Population Health Management for Older Adults: Review of Interventions for Promoting Successful Aging Across the Health Continuum

The Impact of Frailty on Outcomes of Proximal Aortic Aneurysm Surgery: A Nationwide Analysis

(1) Background: This study examines frailty's impact on proximal aortic surgery outcomes. (2) Methods: All patients with a thoracic aortic aneurysm who underwent aortic root, ascending aorta, or arch surgery from the 2016-2017 National Inpatient Sample were included. Frailty was defined by the Adjusted Clinical Groups Frailty Indicator. Outcomes of interest included in-hospital mortality and a composite of death, stroke, acute kidney injury (AKI), and major bleeding (MACE). (3) Results: Among 5745 patients, 405 (7.0%) met frailty criteria. Frail patients were older, with higher rates of chronic pulmonary disease, diabetes, and chronic kidney disease. There was no difference in in-hospital death (4.9% vs. 2.4%, p = 0.169); however, the frail group exhibited higher rates of stroke and AKI. Frail patients had a longer length of stay (17 vs. 8 days), and higher rates of non-home discharge (74.1% vs. 54.3%) than non-frail patients (both p < 0.001). Sensitivity analysis confirmed increased morbidity and mortality in frail individuals. After adjusting for patient comorbidities and hospital characteristics, frailty independently predicted MACE (OR 4.29 [1.88-9.78], p = 0.001), while age alone did not (OR 1.00 [0.99-1.02], p = 0.568). Urban teaching center status predicted a lower risk of MACE (OR 0.27 [0.08-0.94], p = 0.039). (4) Conclusions: Frailty is associated with increased morbidity in proximal aortic surgery and is a more significant predictor of mortality than age. Coordinated treatment in urban institutions may enhance outcomes for this high-risk group.

Effectiveness of a multicomponent activity and horticultural intervention for the hospitalized older adults: A randomized controlled trial: Effectiveness of Intervention for the Hospitalized Older Adults

This study evaluated the effectiveness of different intervention programs in improving function among hospitalized older individuals using the Comprehensive Geriatric Assessment (CGA). A randomized controlled trial consisted of three groups: routine care, horticulture, and multicomponent activities (n = 32 each). Horticultural and multicomponent activity interventions showed beneficial effects on the CGA in hospitalized older individuals, particularly regarding cognitive function and quality-of-life. Additionally, horticultural activities significantly contributed to the perception of older adults' health status. We recommend to select older patients in geriatric wards with long-term hospitalization and adjust the frequency of activities or choose a single intervention program to provide long-term and effective intervention effects.

Greater subjective cognitive decline severity is associated with worse memory performance and lower entorhinal cerebral blood flow in healthy older adults

OBJECTIVE

Subjective cognitive decline (SCD) is a potential early risk marker for Alzheimer's disease (AD), but its utility may vary across individuals. We investigated the relationship of SCD severity with memory function and cerebral blood flow (CBF) in areas of the middle temporal lobe (MTL) in a cognitively normal and overall healthy sample of older adults. Exploratory analyses examined if the association of SCD severity with memory and MTL CBF was different in those with lower and higher cardiovascular disease (CVD) risk status.

METHODS

Fifty-two community-dwelling older adults underwent magnetic resonance imaging, neuropsychological testing, and were administered the Everyday Cognition Scale (ECog) to measure SCD. Regression models investigated whether ECog scores were associated with memory performance and MTL CBF, followed by similar exploratory regressions stratified by CVD risk status (i.e., lower vs higher stroke risk).

RESULTS

Higher ECog scores were associated with lower objective memory performance and lower entorhinal cortex CBF after adjusting for demographics and mood. In exploratory stratified analyses, these associations remained significant in the higher stroke risk group only.

CONCLUSIONS

Our preliminary findings suggest that SCD severity is associated with cognition and brain markers of preclinical AD in otherwise healthy older adults with overall low CVD burden and that this relationship may be stronger for individuals with higher stroke risk, although larger studies with more diverse samples are needed to confirm these findings. Our results shed light on individual characteristics that may increase the utility of SCD as an early risk marker of cognitive decline.

The leading global health challenges in the artificial intelligence era

Millions of people's health is at risk because of several factors and multiple overlapping crises, all of which hit the vulnerable the most. These challenges are dynamic and evolve in response to emerging health challenges and concerns, which need effective collaboration among countries working toward achieving Sustainable Development Goals (SDGs) and securing global health. Mental Health, the Impact of climate change, cardiovascular diseases (CVDs), diabetes, Infectious diseases, health system, and population aging are examples of challenges known to pose a vast burden worldwide. We are at a point known as the "digital revolution," characterized by the expansion of artificial intelligence (AI) and a fusion of technology types. AI has emerged as a powerful tool for addressing various health challenges, and the last ten years have been influential due to the rapid expansion in the production and accessibility of health-related data. The computational models and algorithms can understand complicated health and medical data to perform various functions and deep-learning strategies. This narrative mini-review summarizes the most current AI applications to address the leading global health challenges. Harnessing its capabilities can ultimately mitigate the Impact of these challenges and revolutionize the field. It has the ability to strengthen global health through personalized health care and improved preparedness and response to future challenges. However, ethical and legal concerns about individual or community privacy and autonomy must be addressed for effective implementation.

Global population surpasses eight billion: Are we ready for the next billion?

In November 2022, the global population had officially crossed eight billion. It has long been recognized that socioeconomic or health-related problems in the community always accompany an uncontrolled population expansion. International calls have been made regarding lack of universal health coverage, an insufficient supply of healthcare providers, the burden of noncommunicable disease, population aging and the difficulty in obtaining safe drinking water and food. The present health policy paper discusses how to conquer these crowded world issues, including (1) promoting government and international organization participation in providing appropriate infrastructure, funding and distribution to assist people's health and well-being; (2) shifting health program towards a more preventive approach and (3) reducing inequalities, particularly for the marginalized, isolated and underrepresented population. These fundamental principles of health policy delivery as a response to an increasingly crowded world and its challenges are crucial for reducing the burden associated with excessive healthcare costs, decreased productivity and deteriorating environmental quality.

Evaluation of a technology-enhanced, integrated community health and wellness program for seniors (HWePS): protocol of a non-randomized comparison trial

BACKGROUND

Healthy aging for all in the community is a shared public health agenda for countries with aging populations, but there is a lack of empirical evidence on community-wide preventive models that promote the health of older people residing in socially-disadvantaged communities. The Health and Wellness Program for Seniors (HWePS) is a technology-enhanced, multi-level, integrated health equity intervention model. This study evaluates the effect of the HWePS on the health and well-being of older adults residing in urban, low-income communities.  METHODS/DESIGN: HWePS is a prospective, non-randomized comparison trial conducted in an intervention and a control neighborhood (dong) in Seoul, South Korea, over 12 months. Older people who reside in the small areas and meet the inclusion/exclusion criteria are eligible to participate. The multi-level, multi-faceted HWePS intervention is a preventive community care model for older residents guided by the expanded chronic care model, the comprehensive health literacy intervention model, and the Systems for Person-centered Elder Care model along with health equity frameworks. HWePS consists of four components: a health literacy intervention based on individual and community needs assessments, personalized (self-)care management featuring nurse coaching and peer support, a healthy-living and healthy-aging community initiative, and information and communication technology (ICT) systems. The primary outcomes are self-reported health and health-related quality of life. Outcome assessors and data analysts are blinded to group assignment. Process evaluation will be also conducted.

DISCUSSION

As a multi-level health equity project, HWePS has adopted a novel study design that simultaneously targets individual- and community-level factors known to contribute to health inequality in later life in the community. The study will provide insights into the effectiveness and implementation process of an integrated, multi-level, preventive community care model, which in turn can help improve the health outcomes of older residents and reduce disparities in underserved urban communities.

TRIAL REGISTRATION

ISRCTN29103760. Registered 2 September 2021, https://www.isrctn.com/ISRCTN29103760.

Socio-demographic characteristics and their relation to medical service consumption among elderly in Israel during the COVID-19 lockdown in 2020 as compared to the corresponding period in 2019

PURPOSE

The COVID-19 pandemic has led to the isolation of the population in Israel, including the elderly. The present study aimed to compare the consumption of medical services among adults over the age of 65 in Israel at the time of the first COVID-19 lockdown relative to the corresponding period the year before.

METHODS

We conducted a retrospective longitudinal observational quantitative research based on the Natali Healthcare Solutions Israel database of subscribers. Company subscribers over the age of 65 (N = 103,955) were included in the sample (64.5% women) in two time periods, before the COVID-19 outbreak-P1, in 2019, and during the first COVID-19 lockdown- P2 in 2020. Logistic regression was applied to examine service consumption for study variables.

RESULTS

The average number of referrals to services was lower during the COVID-19 lockdown period (M = 0.3658, SD = 0.781) compared to the corresponding period in the previous year (M = 0.5402, SD = 0.935). The average number of ambulance orders, doctor home visits and service refusals were higher when compared to the same period in the previous year. During both time periods, women (P1- M = 0.5631, SD = 0.951; P2- M = 0.3846, SD = 0.800) required significantly more (p < .000) services than men (P1- M = 0.5114, SD = 0.910; P2- M = 0.3417, SD = 0.753). Older, widowed people, living in non-Jewish/mixed localities, or in average or below average socioeconomic status localities required relatively more services to those with opposite socio-demographic traits (p < .000).

SUMMARY AND CONCLUSIONS

In a large sample of elderly in Israel, findings indicate a decrease in referrals to medical care during the first COVID-19 lockdown period, yet an increase in ambulance orders, doctor visits and service refusals. Socio-demographic characteristics showed a similar effect in both time periods. The period of the first COVID-19 lockdown was characterized by a higher incidence of medical service refusals as compared to the equivalent period in the previous year.

Aging increases the risk of flap necrosis in murine models: A systematic review

Background and Aim

Although a natural phenomenon, aging is a degenerative condition that promotes cellular malfunction and subsequent organ and body dysfunction. According to the World Health Organization, the elderly are the fastest growing age group worldwide. A 2012 population report stated that 43.1 million adults of 65 years or older lived in the United States, which is expected to jump to 83.7 million in 2050, placing an additional burden on an already stretched health-care network. Elderly patients broadly impact our health-care system, as reported in a 2014 wound report. 8.2 million patients were diagnosed with at least one type of wound, with patients 75 years or older making up most of the diagnoses. Aging affects all stages of the wound healing cascade. Although wound healing is downregulated in the elderly, scarce information exists regarding the effects of aging and flap survival in this group. Therefore, this study aims to report the impact of age on the survival of flaps in murine models. We hypothesize that increased aged animals will have decreased flap survival.

Methods

A systematic review was performed on February 1, 2022, following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. We searched for full-text articles written in English, consisting of experimental murine models that compared flap survival between aged and young animals, in the following databases: PubMed, Scopus, CINAHL, and Web of Science. The terms "mice" OR "rats" AND "surgical flaps" AND "aging" guided our search. Models affected by chronic diseases were excluded from the study.

Results

Out of the 208 articles found by our search, seven were included according to our inclusion and exclusion criteria. Five studies used rats as experimental models, while the remaining two used mice. Local flaps were done in five studies, and two performed free flaps, transferring them from young and aged animals to young controls. Five articles reported lower flap survival in elder groups when exposed to ischemic insults. Three papers reported a deficiency in angiogenesis, vasculogenesis, and vascular reactivity as plausible causes for lack of survival, with one author correlating and verifying their results in human subjects. Although one article reported a lack of statistical power, they perceived a trend similar to the previous studies. Finally, one article reported inconclusive and variable results.

Conclusion

Evidence suggests that a lack of angiogenic and vasculogenic response in conjunction with decreased vascular reactivity are responsible for the diminished survival of flaps in the elder. Therapeutic means to boost the angiogenic, vasculogenic, and vascular reactivity response to improve patient outcomes require further research to understand the time course and mechanisms of flap survival in the elderly.

Relevance for Patients

All humans will feel the effects of aging one way or another. However, we can all agree that aging affects our basic biological processes, which negatively affects macroscopic appearance. One of the essential aspects downregulated in the elderly is their ability to respond to tissue injury and hypoxia, creating non-favorable circumstances for wound healing. Furthermore, to manage these non-healing wounds, flaps are raised to create a covering for these defects. However, age also impacts the ability of these flaps to survive, augmenting the problem and entering a vicious circle. To improve outcomes, we must focus our future research on understanding the basic principles of how aging affects the survival of flaps in elderly population.

A mobile health + health coaching application for the management of chronic non-cancer pain in older adults: Results from a pilot randomized controlled study

Introduction

The rapid growth of mobile health (mHealth) devices holds substantial potential for improving care and care outcomes in aging adults with chronic non-cancer pain (CNCP), however, research evaluating these devices in older adults remains limited.

Objective

To ascertain the feasibility and preliminary efficacy of an mHealth intervention (Mymee) that combines symptom, diet, and behavior tracking via a smartphone application with data analytics to detect associations between symptoms and lifestyle factors along with weekly health coaching sessions to mitigate CNCP in adults 55 years of age and older.

Methods

Participants (N = 31) in this pilot study were recruited from one primary care practice in New York City and randomized to an intervention [app + up to 12 health coaching sessions (scheduled approximately once weekly) + usual care] or a control (app + usual care) arm. Feasibility measures included recruitment (proportion of eligible persons who enrolled) and retention rates (proportion of subjects completing a follow-up assessment) as well as adherence with the weekly coaching sessions and logging daily data on the app. Efficacy outcomes (e.g., pain intensity, self-efficacy, disability, anxiety) were assessed at baseline and follow-up (~16 weeks after baseline). Descriptive statistics were obtained and general linear mixed models used for primary analyses.

Results

Participants had a mean (standard deviation) age of 67.32 (9.17) and were mostly female (61%). Feasibility outcomes were mixed as evidenced by recruitment and retention rates of 74% and 65%, respectively. The mean number of weekly coaching sessions attended by intervention participants was 6.05 (SD = 5.35), while the average number of days logging data on the app was 44.82 (34.02). We found a consistent trend in favor of the intervention, where pain intensity, affect, and quality of life measures improved considerably more among intervention (vs. control) participants. Finally, the proportion of participants with GAD-7 scores at follow up decreased by 0.35 to 0, whereas controls did not change, a significant effect in favor of the intervention (p = 0.02).

Conclusions

This study supports the need for future research that seeks to enhance feasibility outcomes and confirm the efficacy of the Mymee intervention among aging adults with CNCP.

Prevention of suicidal behavior in older people: A systematic review of reviews

Older people have the highest rates of suicide, yet the evidence base on effective suicide preventions in late-life is limited. This systematic review of reviews aims to synthesize data from existing reviews on the prevention and/or reduction of suicide behavior in late-life and evidence for effectiveness of interventions. A systematic database search was conducted in eight electronic databases from inception to 4/2020 for reviews targeting interventions among adults ≥ 60 to prevent and/or reduce suicide, suicide attempt, self-harm and suicidal ideation. Four high quality reviews were included and interventions categorized as pharmacological (antidepressant use: 239 RCTs, seven observational studies) and behavioral (physical activity: three observational studies, and multifaceted primary-care-based collaborative care for depression screening and management: four RCTs). The 2009 antidepressant use review found significant risk reduction for suicide attempt/self-harm (OR = 0.06, 95% CI 0.01-0.58) and suicide ideation (OR = 0.39, 95% CI 0.18-0.78) versus placebo. The 2015 review found an increased risk of attempts with antidepressants versus no treatment (RR = 1.18, 95% CI 1.10-1.27) and no statistically significant change in suicides versus no treatment (RR = 1.06, 95% CI 0.68-1.66) or ideation versus placebo (OR = 0.52, 95% CI 0.14-1.94). Protective effects were found for physical activity on ideation in 2 out of 3 studies when comparing active versus inactive older people. Collaborative care demonstrated significantly less attempts/ideation (OR = 0.80, 95% CI 0.68-0.94) in intervention group versus usual care. The results of this review of reviews find the evidence inconclusive towards use of antidepressants for the prevention of suicidal behavior in older people, thus monitoring is required prior to start, dosage change or cessation of antidepressants. Evidence to date supports physical activity and collaborative management for reduction of suicide ideation, but additional trials are required for a meta-analysis. To build on these findings, continued high-quality research is warranted to evaluate the effectiveness of interventions in late life.

Does gender matter to promote mental health through community engagement among older adults?

Objectives: Community engagement is critical for healthy aging. However, how gender plays a role in mental health promotion of late life is less understood. The study objectives were to examine the association between community engagement and mental health and the effect of gender on this association in older adults.Methods: A door-to-door interviewer-administered survey was conducted with 497 older adults in a public housing town in Singapore. The survey used measures of General Health Questionnaire (GHQ-12), Community Integration Measure (CIM), FRAIL Index, Lubben Social Network, and community participation. Multiple regressions were conducted for psychological distress and social dysfunction, assessed by GHQ-12. After testing the main effects, the moderating effects of gender were explored in the regression models.Results: None of the demographic characteristics, except gender, was associated with psychological distress; men reported poorer mental health than women. In regressions, female, community attachment (assessed by CIM), and participation were associated with decreased psychological distress; social networks and community participation were associated with decreased social dysfunction. Interaction effects of gender and community participation were found in psychological distress, not social dysfunction. The reduction of psychological distress by community engagement was higher among males than females.Conclusions: The findings suggest that, besides the importance of community engagement on mental health among older adults, greater efforts should be placed on the development of gender-tailored community interventions for older adults to maximize its benefits.

Patent Landscape of Automated Systems for Personalized Health Management (ASHM): Features, Shortcomings, and Implications for Developing an Optimal ASHM

The current struggle of national health care systems against global epidemic of non-communicable diseases (NCD) is both clinically ineffective and cost ineffective. On the other hand, rapid development of systems biology, P4 medicine and new digital and communication technologies are good prerequisites for creating an affordable and scalable automated system for personalized health management (ASHM). The current practice of ASHM is better represented in patent literature (36 relevant documents found in Google Patents and USPTO) than in scientific papers (17 documents found in PubMed and Google Scholar). However, only a small fraction of publications disclose a complete self-sufficient system. Problems that authors of ASHM aim to address, methodological approaches, and the most important technical solutions are reviewed and discussed along with shortcomings and limitations. Technical solutions for ASHM currently commercialized or described in literature generally fail to enable practicable, scalable and affordable automated and individualized screening, monitoring, prevention and correction of human health conditions. They also fail to provide a decision support system to patients that would help effectively prevent major NCD and their complications, be accessible and cost effective, consider individual lifestyle factors and involve patients in management of their individual health. Based on analysis of the literature, models of health and care, we propose conceptual framework for developing an ASHM that would be free from the mentioned problems.

Effectiveness of horticultural therapy on physical functioning and psychological health outcomes for older adults: A systematic review and meta-analysis

AIMS AND OBJECTIVES

To systematically determine the effectiveness of horticultural therapy (HT) on the physical functioning and psychological health of older people.

BACKGROUND

With advancing age and increased chronic diseases, older adults are vulnerable to physical deterioration and psychological problems. There is evidence that horticultural therapy (HT) has positive effect among older adults. However, less attention has been devoted to systematically evaluating the physical functioning and psychological health effects of HT in older adults.

DESIGN

Systematic review and meta-analysis were conducted based on the checklist for PRISMA.

METHODS

The searches were conducted in PubMed, EMBASE, CINAHL, PsycINFO, Cochrane, China Network Knowledge Infrastructure, Wan Fang, and China Science and Technology Journal Database, from their inception until June 2021. Randomised controlled trials published in either English or Chinese were reviewed. The Review Manager 5.4 software was used for meta-analyses. The quality of included studies was evaluated using the Cochrane risk of bias tool by two independent researchers.

RESULTS

Ten studies involving 884 participants were included. Compared with the control group, HT can significantly improve upper body flexibility and aerobic endurance in older adults with cancer. Besides, HT was found to be more effective for promoting emotional functioning and well-being, subjective social functioning, and quality of life among the elderly. The attendance rate for HT was 66%-100%, and no negative events were found.

CONCLUSION

Horticultural therapy has potentially positive effects on the physical functioning and psychological health of older adults. However, more rigorous randomised controlled trials with larger populations are required to confirm the findings.

RELEVANCE TO CLINICAL PRACTICE

As a safe and promising nonpharmacological intervention, healthcare professionals may consider the HT intervention when caring for older adults with cancer, dementia and frailty.

Twelve Smartphone Applications for Health Management of Older Adults during the COVID-19 Pandemic

This study investigated smartphone applications that may be helpful in managing the health of the elderly during COVID-19. The application searched the seven areas of health management, newly classified in OTPF 4th edition with keywords in the Google Play Store. As a result, two applications meeting the selection criteria were selected for each area. The selected applications are social and emotional health promotion and maintenance: Wysa & MindDoc, symptom and condition management: Ada & Diseases Dictionary, communication with the health care system: Telehealth & Blood Pressure Diary, medication management: Medisafe & MyTherapy, physical activity: FitOn & Samsung Health, nutrition management: Lifesum & Health and Nutrition Guide. Through the analyzed applications, twelve applications with the potential to improve the health management and quality of life in older adults during social distancing or self-isolation due to COVID-19 were identified.

Using aggregated data from Swedish national quality registries as tools to describe health conditions of older adults with complex needs

Background

Combining National Quality Registries (NQRs) with existing National Health Registries (NHRs) might make it possible to get a wider picture of older adults health situation. The aim was to examine the feasibility of aggregating data across different NQRs and existing NHRs to explore the possibility to investigate trajectories and patterns of disease and care, specifically for the most ill older adults.

Method

A Swedish twin population (N = 44,816) was linked to nine NQRs and four NHRs. A descriptive mixed-method study was performed. A manifest content analysis identified which health parameters were collected from each NQR. Factor analysis identified patterns in representation across NQRs. Two case studies illustrated individual trajectories of care by using NQRs and NHRs.

Results

About 36% of the population was registered in one or more NQRs. NQRs included 1849 variables that were sorted into 13 categories with extensive overlap across the NQRs. Health and function variables were identified, but few social or cognitive variables. Even though most individuals demonstrated unique patterns of multi-morbidities, factor analysis identified three clusters of representation in the NQRs with sufficient sample sizes for future investigations. The two cases illustrated the possibility of following patterns of disease and trajectories of care.

Conclusions

NQRs seem to be a significant source for collecting data about a population that may be underrepresented in most research on aging because of their age and poor health. However, NQRs are primarily disease related, and further development of the registries to maximize coverage and utility is needed.

Electronic supplementary material

The online version of this article (10.1007/s40520-020-01629-6) contains supplementary material, which is available to authorized users.

The Role of Prevention in Healthy Aging

This article explores the role of prevention in healthy aging from the perspective of individualized prevention in the clinic and population-based prevention with system-level support. The traditional medical model has significant limitations to effectively target impactful outcomes related to geriatric syndromes that encompass debility, frequent hospitalizations, loss of independence, and disease progression. This article reviews aspects of the clinic visit and subsequent interventions, such as immunizations and screenings, that promote disease and disability prevention. Finally, we review the value of Population Health Management as a model of care for delivering population-based, system-level supported, patient-centered health care plans.

Artificial Intelligence-Powered Digital Health Platform and Wearable Devices Improve Outcomes for Older Adults in Assisted Living Communities: Pilot Intervention Study

BACKGROUND

Wearables and artificial intelligence (AI)-powered digital health platforms that utilize machine learning algorithms can autonomously measure a senior's change in activity and behavior and may be useful tools for proactive interventions that target modifiable risk factors.

OBJECTIVE

The goal of this study was to analyze how a wearable device and AI-powered digital health platform could provide improved health outcomes for older adults in assisted living communities.

METHODS

Data from 490 residents from six assisted living communities were analyzed retrospectively over 24 months. The intervention group (+CP) consisted of 3 communities that utilized CarePredict (n=256), and the control group (-CP) consisted of 3 communities (n=234) that did not utilize CarePredict. The following outcomes were measured and compared to baseline: hospitalization rate, fall rate, length of stay (LOS), and staff response time.

RESULTS

The residents of the +CP and -CP communities exhibit no statistical difference in age (P=.64), sex (P=.63), and staff service hours per resident (P=.94). The data show that the +CP communities exhibited a 39% lower hospitalization rate (P=.02), a 69% lower fall rate (P=.01), and a 67% greater length of stay (P=.03) than the -CP communities. The staff alert acknowledgment and reach resident times also improved in the +CP communities by 37% (P=.02) and 40% (P=.02), respectively.

CONCLUSIONS

The AI-powered digital health platform provides the community staff with actionable information regarding each resident's activities and behavior, which can be used to identify older adults that are at an increased risk for a health decline. Staff can use this data to intervene much earlier, protecting seniors from conditions that left untreated could result in hospitalization. In summary, the use of wearables and AI-powered digital health platform can contribute to improved health outcomes for seniors in assisted living communities. The accuracy of the system will be further validated in a larger trial.

New York State cases of anaphylaxis in elderly patients from 2000 to 2010

BACKGROUND

Limited information is available on the effect of anaphylaxis, a severe, potentially life-threatening allergic reaction, in the elderly population.

OBJECTIVE

To elucidate the frequency of anaphylaxis and the demographic characteristics of elderly patients admitted to New York hospitals from 2000 to 2010.

METHODS

A retrospective analysis of hospitalized patients aged 65 years and older in New York from 2000 to 2010 was conducted using the Statewide Planning and Research Cooperative System, a statewide administrative database. Cases were identified using anaphylaxis International Classification of Diseases, Ninth Revision (ICD-9) codes or an ICD-9-based diagnostic algorithm incorporating the National Institutes of Allergy and Infectious Disease diagnostic criteria. The χ² test was used to measure the association between demographic characteristics and group membership. Regression was used to model group and age as a function of hospital rates.

RESULTS

A total of 3673 hospitalizations were analyzed. Anaphylaxis ICD-9 codes identified 1790 cases (48.7%), the algorithms identified 1701 cases (46.3.%), and 182 cases (5.0%) were identified by both. Hospitalization rates increased significantly during this period (P < .001). Women comprised 61.5% and people of white race comprised 69.8% of the sample. Distribution by age differed by ascertainment method (ICD-9 vs algorithm) among the early-old group (65-74 years of age; 53.8% vs 41.8%) and among the late-old group (≥85 years of age; 11.2% vs 19.3%).

CONCLUSION

Hospitalization rates and anaphylaxis cases increased during the study period among the hospitalized elderly population of New York. Relying on anaphylaxis ICD-9 codes alone missed approximately half of possible cases. The identification and possibly the effect of anaphylaxis among the elderly population may differ, depending on age, race, payer, New York County, and disposition.

Driving status, travel modes and accelerometer-assessed physical activity in younger, middle-aged and older adults: a prospective study of 90 810 UK Biobank participants

Background

Associations between driving and physical-activity (PA) intensities are unclear, particularly among older adults. We estimated prospective associations of travel modes with total PA, sedentary time (ST), light-intensity PA (LPA), and moderate-to-vigorous intensity PA (MVPA) among adults aged 39–70 years.

Methods

We studied 90 810 UK Biobank participants (56.1 ± 7.8 years). Driving status, specific travel modes (non-work travel; commuting to/from work) and covariates were assessed by questionnaire (2006–10). PA was assessed over 7 days by wrist-worn accelerometers (2013–15). We estimated associations using overall and age-stratified multivariable linear-regression models.

Results

Drivers accumulated 1.4% more total PA (95% confidence interval: 0.9, 1.9), 11.2 min/day less ST (–12.9, –9.5), 12.2 min/day more LPA (11.0, 13.3) and 0.9 min/day less MVPA (–1.6, –0.2) than non-drivers. Compared with car/motor-vehicle users, cyclists and walkers had the most optimal activity profiles followed by mixed-mode users (e.g. for non-work travel, cyclists: 10.7% more total PA, 9.0, 12.4; 20.5 min/day less ST, –26.0, –15.0; 14.5 min/day more MVPA, 12.0, 17.2; walkers: 4.2% more total PA, 3.5, 5.0; 7.5 min/day less ST –10.2, –4.9; 10.1 min/day more MVPA, 8.9, 11.3; mixed-mode users: 2.3% more total PA, 1.9, 2.7; 3.4 min/day less ST –4.8, –2.1; 4.9 min/day more MVPA, 4.3, 5.5). Some associations varied by age (p interaction < 0.05), but these differences appeared small.

Conclusions

Assessing specific travel modes rather than driving status alone may better capture variations in activity. Walking, cycling and, to a lesser degree, mixed-mode use are associated with more optimal activity profiles in adults of all ages.

Nutrition self-efficacy assessment: designing and psychometric evaluation in a community-dwelling elderly population

BACKGROUND

Awareness of nutrition self-efficacy dimensions can enable healthcare providers to guide their use in screening and providing a context for positive changes such as in promoting a healthy lifestyle and quality care among elderly people.

OBJECTIVES

Developing an instrument for assessing nutrition self-efficacy among Iranian elderly population.

METHODS

A sequential mixed exploratory design was applied to clarify and determine dimensions of nutrition self-efficacy in a community-dwelling elderly population in two phases. The first phase included a related literature review and a qualitative study. The validity and reliability of the tool were investigated in the second phase. The instrument's content validity was assessed by experts in nutrition self-efficacy's field and reliability was determined by internal consistency and construct reliability.

RESULTS

Three factors (adherence efficacy, preventive behaviors, and information effectiveness) and 29 items were obtained after assessing the face, content, and construct validity. The reliability of the nutrition self-efficacy questionnaire (NSEQ) exceeded α > 0.7. Concerning the cumulative percent of the variance, the three factors determined 64.05% of the total variance.

CONCLUSIONS

The NSEQ designed in this study, using the background experiences of the elderly living in the community and a review of related texts, and has acceptable reliability and validity. However, the diet self-efficacy questionnaire cannot yet be used as a gold standard, but it can be recommended for use as a measurement of individual diet self-efficacy in a community-dwelling elderly population.

Contemporary considerations relating to health promotion and older people

Health promotion in later life can support healthy ageing and wellbeing. Nurses across the continuum of care have an important role in promoting positive health and wellbeing messages, but they must be cognisant of the need to engage in, modify and tailor health promotion for and with older adults. This article provides an overview of contemporary issues relevant to health promotion and older people, and the role and contribution of nurses.

The Effectiveness of Horticultural Therapy on Older Adults: A Systematic Review

OBJECTIVES

Although the therapeutic effects of horticulture on older adults have been widely investigated, a recent and comprehensive synthesis of available evidence on outcomes is lacking. We systematically reviewed evidence for the therapeutic effects of horticulture on older adults.

DESIGN

A systematic search of PubMed, MEDLINE, Sage Journals, ProQuest, Science Direct, and CINAHL was conducted. Articles were selected if they were quantitative studies published in English from 2008 to 2018.

SETTING AND PARTICIPANTS

Articles were selected if they included participants aged 60 years and older and used horticulture as the main intervention.

MEASURES

Experimental studies were appraised using the Physiotherapy Evidence Database Scale.

RESULTS

The systematic search yielded 20 articles. Significant pre-post improvement was reported in quality of life, anxiety, depression, social relations, physical effects, and cognitive effects. However, between-group results were lacking or nonsignificant.

CONCLUSIONS AND IMPLICATIONS

There is evidence for benefits of horticulture among older adults, particularly in long-term care facilities. Nonetheless, as the robustness of evidence is lacking, more rigorous randomized controlled trials and between-group effects need to be investigated.

Exploring the feasibility, sustainability and the benefits of the GrACE + GAIT exercise programme in the residential aged care setting

Background

The feasibility and benefits of a 24-week targeted progressive supervised resistance and weight-bearing exercise programme (Group Aged Care Exercise + GAIT (GrACE + GAIT)) in the residential aged care (RAC) setting was investigated as very little peer-reviewed research has been conducted in relation to exercise programmes of this duration in this cohort.

Methods

A quasi-experimental study design consisting of two groups (control and exercise) explored a 24-week targeted progressive supervised resistance and weight-bearing exercise programme (GrACE + GAIT) in two RAC facilities in Northern New South Wales, Australia. A total of 42 adults consented to participate from a total of 68 eligible residents (61.7%). The primary outcome measures were feasibility and sustainability of the exercise programme via intervention uptake, session adherence, attrition, acceptability and adverse events. Secondary measures included gait speed and the spatio-temporal parameters of gait, handgrip muscle strength and sit to stand performance.

Results

Twenty-three residents participated in the exercise intervention (mean (SD) 85.4 (8.1) years, 15 females) and 19 in the control group (87.4 (6.6) years 13 females). Exercise adherence was 79.3%, with 65% of exercise participants attending ≥70% of the sessions; 100% of those originally enrolled completed the programme and strongly agreed with the programme acceptability. Zero exercise-related adverse events were reported. ANCOVA results indicated that post-intervention gait speed significantly increased (p < 0.001) with an 18.8% increase in gait speed (m/s).

Discussion

The GrACE + GAIT programme was shown to be feasible and significantly improve adults living in RAC facilities gait speed, handgrip strength and sit to stand performance. These results suggest that the GrACE + GAIT programme is suitable for use in the RAC sector and that it has the potential to reduce disability and improve function and quality of life of the residents.

Positive perception of aging is a key predictor of quality-of-life in aging people

OBJECTIVE

We conducted a cross-sectional survey in France in a cohort over 55 years of age to characterize the impact of psychological dimensions on quality-of-life (QoL).

METHODS

The predictors of QoL in relation with aging were studied using an adapted quality-of-life model, based on emotional, cognitive and physical symptoms, functional status, and general health perception. Adding psychological dimensions such as self-esteem, psychological distress, perceptions of ageing and coping, was hypothesized to improve the QoL model. Responses were analyzed using structural equation modeling and path analysis.

RESULTS

The study involved 258 participants, mean age 66.9±7.9 years. Psychological distress and positive perception of aging exhibited the strongest direct impact on QoL (p<0.0001). Psychological distress also appeared to be mediator on QoL for perceived health status, self-esteem and negative perception of aging. Coping centred on emotion exhibited direct impact on self-esteem and so, indirect impact on QoL (p = 0.0002). Perception of personal financial situation (p = 0.0007) and coping centred on social support (p = 0.02) appeared as direct mediators influencing QoL.

CONCLUSIONS

Psychological dimensions are predictors of QOL and have to be taken into account to maximize the resources with a view to successful aging. Further interventions targeting successful aging should focus on positive perception aging.

Instrumental Assessment of the Face Skin Aging in Women

The aim of this study is to conduct several non-invasive methods for assessing the level of circulatory disturbance, elasticity and aging of skin in patients of different age groups in order to expand the diagnostic capabilities and evaluate the effectiveness of current research in aesthetic medicine. Clinical and instrumental exploration of 160 women aged 17 to 75 years with varying degrees of involutional skin changes was carried out. To objectify the assessment of skin condition, in all group of patients modern instrumental methods were used, such as: elastometry, ultrasound examination of the skin, laser Doppler flowmetry, transcutaneous oxygen tension. Concurrent implementation of several non-invasive methods for assessing the level of circulatory disturbance, elasticity and aging of the skin, allowed us to find new possibilities for studying the functional state of the skin. These methods extend the possibilities of ultrasonic research methods used today in aesthetic cosmetology. The obtained comparative data of elastometry, ultrasonography, laser Doppler flowmetry and transcutaneous oximetry in patients of different age groups showed the presence of elasticity and structure defect, skin thickness and subcutaneous fat, as well as microcirculation changes since 25 years and marked changes after 40 years.

The Effect of Usual Source of Care on the Association of Annual Healthcare Expenditure with Patients' Age and Chronic Disease Duration

Along with rapid population aging, the importance of chronic disease management increases with high growth of national healthcare expenditures, and efficient spending on healthcare is required to reduce unnecessary utilizations. For that reason, this study examined the association of annual healthcare expenditure with age and disease duration of chronic patients. Furthermore, the study investigated the effect of usual source of care (USOC) to suggest directions for preventive management of chronic disease. Using Korean Health Panel Study data, this study selected 1481 outpatients, who had out-of-pocket costs for hypertension or diabetes, and their total healthcare and chronic disease management (CDM) costs were examined. With patient aging, CDM cost decreased while the total healthcare cost increased, but longer duration of hypertension or diabetes resulted in increases in both CDM and total healthcare costs. In addition, the moderating effect of USOC indicated that elderly patients had increased CDM costs when they had a regular site for healthcare. In contrast, patients with longer duration had reductions in both CDM and total healthcare costs while having a regular doctor increased CDM cost. The results of this study could be an evidence for future policies to suggest proper preventive management plans for specific subjects.