviews were analysed thematically. RESULTS Three themes are presented. (1) Social care needs: having dementia can reduce an individual's ability to cope with their visual impairment, and lead to increased dependency and reduced daily stimulation. (2) Barriers to using technology to meet social care needs: difficulties were reported with learning to use unfamiliar technology and the cost of visual impairment aids, and for some, the presence of dementia made visual impairment aids unusable and vice versa. (3) Familiarity as a facilitator for meeting social care needs: living at home or taking furnishings and ornaments into a new home facilitated independence, and continuity of paid carers/volunteers facilitated the caring relationship between the individual and staff/volunteer. CONCLUSION Care workers will better serve older people if they are aware of the social care and support needs that arise from having both dementia and visual impairment.
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Affiliation(s)
- Samuel Robert Nyman
- a Psychology Department, Faculty of Science and Technology , Bournemouth University , Poole , UK.,b Bournemouth University Dementia Institute, Bournemouth University , Poole , UK
| | - Anthea Innes
- b Bournemouth University Dementia Institute, Bournemouth University , Poole , UK
| | - Michelle Heward
- b Bournemouth University Dementia Institute, Bournemouth University , Poole , UK
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The association between personal income and aging: A population-based 13-year longitudinal study. Arch Gerontol Geriatr 2017; 70:76-83. [DOI: 10.1016/j.archger.2017.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 12/23/2016] [Accepted: 01/02/2017] [Indexed: 11/22/2022]
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Wettstein M, Tauber B, Wahl HW, Frankenberg C. 12-Year Associations of Health with Personality in the Second Half of Life. GEROPSYCH 2017. [DOI: 10.1024/1662-9647/a000162] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Abstract. We examined longitudinal associations between personality, objective (physician-rated) and self-rated health over 12 years in two German cohorts (midlife cohort, born 1950/52, nT0 = 502; late-life cohort, born 1930/32, nT0 = 500) from the Interdisciplinary Longitudinal Study of Adult Development (ILSE). Based on cross-lagged panel design analyses controlling for sex, education, depression, and cognitive abilities, we found that after 12 years better baseline objective health predicted lower Neuroticism and higher Agreeableness, whereas baseline Extraversion and Conscientiousness were positive predictors of later self-rated health. Our findings thus illustrate that the direction of longitudinal personality-health associations is dependent on whether objective or self-rated health is considered, whereas relations do not seem to be considerably different in midlife vs. in old age.
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Affiliation(s)
- Markus Wettstein
- Department of Psychological Aging Research, Heidelberg University, Germany
| | - Benjamin Tauber
- Department of Psychological Aging Research, Heidelberg University, Germany
| | - Hans-Werner Wahl
- Department of Psychological Aging Research, Heidelberg University, Germany
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Stessman J, Bursztyn M, Gershinsky Y, Hammerman-Rozenberg A, Jacobs JM. Hypertension and Its Treatment at Age 90 Years: Is There an Association with 5-Year Mortality? J Am Med Dir Assoc 2017; 18:277.e13-277.e19. [DOI: 10.1016/j.jamda.2016.12.076] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 12/23/2016] [Indexed: 10/20/2022]
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Stessman J, Rottenberg Y, Fischer M, Hammerman-Rozenberg A, Jacobs JM. Handgrip Strength in Old and Very Old Adults: Mood, Cognition, Function, and Mortality. J Am Geriatr Soc 2017; 65:526-532. [PMID: 28102890 DOI: 10.1111/jgs.14509] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine the trajectory of handgrip strength (HGS) from age 70 to 90 and its association with mood, cognition, functional status, and mortality. DESIGN Prospective follow-up of an age-homogenous representative community-dwelling cohort (born 1920-21) in the Jerusalem Longitudinal Cohort Study (1990-2015). SETTING Home-based assessment. PARTICIPANTS Subjects aged 70 (n = 327), 78 (n = 384), 85 (n = 1187), and 90 (n = 406), examined in 1990, 1998, 2005, and 2010, respectively. MEASUREMENTS Handgrip strength (kg) (dynamometer), low HGS defined as sex-specific lowest quartile grip; geriatric assessment; all-cause mortality (1990-2015). RESULTS Mean HGS declined between age 70 and 90 from 21.3 ± 7.2 to 11.5 ± 5.6 kg in women and from 35.3 ± 8.4 to 19.5 ± 8.2 kg in men. Cross-sectional associations were observed between low HGS and poor functional measures (age 70-90), lower educational and financial status, smoking, and diabetes mellitus (ages 78-90). After adjustment for baseline education, self-rated health, physical activity, diabetes mellitus, depression, and cognition, low HGS predicted subsequent activity of daily living dependence from age 78 to 85 (odds ratio (OR) = 2.68, 95% confidence interval (CI) = 1.04-6.89) and 85 to 90 (OR = 2.31, 95% CI = 1.01-5.30), whereas the adjusted ORs for activities of daily living difficulty and depression failed to achieve significance. HGS did not predict subsequent cognitive decline. Survival rates were significantly lower in participants with low HGS (Quartile 1) than in those with normal HGS (Quartiles 2, 3, 4) throughout follow-up from ages 78 to 85, 85 to 90, and 90 to 95. Similarly, after adjusting for sex, education, self-rated health, body mass index, hypertension, diabetes mellitus, ischemic heart disease, and smoking, a low HGS was associated with significantly higher mortality. CONCLUSIONS Mean HGS declined progressively with age, and participants in the lowest age-specific quartile of HGS had a higher risk of subsequent functional decline and mortality.
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Affiliation(s)
- Jochanan Stessman
- Jerusalem Institute of Aging Research, Hadassah-Hebrew University Medical Center and Hebrew University-Hadassah Medical School, Jerusalem, Israel.,Department of Geriatrics and Rehabilitation, Hadassah-Hebrew University Medical Center and Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Yakir Rottenberg
- Jerusalem Institute of Aging Research, Hadassah-Hebrew University Medical Center and Hebrew University-Hadassah Medical School, Jerusalem, Israel.,Department of Oncology, Hadassah-Hebrew University Medical Center and Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Matan Fischer
- Jerusalem Institute of Aging Research, Hadassah-Hebrew University Medical Center and Hebrew University-Hadassah Medical School, Jerusalem, Israel.,Department of Internal Medicine, Hadassah-Hebrew University Medical Center and Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Aliza Hammerman-Rozenberg
- Jerusalem Institute of Aging Research, Hadassah-Hebrew University Medical Center and Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Jeremy M Jacobs
- Jerusalem Institute of Aging Research, Hadassah-Hebrew University Medical Center and Hebrew University-Hadassah Medical School, Jerusalem, Israel.,Department of Geriatrics and Rehabilitation, Hadassah-Hebrew University Medical Center and Hebrew University-Hadassah Medical School, Jerusalem, Israel
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Abstract
BACKGROUND Negotiating stairs is identified as a challenging task by older people, and using a handrail to climb stairs is a compensatory gait strategy to overcome mobility difficulties. We examine the association between handrail use to climb stairs at increasing ages, and long term survival. METHODS Data were collected by the Jerusalem Longitudinal Study, which is a prospective study of a representative sample from the 1920-1921 birth-cohort living in West Jerusalem. Comprehensive assessment at home in 1990, 1998, and 2005, at ages 70 (n=446), 78 (n=897), and 85 (n=1041) included direct questioning concerning handrail use for climbing stairs. Mortality data were collected from age 70-90. RESULTS The frequency of handrail use to climb stairs at ages 70, 78, 85 years was 23.1% (n=103/446), 41.0% (n=368/897), and 86.7% (n=903/1041) respectively. Handrail use was associated throughout follow-up with a consistent pattern of negative demographic, functional and medical parameters. Between ages 70-78, 70-90, 78-85, 78-90, and 85-90, survival was significantly lower among subjects using a handrail, with unadjusted mortality Hazard Ratios of HR 1.57 (95%CI, 1.01-2.42), HR 1.65 (95%CI, 1.27-2.14), HR 1.78 (95%CI, 1.41-2.25), HR 1.71 (95%CI, 1.41-2.06), and HR 1.53 (95%CI, 1.01-2.33) respectively. HR's remained significant at all ages after adjusting for sociodemographic factors (gender, education, marital, and financial status), and common medical conditions (ischemic heart disease, hypertension, diabetes, chronic pain), as well as between ages 78-85 and 78-90 after adjusting for functional covariables (self-rated health, physical activity, depression, BMI and ADL difficulties). CONCLUSION Using a handrail to climb stairs is increasingly common with rising age, was associated with a negative profile of health parameters and is associated with subsequent mortality.
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Affiliation(s)
- J Stessman
- Professor Jochanan Stessman, Institute of Aging Research, Department of Geriatrics and Rehabilitation, Hadassah Hebrew-University Medical Center, Mt. Scopus. P.O. Box 24035, Jerusalem 91240, Israel. E-mail: , Tel: 972-2-5844474, Fax: 972-2-5810918
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Lin CM, Chang YJ, Liu CK, Yu CS, Lu HHS. First-ever ischemic stroke in elderly patients: predictors of functional outcome following carotid artery stenting. Clin Interv Aging 2016; 11:985-95. [PMID: 27555753 PMCID: PMC4968667 DOI: 10.2147/cia.s111637] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Age is an important risk factor for stroke, and carotid artery stenosis is the primary cause of first-ever ischemic stroke. Timely intervention with stenting procedures can effectively prevent secondary stroke; however, the impact of stenting on various periprocedural physical functionalities has never been thoroughly investigated. The primary aim of this study was to investigate whether prestenting characteristics were associated with long-term functional outcomes in patients presenting with first-ever ischemic stroke. The secondary aim was to investigate whether patient age was an important factor in outcomes following stenting, measured by the modified Rankin scale (mRS). In total, 144 consecutive patients with first-ever ischemic stroke who underwent carotid artery stenting from January 2010 to November 2014 were included. Clinical data were obtained by review of medical records. The Barthel index (BI) and mRS were used to assess disability before stenting and at 12-month follow-up. In total, 72/144 patients showed improvement (mRS[+]), 71 showed stationary and one showed deterioration in condition (mRS[-]). The prestenting parameters, ratio of cerebral blood volume (1.41 vs 1.2 for mRS[-] vs mRS[+]), BI (75 vs 85), and high-sensitivity C-reactive protein (hsCRP 5.0 vs 3.99), differed significantly between the two outcome groups (P<0.05). The internal carotid artery/common carotid artery ratio (P=0.011), BI (P=0.019), ipsilateral internal carotid artery resistance index (P=0.003), and HbA1c (P=0.039) were all factors significantly associated with patient age group. There was no significant association between age and poststenting outcome measured by mRS with 57% of patients in the ≥75 years age group showing mRS(-) and 43% showing mRS(+) (P=0.371). Our findings indicate that in our elderly patient series, carotid artery stenting may benefit a significant proportion of carotid stenotic patients regardless of age. Ratio of cerebral blood volume, BI, and admission hsCRP could serve as important predictors of mRS improvement and may facilitate differentiation of patients at baseline.
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Affiliation(s)
- Chih-Ming Lin
- Department of Neurology, Stroke Center, Changhua Christian Hospital, Changhua; Department of Biological Science and Technology, National Chiao Tung University, Hsinchu
| | - Yu-Jun Chang
- Epidemiology and Biostatistics Center, Changhua Christian Hospital, Changhua
| | - Chi-Kuang Liu
- Department of Medical Imaging, Changhua Christian Hospital, Changhua
| | - Cheng-Sheng Yu
- Institute of Statistics and Big Data Research Center, National Chiao Tung University, Hsinchu, Taiwan
| | - Henry Horng-Shing Lu
- Institute of Statistics and Big Data Research Center, National Chiao Tung University, Hsinchu, Taiwan
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Murakami K, Asayama K, Satoh M, Inoue R, Tsubota-Utsugi M, Hosaka M, Matsuda A, Nomura K, Murakami T, Kikuya M, Metoki H, Imai Y, Ohkubo T. Risk Factors for Stroke among Young-Old and Old-Old Community-Dwelling Adults in Japan: The Ohasama Study. J Atheroscler Thromb 2016; 24:290-300. [PMID: 27487854 PMCID: PMC5383545 DOI: 10.5551/jat.35766] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
AIM Few studies have addressed stroke risk factors in older populations, particularly among the old-old. We examined differences in traditional risk factors for stroke among the old-old compared with the young-old in community-dwelling Japanese adults. METHODS We followed 2,065 residents aged ≥ 60 years who had no history of stroke. Traditional risk factors for stroke were obtained from a self-administered questionnaire at baseline. We classified participants into two age categories, 60-74 years (n=1,502) and ≥ 75 years (n=563), and assessed whether traditional risk factors were differentially associated with stroke incidence according to age category. Hazard ratios were calculated by the Cox proportional hazards model, adjusting for confounding factors and competing risk of death. RESULTS During a median follow-up of 12.8 and 7.9 years, 163 and 111 participants aged 60-74 and ≥ 75 years, respectively, developed a first stroke. Hypertension was consistently associated with increased risk of stroke, regardless of age category. Diabetes mellitus was associated with increased risk of stroke in those aged 60-74 years (hazard ratio, 1.50; 95% confidence interval, 1.00-2.25), but not in those aged ≥ 75 years (hazard ratio, 0.65; 95% confidence interval, 0.33-1.29), with significant interaction by age (P=0.035). No traditional risk factor other than hypertension was associated with stroke among those aged ≥ 75 years. CONCLUSION Those with hypertension had significantly higher stroke risk among old people, while diabetes mellitus was differentially associated with stroke according to age category. Our findings indicate the importance of different prevention strategies for stroke incidence according to age category.
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Affiliation(s)
- Keiko Murakami
- Department of Hygiene and Public Health, Teikyo University School of Medicine
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Lavan AH, Gallagher PF, O’Mahony D. Methods to reduce prescribing errors in elderly patients with multimorbidity. Clin Interv Aging 2016; 11:857-66. [PMID: 27382268 PMCID: PMC4922820 DOI: 10.2147/cia.s80280] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The global population of multimorbid older people is growing steadily. Multimorbidity is the principal cause of complex polypharmacy, which in turn is the prime risk factor for inappropriate prescribing and adverse drug reactions and events. Those who prescribe for older frailer multimorbid people are particularly prone to committing prescribing errors of various kinds. The causes of prescribing errors in this patient population are multifaceted and complex, including prescribers' lack of knowledge of aging physiology, geriatric medicine, and geriatric pharmacotherapy, overprescribing that frequently leads to major polypharmacy, inappropriate prescribing, and inappropriate drug omission. This review examines the various ways of minimizing prescribing errors in multimorbid older people. The role of education in physician prescribers and clinical pharmacists, the use of implicit and explicit prescribing criteria designed to improve medication appropriateness in older people, and the application of information and communication-technology systems to minimize errors are discussed in detail. Although evidence to support any single intervention to prevent prescribing errors in multimorbid elderly people is inconclusive or lacking, published data support focused prescriber education in geriatric pharmacotherapy, routine application of STOPP/START (screening tool of older people's prescriptions/screening tool to alert to right treatment) criteria for potentially inappropriate prescribing, electronic prescribing, and close liaison between clinical pharmacists and physicians in relation to structured medication review and reconciliation. Carrying out a structured medication review aimed at optimizing pharmacotherapy in this vulnerable patient population presents a major challenge. Another challenge is to design, build, validate, and test by clinical trials suitably versatile and efficient software engines that can reliably and swiftly perform complex medication reviews in older multimorbid people. The European Union-funded SENATOR and OPERAM clinical trials commencing in 2016 will examine the impact of customized software engines in reducing medication-related morbidity, avoidable excess cost, and rehospitalization in older multimorbid people.
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Affiliation(s)
- Amanda H Lavan
- Department of Geriatric Medicine, Cork University Hospital, University College Cork, Cork, Ireland
| | - Paul F Gallagher
- Department of Geriatric Medicine, Cork University Hospital, University College Cork, Cork, Ireland
| | - Denis O’Mahony
- Department of Geriatric Medicine, Cork University Hospital, University College Cork, Cork, Ireland
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Lowenstine LJ, McManamon R, Terio KA. Comparative Pathology of Aging Great Apes: Bonobos, Chimpanzees, Gorillas, and Orangutans. Vet Pathol 2015; 53:250-76. [PMID: 26721908 DOI: 10.1177/0300985815612154] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The great apes (chimpanzees, bonobos, gorillas, and orangutans) are our closest relatives. Despite the many similarities, there are significant differences in aging among apes, including the human ape. Common to all are dental attrition, periodontitis, tooth loss, osteopenia, and arthritis, although gout is uniquely human and spondyloarthropathy is more prevalent in apes than humans. Humans are more prone to frailty, sarcopenia, osteoporosis, longevity past reproductive senescence, loss of brain volume, and Alzheimer dementia. Cerebral vascular disease occurs in both humans and apes. Cardiovascular disease mortality increases in aging humans and apes, but coronary atherosclerosis is the most significant type in humans. In captive apes, idiopathic myocardial fibrosis and cardiomyopathy predominate, with arteriosclerosis of intramural coronary arteries. Similar cardiac lesions are occasionally seen in wild apes. Vascular changes in heart and kidneys and aortic dissections in gorillas and bonobos suggest that hypertension may be involved in pathogenesis. Chronic kidney disease is common in elderly humans and some aging apes and is linked with cardiovascular disease in orangutans. Neoplasms common to aging humans and apes include uterine leiomyomas in chimpanzees, but other tumors of elderly humans, such as breast, prostate, lung, and colorectal cancers, are uncommon in apes. Among the apes, chimpanzees have been best studied in laboratory settings, and more comparative research is needed into the pathology of geriatric zoo-housed and wild apes. Increasing longevity of humans and apes makes understanding aging processes and diseases imperative for optimizing quality of life in all the ape species.
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Affiliation(s)
- L J Lowenstine
- Pathology, Microbiology, and Immunology, School of Veterinary Medicine, University of California, Davis, CA, USA Mountain Gorilla Veterinary Project-Gorilla Doctors, Karen C. Drayer Wildlife Health Center, School of Veterinary Medicine, University of California, Davis, CA, USA
| | - R McManamon
- Zoo and Exotic Animal Pathology Service, Infectious Diseases Laboratory, Department of Pathology, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
| | - K A Terio
- Zoological Pathology Program, University of Illinois College of Veterinary Medicine, Maywood, IL, USA
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Thordardottir B, Chiatti C, Ekstam L, Malmgren Fänge A. Heterogeneity of Characteristics among Housing Adaptation Clients in Sweden--Relationship to Participation and Self-Rated Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 13:ijerph13010091. [PMID: 26729145 PMCID: PMC4730482 DOI: 10.3390/ijerph13010091] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 12/21/2015] [Accepted: 12/23/2015] [Indexed: 01/14/2023]
Abstract
The aim of the paper was to explore the heterogeneity among housing adaptation clients. Cluster analysis was performed using baseline data from applicants in three Swedish municipalities. The analysis identified six main groups: “adults at risk of disability”, “young old with disabilities”, “well-functioning older adults”, “frail older adults”, “frail older with moderate cognitive impairments” and “resilient oldest old”. The clusters differed significantly in terms of participation frequency and satisfaction in and outside the home as well as in terms of self-rated health. The identification of clusters in a heterogeneous sample served the purpose of finding groups with different characteristics, including participation and self-rated health which could be used to facilitate targeted home-based interventions. The findings indicate that housing adaptions should take person/environment/activity specific characteristics into consideration so that they may fully serve the purpose of facilitating independent living, as well as enhancing participation and health.
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Affiliation(s)
- Björg Thordardottir
- Department of Health Sciences, Faculty of Medicine, Lund University, Box 157, Lund 221 00, Sweden.
| | - Carlos Chiatti
- Department of Health Sciences, Faculty of Medicine, Lund University, Box 157, Lund 221 00, Sweden.
- Italian National Research Center on Aging, Via S. Margherita 5, Ancona 60124, Italy.
| | - Lisa Ekstam
- Department of Health Sciences, Faculty of Medicine, Lund University, Box 157, Lund 221 00, Sweden.
| | - Agneta Malmgren Fänge
- Department of Health Sciences, Faculty of Medicine, Lund University, Box 157, Lund 221 00, Sweden.
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Singh S, Bajorek B. Pharmacotherapy in the ageing patient: The impact of age per se (A review). Ageing Res Rev 2015; 24:99-110. [PMID: 26226330 DOI: 10.1016/j.arr.2015.07.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 07/17/2015] [Indexed: 12/23/2022]
Abstract
A literature search was carried out to review the influence of 'ageing' on pharmacotherapeutic decision-making, specifically how 'age' is defined and considered in the utilisation of medication. Embase, Medline, International Pharmaceutical Abstracts, and Google scholar were canvassed in a three-tiered search according to pre-established inclusion criteria. In tier 1, a total of 22 studies were identified highlighting the underutilisation of medication in elderly patients, with a particular focus on warfarin. Four studies highlighted an age-bias in medication-prescribing for elderly patients, specifically in relation to medicines for rheumatoid arthritis, angina, and hypertension. Tier 2 identified diverse definitions for 'elderly', including biological age, chronological age, physiological age, as well as various descriptions of 'elderly' in clinical trials and guidelines. Finally, medication optimisation tools were identified through the third tier, emphasising the use of chronological age to describe the 'elderly'. Old age influences pharmacotherapeutic decision-making at various levels, however, what complicates the situation is the absence of a comprehensive definition of 'elderly'. Clinical recommendations need to be based more on objective factors known to affect medication effectiveness and safety.
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