Carboxymethylcellulose-induced depletion attraction to stabilize high internal phase Pickering emulsions for the elderly: 3D printing and β-carotene delivery

In this study, a carboxymethylcellulose (CMC) induced depletion attraction was developed to stabilize high internal phase Pickering emulsions (HIPPEs) as age-friendly 3D printing inks. The results demonstrated that depletion force induced the adsorption of yolk particles at the droplet interface and the formation of osmotic droplet clusters, thereby increasing the stability of HIPPEs. In addition, the rheological properties and nutrient delivery properties of HIPPEs could be adjusted by the mass ratio of yolk/CMC. The HIPPEs stabilized at yolk/CMC mass ratio 20:7.5 showed optimal printability, viscoelastic, structural recovery, and swallowability. HIPPEs have been applied to 3D printing, International Dysphagia Dietary Standardization Initiative (IDDSI) test, and in vitro digestive simulation in the elderly, indicating their attractive appearance, safe swallowability, and enhanced bioaccessibility of β-carotene. Our work provides new ideas for developing age-friendly foods with plasticity and nutrient delivery capacity by depletion attraction stabilizing HIPPEs.

What exercise strategies are best for people with cognitive impairment and dementia? A systematic review and meta-analysis

OBJECTIVE

Explore the types of exercise that are appropriate for people with dementia, as well as the intensity and frequency of exercise training that is appropriate for older patients to carry out.

METHODS

Cochrane Library, PubMed, Embase, Web of Science, Scopus databases were searched by computer to collect RCT studies that met the inclusion criteria of this article. The search time limit was until January 2024. Two reviewers independently screened literature, extracted data, and assessed the quality and risk of bias of the included studies. Then, meta-analysis was performed using RevMan 5.4 and Stata 15.1 software.

RESULTS

The results of our study showed that physical exercise improved patients' cognitive ability and walking ability, with aerobic and multicomponent training showing the best improvement, and that the number of training sessions should not be too high, with the experimental group showing the best results when the total number of interventions was less than 30.

CONCLUSION

We recommend long-term exercise training for middle-aged and elderly patients with dementia or those who are predisposed to dementia. The type of training we recommend is multi-component training and aerobic training, and we recommend 2-3 sessions of exercise per week for about 60 min each.

The relationship between blood pressure and functional fitness of older adults in Korea

Hypertension, also known as high blood pressure (BP), is a critical health issue that can cause cardiovascular disease. It is observed more frequently in older adults. Thus, this study aimed to identify the functional fitness and body composition factors that significantly influence both systolic and diastolic BPs in older adults. Data from 155,266 older adults (51,751 men [33.3%] and 103,505 women [66.7%]) who underwent functional fitness tests between 2013 and 2018 were analyzed. The following seven functional fitness tests were conducted: (a) aerobic endurance (2-min step), (b) upper body muscle strength (hand grip strength), (c) lower body muscle endurance (chair sit-and-stand), (d) flexibility (sit-and-reach), (e) agility (Timed Up and Go), and (f) body composition (body mass index [BMI] and body fat percentage). Systolic and diastolic BPs were used as outcome variables. In examining the proposed relationships, the regression analysis revealed that BMI, body fat percentage, sit-and-reach, 2-min step, hand grip, chair sit-and-stand, and Timed Up and Go were significantly associated with reduced systolic and diastolic body pressures.

Development of an Elliptical Perturbation System that provides unexpected perturbations during elliptical walking (the EPES system)

BACKGROUND

'Perturbation-based balance training' (PBBT) is a training method that was developed to improve balance reactive responses to unexpected balance loss. This training method is more effective in reducing fall rates than traditional balance training methods. Many PBBTs are performed during standing or treadmill walking which targeted specifically step reactive responses, we however, aimed to develop and build a mechatronic system that can provide unexpected perturbation during elliptical walking the Elliptical Perturbation System (the EPES system), with the aim of improving specifically the trunk and upper limbs balance reactive control.

METHODS

This paper describes the development, and building of the EPES system, using a stationary Elliptical Exercise device, which allows training of trunk and upper limbs balance reactive responses in older adults.

RESULTS

The EPES system provides 3-dimensional small, controlled, and unpredictable sudden perturbations during stationary elliptical walking. We developed software that can identify a trainee's trunk and arms reactive balance responses using a stereo camera. After identifying an effective trunk and arms reactive balance response, the software controls the EPES system motors to return the system to its horizontal baseline position after the perturbation. The system thus provides closed-loop feedback for a person's counterbalancing trunk and arm responses, helping to implement implicit motor learning for the trainee. The pilot results show that the EPES software can successfully identify balance reactive responses among participants who are exposed to a sudden unexpected perturbation during elliptical walking on the EPES system.

CONCLUSIONS

EPES trigger reactive balance responses involving counter-rotation action of body segments and simultaneously evoke arms, and trunk reactive response, thus reactive training effects should be expected.

Cardiovascular disease onset in old people with severe hypercholesterolemia

BACKGROUND AND AIMS

Familial hypercholesterolemia (FH) variants are associated with higher atherosclerotic cardiovascular disease risk (ASCVD) even when compared with other forms of severe hypercholesterolemia, especially in young people. Lipid lowering therapies (LLT) may change hypercholesterolemia natural history. This study aimed at evaluating factors associated with occurrence of ASCVD in old severe hypercholesterolemics diagnosed or not with FH and undergoing LLT.

METHODS

Hypercholesterolemic individuals ≥60 years participating on a genetic cascade screening for FH were divided in 4 groups (2 × 2) according to the presence (variant+) or not (variant-) of FH genetic variants and previous ASCVD (ASCVD+ and ASCVD-). Biomarkers associated with new incident ASCVD events were tested using Cox models. Continuous data shown as medians (%25; %75).

RESULTS

From 4,111 genotyped individuals, 377 (9.1%) were elderly [age 66 (63; 71) years], 28.9% males, 42.7% variant+, 32.1% with previous ASCVD, LLT duration 9 (5; 16) years, and on treatment LDL-cholesterol 144 (109; 200) mg/dL. After 4.8 (7; 3) years of follow up there were 47 incident events (12.4%, 2.7% patient/year). The annualized event rates were 0.8% (95% CI 0.36%; 1.70%), 2.3% (95% CI 1.3%; 4.1%), 5.2% (95% CI 2.8%; 9.7%) and 6.3% (95% CI 4.0%; 10.0%) respectively for groups variant-/ASCVD-, variant+/ASCVD-, variant-/ASCVD+ and, variant+/ASCVD+ (p log rank p < 0.001). Only presence of previous ASCVD was independently associated with incident ASCVD [hazard ratio 3.236 (95%CI 1.497-6.993, p = 0.003)]. No interaction was found for previous ASCVD and variants.

CONCLUSIONS

In old severe hypercholesterolemic individuals undergoing long-term LLT previous ASCVD was associated with incident events while FH causing variants were not.

Residents' experiences of encounters with staff and communication in nursing homes during the Covid-19 pandemic: a qualitative interview study

BACKGROUND

The Covid-19 pandemic and associated visiting restrictions have challenged communication with others for older people residing in nursing homes.

AIM

The aim of this study was to explore residents' experiences of encounters and communication with staff and relatives and friends during the Covid-19 pandemic.

DESIGN

An exploratory study with an inductive approach.

METHODS

Semi-structured telephone interviews with 16 Swedish nursing home residents were conducted. Data were analyzed using qualitative content analysis; the study reports according to the COREQ checklist.

RESULTS

Three main categories emerged: (1) Mixed feelings and experiences of encounters with nursing staff, (2) Adapting to hampered communication and finding strategies to overcome language barriers, and (3) Facing pandemic restrictions and living an adjusted life. Nine subcategories are reported within these categories. Residents mainly reported good encounters with staff and receiving the care they needed, but unhelpful encounters were also reported. To manage communication with staff with limited Swedish language skills, residents developed several strategies. During the visiting ban, residents felt secure but also lonely. Staying connected with the outside world required residents to use the phone and handle other digital aids, such as video calls, but lack of technical skills among staff hindered frequent use of video calls.

CONCLUSION

This study highlights how residents can feel safe in extreme situations, but increased competence, including digital literacy and language skills, among staff is required. Care providers should provide relevant information to residents and staff and employ competent staff. Findings indicate that communication plans need to include enabling communication for residents both within and outside nursing homes, taking staff language skills into consideration.

Application of machine learning model to predict lacunar cerebral infarction in elderly patients with femoral neck fracture before surgery

BACKGROUND

Femoral neck fracture and lacunar cerebral infarction (LCI) are the most common diseases in the elderly. When LCI patients undergo a series of traumas such as surgery, their postoperative recovery results are often poor. Moreover, few studies have explored the relationship between LCI and femoral neck fracture in the elderly. Therefore, this study will develop a ML (machine learning)-based model to predict LCI before surgery in elderly patients with a femoral neck fracture.

METHODS

Professional medical staff retrospectively collected the data of 161 patients with unilateral femoral neck fracture who underwent surgery in the Second Affiliated Hospital of Wenzhou Medical University database from January 1, 2015, to January 1, 2020. Patients were divided into two groups based on LCI (diagnosis based on cranial CT image): the LCI group and the non-LCI group. Preoperative clinical characteristics and preoperative laboratory data were collected for all patients. Features were selected by univariate and multivariate logistic regression analysis, with age, white blood cell (WBC), prealbumin, aspartate aminotransferase (AST), total protein, globulin, serum creatinine (Scr), blood urea nitrogen (Bun)/Scr, lactate dehydrogenase (LDH), serum sodium and fibrinogen as the features of the ML model. Five machine learning algorithms, Logistic regression (LR), Gradient Boosting Machine (GBM), Extreme Gradient Boosting (XGBoost), Random Forest (RF), and Decision tree (DT), were used in combination with preoperative clinical characteristics and laboratory data to establish a predictive model of LCI in patients with a femoral neck fracture. Furthermore, indices like the area under the receiver operating characteristic (AUROC), sensitivity, specificity, and accuracy were calculated to test the models' performance.

RESULTS

The AUROC of 5 ML models ranged from 0.76 to 0.95. It turned out that the RF model demonstrated the highest performance in predicting LCI for femoral neck fracture patients before surgery, whose AUROC was 0.95, sensitivity 1.00, specificity 0.81, and accuracy 0.90 in validation sets. Furthermore, the top 4 high-ranking variables in the RF model were prealbumin, fibrinogen, globulin and Scr, in descending order of importance.

CONCLUSION

In this study, 5 ML models were developed and validated for patients with femoral neck fracture to predict preoperative LCI. RF model provides an excellent predictive value with an AUROC of 0.95. Clinicians can better conduct multidisciplinary perioperative management for patients with femoral neck fractures through this model and accelerate the postoperative recovery of patients.

Effect of different weekly frequencies of Chen-style Tai Chi in elders with chronic non-specific low back pain: study protocol for a randomised controlled trial

BACKGROUND

Tai Chi (TC), as one of mild to moderate exercise therapies specifically recommended by clinical practice guideline from the American College of Physician, is a viable option for chronic non-specific low back pain (CNLBP) treatment. Nevertheless, limited studies focused on the effect of different weekly frequencies of TC in elders with CNLBP. This superiority study aims to compare the differences of TC with different weekly frequencies in elders with CNLBP on the premise of proving its effectiveness, and identifying whether mindfulness mediates the effect of TC on treatment outcomes.

METHODS

In total, 284 senior citizens with CNLBP will be recruited in this single-centre, randomised, single-blinded (outcome assessors, data managers and the statistician), parallel controlled trial. Participants will be randomly divided into either one of three TC groups (1, 3, or 5 sessions/week, on the basis of weekly health educational lectures) or weekly health educational lectures, sustaining for 12 weeks, followed by 12 weeks of follow-up after the end of intervention. The primary outcome (the changes of LBP intensity at rest) will be measured at baseline before randomisation and immediately after the completion of weeks 4, 8 and 12 of the intervention, and the end of follow-up (week 24) using the visual analogue scale (VAS, 0-10 cm) to put a mark on the VAS scale to show how severities of their average low back pain have been over the past 24 h. Secondary outcomes, including Beck Depression Inventory-II, Pain Catastrophising Scale and Five Facet Mindfulness Questionnaire, Oswestry Disability Index and Short Form-36, will be measured at baseline and immediately after the completion of week 12 of the intervention and end of follow-up. The intention-to-treat and per-protocol principles will be used to analyse outcomes with a setting at α = 0.05 as statistical significance.

DISCUSSION

This comprehensive and detailed protocol will be the first trial to compare the effectiveness of different weekly frequencies of TC in elders with CNLBP. The outcomes may provide valuable data about the choice of the ideal number of sessions to further normalise the application of exercise for clinicians.

TRIAL REGISTRATION

Chinese clinical trial registry ChiCTR2200058190 . Registered on 1 April 2022.

Identification of Central Symptoms in Depression of Older Adults With the Geriatric Depression Scale Using Network Analysis and Item Response Theory

OBJECTIVE

This study aimed to identify the central symptoms of late-life depression using network analysis and the item response theory.

METHODS

A total of 3,472 older adults were enrolled and the Geriatric Depression Scale-15 (GDS-15) was used to evaluate the depressive symptoms. To identify the central symptoms and the network structures among the individual symptoms, the analyses of symptom network structures and item response theory were performed.

RESULTS

Among items on the GDS-15, "Happy," "Hopeless," "Empty," "Bored," "Worthless," and "Good spirits" showed significantly higher strength centrality than the other symptoms. Among all the edges, the edge between "Empty" and "Bored" was the strongest; however, these two symptoms were not connected strongly to other symptoms. In the analysis of item response theory, "Empty," "Bored," "Hopeless," "Worthless," "Happy," "Helpless," and "Satisfied" presented a very high value on the discrimination parameter.

CONCLUSION

Our study identified the central symptoms and the network structures among symptoms listed on the GDS-15. Most of central symptoms identified by network analysis and item response theory coincided. Our results suggest that these central symptoms need to be prioritized as highly comorbid symptoms and can contribute to the development of a brief screening tool for the elderly.

Development of visual-motor integration scale for the Korean old people

Effective methods to detect old people cognitive decline in early stages are needed in Korea, which is the fastest aging country in the world. This study aimed to develop a brief cognitive function measurement, Visual-Motor Integration Scale for the Korean elderly (VMIS-KE). In this methodological research, 16 preliminary items on visual-motor integration for the old people were chosen after literature review and expert validation. One hundred eighty participants aged 20–79 years were recruited to verify the validity and reliability of this measurement from community sources in Daegu city. The collected data were analyzed by exploratory factor analysis and confirmative factor analysis using SPSS and AMOS 18.0 program. The three factors (figure cognition, memory, and spatial cognition) with 12 items were finally extracted. Goodness of the fit was confirmed through confirmatory factor analysis. The Cronbach α was 0.867. The scores of overall VMIS-KE and every subcategory significantly decreased with age, especially in the 70s. VMIS-KE is the first valid and reliable measurement to assess cognitive decline of the Korean old people through visual motor integration, and can easily and quickly detect high-risk groups of dementia regardless of their educational level.

Optimal care for the management of older people non-weight bearing after lower limb fracture: a consensus study

Background

Older people who are non-weight-bearing after a lower limb fracture are at risk of poor outcomes but there are no clinical guidelines for this group of patients. Given the paucity of the research evidence base, we conducted a consensus exercise to ascertain expert opinion about the management of this group.

Methods

A three-round e-Delphi technique was planned to use the online JISC survey tool with a multidisciplinary panel of health professionals. Panellists were invited by email via professional organisations and UK NHS Trusts. The initial statements for this study were prepared by the authors based upon the findings of their scoping review. Consensus required >/= 70% agreement with statements.

Results

Only 2 survey rounds were required. Ninety panellists, representing seven clinical disciplines, reached consensus for 24 statements about general issues (osteoporosis detection and management, falls risk reduction and nutrition) and specific non-weight bearing issues (such as the need for activity to be promoted during this period).

Conclusions

These findings can be used in the generation of a clinical guideline for this group of patients.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02265-z.

Relations between postural sway and cognitive workload during various gaze tasks in healthy young and old people

The purpose of this study was to determine whether postural control would differ under various gaze tasks while standing in a wide or narrow stance between healthy young and old people, and also investigate whether postural sway and cognitive workload are affected by dual-task balance. Ten young and 10 healthy old people participated in this study. Each participant stood upright under four gaze conditions (fixation, saccade, pursuit, vestibular-ocular reflex) and two stance conditions (wide and narrow stance) in a total of 16 trials. Postural sway was measured by the mean sway amplitude of the center of pressure in the medial-lateral and anteriorposterior directions. Cognitive workload was measured through pupil response as an index of cognitive activity (ICA) by using Eye tracking system and Eyeworks. The results showed that postural sway significantly reduced when performing saccadic eye movement in both groups but greater postural sway was evoked in vestibular-ocular reflex condition. In addition, although old people had a significant increase in ICA compared to the young, there were no significant differences among all the gaze conditions in old people. These results confirmed that saccadic eye movements are the most beneficial for reducing postural sway regardless of aging and also provide some insight that pupil response represents an indicator of cognitive workload during dual-task balance context. These findings suggest that eye movement exercises may be considered as an effective intervention to improve postural control so a fall prevention program applying eye movement should be extended to individuals who are at risk of falling.

Development and piloting of a perturbation stationary bicycle robotic system that provides unexpected lateral perturbations during bicycling (the PerStBiRo system)

Background

Balance control, and specifically balance reactive responses that contribute to maintaining balance when balance is lost unexpectedly, is impaired in older people. This leads to an increased fall risk and injurious falls. Improving balance reactive responses is one of the goals in fall-prevention training programs. Perturbation training during standing or treadmill walking that specifically challenges the balance reactive responses has shown very promising results; however, only older people who are able to perform treadmill walking can participate in these training regimes. Thus, we aimed to develop, build, and pilot a mechatronic Perturbation Stationary Bicycle Robotic system (i.e., PerStBiRo) that can challenge balance while sitting on a stationary bicycle, with the aim of improving balance proactive and reactive control.

Methods

This paper describes the development, and building of the PerStBiRo using stationary bicycles. In addition, we conducted a pilot randomized control trial (RCT) with 13 older people who were allocated to PerStBiRo training (N = 7) versus a control group, riding stationary bicycles (N = 6). The Postural Sway Test, Berg Balance Test (BBS), and 6-min Walk Test were measured before and after 3 months i.e., 20 training sessions.

Results

The PerStBiRo System provides programmed controlled unannounced lateral balance perturbations during stationary bicycling. Its software is able to identify a trainee’s proactive and reactive balance responses using the Microsoft Kinect™ system. After a perturbation, when identifying a trainee’s trunk and arm reactive balance response, the software controls the motor of the PerStBiRo system to stop the perturbation. The pilot RCT shows that, older people who participated in the PerStBiRo training significantly improved the BBS (54 to 56, p = 0.026) and Postural Sway velocity (20.3 m/s to 18.3 m/s, p = 0.018), while control group subject did not (51.0 vs. 50.5, p = 0.581 and 15 m/s vs. 13.8 m/s, p = 0.893, respectively), 6MWT tended to improve in both groups.

Conclusions

Our participants were able to perform correct balance proactive and reactive responses, indicating that older people are able to learn balance trunk and arm reactive responses during stationary bicycling. The pilot study shows that these improvements in balance proactive and reactive responses are generalized to performance-based measures of balance (BBS and Postural Sway measures).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02015-1.

Analysis of gait pattern between genders in Korean old people and the effect of dimensionless numbers

The purpose of this study was to comparatively analyze normal gait on the plains by gender for old people reference data for the normal gait pattern for the old people. Participants were selected according to the Korean standard body type provided by the Ministry of Health and Welfare and used a three-dimensional motion analysis system. Cortex, Orthotrak, and Excel were used as the software for analyzing the extracted data, and IBM SPSS Statistics ver. 24.0 was used for statistical analysis. When data standardization was performed using the dimensionless numbers conversion, the step length and stride length of the lower extremities, which had differences between genders before dimensionless numbers conversion, showed no difference after dimensionless numbers conversion. Cadence, step time, and single support time of the left lower extremity, which had no difference between genders before dimensionless numbers conversion, were found to have significant differences after dimensionless numbers conversion. In addition, as a result of analyzing the coefficient of variation value to find out the degree of change in data due to dimensionless numbers conversion, there were increase and decrease in the coefficient of variation value ranging from −8.11% to 6.67% before and after dimensionless numbers conversion, which means dimensionless numbers conversion can affect the statistical test.

Immunotherapy in older patients with cancer

Ageing implicates a remodeling of our immune system, which is a consequence of the physiological senescence of our cells and tissues coupled with environmental factors and chronic antigen exposure. An immune system that senesces includes more differentiated cells with accumulation of highly differentiated CD4 and CD8 T cells. The pool of naive T cells decreases with the exponential thymic involution induced by age. Differentiated T cells have similar, if not higher, functional capacities but scarce studies are looking at the impact of senescence among specific T cells. After a stimulation, other immune cells (monocytes, dendritic cells and NK) are functionally altered during ageing. It is as if the immune system was more efficient at the basal level, but less efficient after a stimulation in the old compared to young people, likely due to less reserve. Concerning the clinical impact, older people are more prone to certain pathogens and their clinical manifestations differ from the younger people. Severe flu and VZV reactivation are more frequent with an altered cellular response to vaccination. Vaccination failure can have detrimental consequences in people presenting frailty criteria. Old people frailty is majored by their comorbidities and diseases like cancer. Thus, chemotherapies are employed with circumspection in older patients. The use of anti-PD-1/PD-L1 immunotherapies is therefore attractive, because of less side effects with a better response compared to chemotherapy. Old persons inclusion is lacking in current studies and clinical trials. Some subgroups or pooled analyses confirm the gain in response without increased toxicities in older patients but their inclusion criteria differ from the real-life practice. Specific studies focusing on this population are needed because of the increasing cancer incidence with age and the overall ageing of the population.

Sedentary behavior and kidney function in adults: a narrative review

There is increasing evidence for an association between SB and CKD, an emerging public health problem particularly affecting old people. For this reason a systematic literature search was carried out in Embase and PubMed (Jan 2000-Dec 2018) looking for an association between SB and kidney function. A total of 10 studies met the inclusion criteria (7 cross-sectional and 3 longitudinal investigations). A sedentary lifestyle was positively and independently of several confounders related to an impaired kidney function (chronic kidney disease or decrease of glomerular filtration rate), particularly in cross-sectional studies; however, more studies are needed to further establish the current evidence and to explore the exact independent mechanisms of sedentary behavior in relation to kidney function. Due to the inconsistency of the few longitudinal studies, future investigations are required to explore if SB is prospectively associated with a higher risk of developing CKD.

Effects of mirror feedback during balanced exercise performance in the old people with mild cognitive impairment

Unbalanced movements between the bilateral sides may lead to dyskinesia and reduced motor function. The upper limbs are the most complex joints with different rate of usage between the limbs. The dominant side is repeatedly used more than the contralateral side for better dexterity and musculoskeletal utility. Such imbalance between the two bilateral sides may lead to further difference in movement ability. This study aimed to observe the feasibility of the mirror feedback method in the upper limb movements in the old people with mild cognitive impairment. Twenty-seven-old people with history of stroke were selected. Motion sensors were used to assess the location and motion of two limbs in synchronized lateral raise that include the abduction and adduction motions during the mirror feedback and no feedback trials. The results of the mirror feedback showed comparatively similar motions between the left and right upper limbs. The results of the study may indicate possible recommendation of mirror feedback method for synchronizing exercise motion of the upper limbs for the old people with mild cognitive impairment.

Effects of Otago exercise combined with action observation training on balance and gait in the old people

This study aimed to investigate the effects of Otago exercise combined with action observation (AO) training on the balance, and gait in the old people to prevent falls in the community. A total of 30 old women participated and randomly assigned into three groups: AO plus Otago (n=10), Otago (n=10), or control (n=10). The AO plus Otago and Otago groups performed 50 min of strength training and balance exercises from the Otago Exercise Program 3 times a week for 12 weeks. The AO plus Otago group received an additional 20 min of training 3 times a week. We used the electronic muscle dynamometer to changes in strength, Timed Up and Go (TUG) test to evaluate dynamic balance, and the short version of the Falls Efficacy Scale-International was used to evaluate the fear of falls, and GAITRite was used to evaluate changes in the spatiotemporal parameters of walking. The muscle strength significantly increased in the AO plus Otago and Otago groups compared to the strength before training. The TUG test showed a significant improvement in the dynamic balance in both intervention groups. A significant increase was observed in the walking speed, cadence, step length, and stride length in both intervention groups. We also noted a significant change in the efficacy measures for falls. It is expected that Otago exercise combined with AO training will be used as an intervention method in hospital treatment programs and the old people facilities for preventing falls in the old people.

Walking meditation promotes ankle proprioception and balance performance among elderly women

BACKGROUND

Age-related change of proprioception affects body balance among the elderly. Walking meditation (WM)-a mindfulness practice-involves focusing on leg movements while walking slowly, possibly improving brain processes for perception and balance adjustments. This study investigates the WM's effects on ankle proprioception and balance among the elderly.

METHODS

Fifty-eight women aged 69.25 ± 6.06 were randomized into control (n = 29) and WM (n = 29) groups. The WM group engaged in 8 weeks of WM practice (30 min/day, 3 days/week). The absolute angular error of the ankle reposition test (AAE) was measured by an electrogoniometer. The balance performance was evaluated using the Berg Balance Scale (BBS), Functional Reach Test (FRT), and Timed Up and Go test (TUG). Data were analyzed using two-way ANOVA and Bonferroni post hoc test and BBS with nonparametric statistics.

RESULTS

At baseline, the WM group's AAE, BBS, FRT, and TUG were 4.2 ± 1.6°, 51.3 ± 4.1 points, 21.7 ± 5.7 cm, and 11.1 ± 2.5 s, respectively, whereas those of the control group were 3.6 ± 2.0°, 51.0 ± 5.0 points, 21.6 ± 5.2 cm, and 10.2 ± 3.1 s, respectively. Post-training, WM group showed significant decrease in AAE (2.4 ± 0.9°) and displayed improvements in BBS, FRT, and TUG (55.4 ± 0.9 points, 29.1 ± 5.8 cm, and 8.1 ± 1.1 s, respectively) (p < 0.01). Conversely, the control group presented no change in AAE, significant decreases in BBS and FRT, and slower TUG (p < 0.01). No difference was found between WM and control groups at the baseline. However, post-training, WM group demonstrated significant improvements in AAE, BBS, FRT, and TUG as compared to the control group (p < 0.001).

CONCLUSIONS

WM practice improved the balance and ankle reposition sense among the elderly. It can be used as an alternative form of training to promote balance and ankle proprioception. The results supported that balance performance worsens among the elders who do not engage in physical training.

Life satisfaction as the main factor behind the elderly`s health knowledge utilization: A qualitative study in an Iranian context

Background: The elderly population’s health has become a priority as their numbers are on the rise and they are increasingly becoming vulnerable to physical and mental diseases. Studies show that an elderly person’s health depends on his/her utilization of health knowledge in daily life. Hence, here we investigated the contributing factors of knowledge utilization in the elderly population.

Methods: A qualitative study was conducted through conventional content analysis. Semi-structured in-depth interviews were held with 29 elderly individuals from Tehran. A focus group discussion was conducted (eight elderly individuals), and an expert panel was held with nine experts to complement the results.

Results: Upon data analysis, four categories and seven subcategories were extracted. The main categories included provision of basic needs, maintaining dignity, life satisfaction, and negative feelings toward self and others. The concept of ‘life satisfaction’ held a pivotal role in relation to the other categories.

Conclusion: Life satisfaction was the main category in the utilization of health knowledge among the elderly. Aging should be foreseen and forethought to increase life satisfaction. The followings can be effective in increasing life satisfaction in the elderly: Promoting positive-thinking, placing greater emphasis on spiritualism in life, employment of the elderly, and promoting the culture and tradition of respecting the elderly.

Life satisfaction as the main factor behind the elderly`s health knowledge utilization: A qualitative study in an Iranian context

Background: The elderly population's health has become a priority as their numbers are on the rise and they are increasingly becoming vulnerable to physical and mental diseases. Studies show that an elderly person's health depends on his/her utilization of health knowledge in daily life. Hence, here we investigated the contributing factors of knowledge utilization in the elderly population. Methods: A qualitative study was conducted through conventional content analysis. Semi-structured in-depth interviews were held with 29 elderly individuals from Tehran. A focus group discussion was conducted (eight elderly individuals), and an expert panel was held with nine experts to complement the results. Results: Upon data analysis, four categories and seven subcategories were extracted. The main categories included provision of basic needs, maintaining dignity, life satisfaction, and negative feelings toward self and others. The concept of 'life satisfaction' held a pivotal role in relation to the other categories. Conclusion: Life satisfaction was the main category in the utilization of health knowledge among the elderly. Aging should be foreseen and forethought to increase life satisfaction. The followings can be effective in increasing life satisfaction in the elderly: Promoting positive-thinking, placing greater emphasis on spiritualism in life, employment of the elderly, and promoting the culture and tradition of respecting the elderly.

Do older adults know the purpose of their medications? A survey among community-dwelling people

PURPOSE

This study assessed the level of knowledge among community-dwelling older individuals about the purpose of medications and the characteristics that influenced that knowledge. We focused on drugs frequently used and/or often involved in iatrogenic events.

METHODS

This cross-sectional survey included 2690 community-dwelling older adults, aged 68 years and above, who reported using at least one drug of interest, in the canton of Vaud, Switzerland. Participants reported drugs that they currently used and described their purpose. A good knowledge level was defined as knowledge of the exact purpose or identification of the anatomical system or organ targeted by the drug. We performed a multivariate logistic regression analysis to identify factors associated with a good knowledge level for all drugs of interest. Sampling weights were employed to provide representative estimates.

RESULTS

On average, patients had good knowledge of 80.6% of the drugs reported. The highest knowledge levels were demonstrated for non-steroidal antiinflammatory drugs, antidiabetics, analgesics, and endocrinological drugs and the lowest for platelet aggregation inhibitors, minerals, anticoagulants, and other narrow therapeutic index drugs. Overall, 66% of participants had good knowledge of the purpose of all the drugs of interest. Polypharmacy and receiving help with drug management were negatively associated with good knowledge (adjusted OR_{4-5 drugs} 0.45; 95% CI 0.29-0.71, adjusted OR_{≥ 6 drugs} 0.20; 95% CI 0.13-0.31, and adjusted OR_help 0.42; 95% CI 0.18-0.99).

CONCLUSION

This study showed that education about drugs was lacking among patients that received multiple drugs, particularly patients that used anticoagulants and antiplatelet inhibitors.

Elder abuse and its impact on quality of life in nursing homes in China

There are limited available data on elder abuse and its impact on quality of life (QOL) in China. This study investigated the prevalence of elder abuse in nursing homes and its associated demographic, clinical factors and QOL in Macau and Guangzhou, China. A total of 681 subjects (244 in Macau and 437 in Guangzhou) were consecutively recruited. The prevalence of elder abuse was 11.48% and 8.24% in Macau and Guangzhou, respectively. Multivariate analyses revealed that having a religion and depressive symptoms were independently and positively associated with elder abuse. No significant association between elder abuse and any QOL domain was found. Elder abuse is common in nursing homes in both Macau and Guangzhou. Appropriate strategies and educational programs should be developed for health professionals to reduce the risk of elder abuse.

Use of complementary therapies in nursing homes: Descriptive study

INTRODUCTION

Complementary therapies may have positive effect on residents in nursing homes. The aim of this research was to investigate what kind of complementary therapies are provided in Icelandic nursing homes and who are the providers. Also whether the nursing homes need assistance to support the use of such therapies.

METHOD

A questionnaire was mailed to all the nursing homes in Iceland (N = 59). Total of forty-five nursing homes replied or 76% response rate.

RESULTS

Registered nurses and licenced practical did most of the planning and provision of complementary therapies. The most common therapies were: heat packs, physical exercise and massage. Managers would like to have more knowledge and support in providing complementary therapies.

CONCLUSION

The use of some complementary therapies is common in Icelandic nursing homes. More knowledge is needed to support the use of CT in Icelandic nursing homes.

Estimating renal function in old people: an in-depth review

Estimates of glomerular filtration rate (eGFR) should provide accurate measure of an individual's kidney function because important clinical decisions such as timing of renal replacement therapy and drug dosing may be dependent on eGFR. Formulae from which eGFR is derived are generally based on serum creatinine measurement, such as Cockcroft-Gault, MDRD and CKD-EPI. More recently, calculation of eGFR using other laboratory biomarkers such as cystatin C has emerged with apparent greater accuracy. In old people, there is age-related physiological change in the kidney, which could lead to reduced GFR. Likewise, physiological changes in body composition that occur with the ageing process impede the use of a single creatinine-based calculation of eGFR across all adult age groups. Studies have shown differences in the prevalence of CKD based on the type of equation used to estimate GFR. This review discusses the evolution of eGFR calculations and the relative accuracy of such equations in older population.

Drug-related problems and medication reviews among old people with dementia

BACKGROUND

Drug-related problems, including medication errors and adverse drug events, are common among old people. Due to, for example, greater susceptibility to side effects, people with dementia are even more at risk of drug-related problems. The objectives of this study were to assess the occurrence and character of drug-related problems found among old people with dementia or cognitive impairment.

METHODS

Data from a randomized controlled clinical trial exploring the effects of a pharmacist intervention as part of a hospital ward team in patients 65 years and older with dementia or cognitive impairment were used. The study was conducted between 2012 and 2014 in the orthopedic and medicine wards in two hospitals located in Northern Sweden. Drug-related problems identified in this patient group were classified and described, and associations with different factors were investigated.

RESULTS

Clinical pharmacists identified at least one DRP in 66% (140/212) of participants in the intervention group, for a total of 310 DRPs. Ineffective drug/inappropriate drug and unnecessary drug therapy were the most common drug-related problems. Discontinuation of drug therapy was the most common action carried out. Drug-related problems were more common among people prescribed a larger number of drugs and among people with an earlier stroke.

CONCLUSIONS

Drug-related problems are common among people with dementia and cognitive impairment. Comprehensive medication reviews conducted by clinical pharmacists as part of a health care team might be important to prevent, identify and solve these problems.

Pharmacist participation in hospital ward teams and hospital readmission rates among people with dementia: a randomized controlled trial

Purpose

To assess whether comprehensive medication reviews conducted by clinical pharmacists as part of a healthcare team reduce drug-related hospital readmission rates among people with dementia or cognitive impairment.

Methods

This randomized controlled trial was carried out between January 9, 2012, and December 2, 2014. Patients aged ≥65 years with dementia or cognitive impairment admitted to three wards at two hospitals located in Northern Sweden were included.

Results

Of the 473 deemed eligible for participation, 230 were randomized to intervention and 230 to control group by block randomization. The primary outcome, risk of drug-related hospital readmissions, was assessed at 180 days of follow-up by intention-to-treat analysis.

During the 180 days of follow-up, 18.9% (40/212) of patients in the intervention group and 23.0% (50/217) of those in the control group were readmitted for drug-related reasons (HR = 0.80, 95% CI = 0.53–1.21, p = 0.28, univariable Cox regression). Heart failure was significantly more common in the intervention group. After adjustment for heart failure as a potential confounder and an interaction term, multiple Cox regression analysis indicated that pharmacist participation significantly reduced the risk of drug-related readmissions (HR = 0.49, 95% CI = 0.27–0.90, p = 0.02). A post-hoc analysis showed a significantly reduced risk of 30-day readmissions due to drug-related problems in the total sample (without adjustment for heart failure).

Conclusion

Participation of clinical pharmacists in healthcare team conducting comprehensive medication reviews did not significantly reduce the risk of drug-related readmissions in patients with dementia or cognitive impairment; however, post-hoc and subgroup analyses indicated significant effects favoring the intervention. More research is needed. Trial registration: Clinical trials NCT01504672.

Electronic supplementary material

The online version of this article (doi:10.1007/s00228-017-2249-8) contains supplementary material, which is available to authorized users.

A structural equation model of the relation between socioeconomic status, physical activity level, independence and health status in older Iranian people

BACKGROUND AND AIM

Health status is an independent predictor of mortality, morbidity and functioning in older people. The present study was designed to evaluate the link between socioeconomic status (SES), physical activity (PA), independence (I) and the health status (HS) of older people in Iran, using structural equation modelling.

METHODS

Using computerized randomly selection, a representative sample of 851 75-year-olds living in Tehran (2007-2008), Iran, was included. Participants answered questions regarding indicators of HS, SES and also PA and I through interviews. Both measurement and conceptual models of our hypotheses were tested using Mplus 5. Maximum-likelihood estimation with robust standard errors (MLR estimator), chi-square tests, the goodness of fit index (and degrees of freedom), as well as the Comparative Fit Index (CFI), and the Root Mean Square Error of Approximation (RSMEA) were used to evaluate the model fit.

RESULTS

The measurement model yielded a reasonable fit to the data, χ2=110.93, df=38; CFI=0.97; RMSEA=0.047, with 90% C.I.=0.037-0.058. The model fit for the conceptual model was acceptable; χ2=271.64, df=39; CFI=0.91; RMSEA=0.084, with 90% C.I.=0.074-0.093. SES itself was not a direct predictor of HS (β=0.13, p=0.059) but it was a predictor of HS either through affecting PA (β=0.31, p<0.001) or I (β=0.57, p<0.001).

CONCLUSION

Socioeconomic status appeared to influence health status, not directly but through mediating some behavioral and self-confidence aspects including physical activity and independence in ADL.

Physical activity, fitness, and all-cause mortality: An 18-year follow-up among old people

BACKGROUND

Little is known about change in physical activity (PA) and its relationship to all-cause mortality among old people. There is even less information about the association between PA, fitness, and all-cause mortality among people aged 80 years and above. The objective is to investigate persistence and change in PA over 5 years as a predictor of all-cause mortality, and fitness as a mediator of this association, among people aged 80 and 85 years at the beginning of an 18-year mortality follow-up period.

METHODS

Using Evergreen Project data (started in 1989), 4 study groups were formed according to self-reported changes in PA level, over a 5-year period (starting in 1989-1990 and ending in 1994-1995): remained active (RA, control group), changed to inactive (CI), remained inactive (RI), and changed to active (CA). Mortality was followed up over the 18-year period (1994-2012). Cox models with different covariates such as age, sex, use of alcohol, smoking, chronic diseases, and a 10 m walking test were used to analyze the association between change in PA level and mortality.

RESULTS

Compared to RA, those who decreased their PA level (CI) between baseline and follow-up had higher all-cause mortality (hazard ratio (HR = 2.09; 95%CI: 1.63-2.69) when adjusted for age, gender, and chronic diseases. RI showed the highest all-cause mortality (HR = 2.16; 95%CI: 1.59-2.93). In CA, when compared against RA, the risk of all-cause mortality was not statistically significant (HR = 1.51; 95%CI: 0.95-2.38). In comparison with RA, when walking speed over 10 m was added as a covariate, all-cause mortality risk was almost statistically significant only in CI (HR = 1.37; 95%CI: 1.00-1.87).

CONCLUSION

Persistence and change in PA level was associated with mortality. This association was largely explained by fitness status. Randomized controlled studies are needed to test whether maintaining or increasing PA level could lengthen the life of old people.

Population based haematology reference ranges for old people in rural South-West Uganda

Background

Haematology reference values are needed to interpret haematology results and make clinical decisions, but these have not been established for old people in sub-Saharan Africa. The objective of this study was to establish haematology reference values for people aged 50 years and above in Uganda, to compare the haematology reference values for those aged 65 years and over with those less than 65 years and to compare these haematology reference values with established haematology reference values for old people from high income countries.

Methods

A total of 1449 people aged 50 years and above were recruited from the Medical Research Council/Uganda Virus Research Institute general population cohort between January 2012 and January 2013 (response rate 72.3 %). From the blood samples collected, we did haematology, HIV testing and malaria tests. We also obtained stool samples and tested them for hookworm infection. Questionnaire data were obtained through interviews. In the analysis, we excluded those with HIV infection, malaria infection, hookworm infection and those not feeling well at the time of recruitment. Medians and reference ranges for 12 haematology parameters were determined, based on the Clinical Laboratory and Standards institute’s guidelines.

Results

In total, 903 people aged 50 years and above were included in the analysis with the majority 545 (60.3 %) being female. Men had significant difference in median haemoglobin, haematocrit, erythrocytes counts and white blood cells counts, which were higher than those of women. Women had significant difference in mean platelet counts and neutrophil percentages which were higher than those of men. Comparing those aged 65+ and those aged less than 65 years, the following parameters were significantly lower in those aged above 65 years: haemoglobin, haematocrit, erythrocytes counts, platelets and mean corpuscular volume. Compared to the reference intervals from old people in high income countries, all the haematology parameters from our study population were low.

Conclusion

The differences between haematology reference ranges in old people compared to adults and the very old (65+) compared to those between 50 and 65 call for more population based studies using nationwide surveys to be carried out among old people in other study settings in Uganda and the rest of Africa to explore the differences in haematology reference ranges between these different age groups with a view of establishing whether there is need to have separate reference range for these different categories of old people.

OLDER PEOPLE WITH CHRONIC KIDNEY DISEASE: DEFINITION, AND INFLUENCE OF BIOMARKERS AND MEDICATIONS UPON CARDIOVASCULAR AND RENAL OUTCOMES

BACKGROUND

Chronic kidney disease (CKD) is a global problem. With an ageing population the burden on the health services has increased due to the growing number of older people with CKD. This group of individuals is far different to the younger CKD population and their risk of cardiovascular death is far greater than the risk of progressing to end stage kidney disease (ESKD).

OBJECTIVE

In this review we explore the role of certain biomarkers and medications in predicting the risk of progression to ESKD and death in old people with CKD.

METHODS

An electronic literature search of EMBASE and MEDLINE databases was performed using Healthcare Databases Advanced Search (HDAS) in December 2014.

RESULTS

Albuminuria is a key biomarker in predicting the risk of death and progression to ESKD. Cystatin C appears to be superior in predicting the risk of cardiovascular and non-cardiovascular death compared to GFR or creatinine. Several inflammatory biomarkers can be used to predict the risk of death and progression to CKD but measuring and monitoring them in routine clinical practice will be expensive and impractical. The effects of long-term RAAS inhibition in older people are not well established. Older people especially those with CKD receive suboptimal secondary preventive measures. Due to multiple comorbidities older people with CKD are usually receiving a number of medications. This can potentially lead to significant adverse drug events (ADE) due to drug interactions.

CONCLUSION

Novel non-traditional risk factors like albuminuria, Cystatin C and inflammatory biomarkers play an important role in predicting their risk of death and progression to ESKD. The efficacy and safety of medications in older people with CKD is not well established and requires more extensive, focused study.

[Reasons for admission of elderly people in reanimation in the Gabriel Touré teaching hospital of Bamako]

INTRODUCTION

Reanimation consists of the taking care of patients of all ages presenting or likely to present one or more acute failures directly affecting their likelihood of survival. According to the Society of Reanimation of the French Languages in 2012, in the United States 50% of the patients admitted in reanimation have more than 65 years whereas in France, the patients older than 80 years represent more than 10% of the admissions of the intensive care units.

OBJECTIVE

To determine the reasons for admission of the elderly patients in reanimation of the Gabriel Touré teaching hospital.

PATIENTS AND METHOD

A cross-sectional study was conducted from October 2010 to September 2011 in the Gabriel Touré teaching hospital of Bamako. Patients aged 65 year old and up were included. All patients were the subject of a meticulous clinical examination. Data graphing was done using Excel. The analysis of the data was made on the SPSS 17.0 software. The statistical test used was Chi₂ with a significance fixed to P = 0, 05.

RESULTS

During the period of study, the data of 95 elderly people was collected for 501 admissions (18.9%); the 65 to 74 years old age bracket represented 63.3% (figure 1). The sex-ratio was 1.4 in favour of men. Mental deterioration was the principal cause for admission in 65.3% of the cases. Cerebral vascular accidents were the most encountered pathology with 40.7% of cases. The most common noted prognosis was the likelihood of intervention complications.

CONCLUSION

The most common admission factors were mental deterioration, respiratory distress syndrome. The prognosis is conservative considering the patients' old age, medical pathology, and a Glasgow score inferior to 8 at the time of admission.

Association between dietary folate intake and serum insulin-like growth factor-1 levels in healthy old women

OBJECTIVE

High serum levels of insulin-like growth factor-1 (IGF-1) seem to coincide with higher rates of some types of cancer and the risk of all-cause mortality in old people. Eating vegetables seems to reduce IGF-1 levels because they are rich in micronutrients such as vitamins. This study investigates the possible association between vitamin intake and IGF-1 levels in a representative group of healthy elderly women with Mediterranean dietary habits.

DESIGN

This cross-sectional study included 124 healthy women with a mean age of 71.3 ± 4.2 years and a mean body mass index (BMI) of 27.37 ± 3.48 kg/m(2) attending a mild fitness program twice a week at public gyms in Padova. The main parameters considered were IGF-1 (measured by chemiluminescence) and diet, assessed on the basis of a 3-day record and a questionnaire on the frequency with which they usually ate certain foods.

RESULTS

The mean IGF-1 level for the sample as a whole was 136.2 ± 38.9 μg/l, and was significantly lower in women with a higher folate intake (p = 0.04). On simple linear analysis, the vitamins found associated with serum IGF-1 levels were: folates (r: -0.25; p = 0.003); vitamin E (r: -0.21; p = 0.01); vitamin D (r: -0.17; p = 0.03); and riboflavin (r: -0.16; p=0.03). After removing the effect of calorie, protein, carbohydrate and fat intake, and other known potential confounders (age, BMI, alcohol intake), only folate intake correlated with IGF-1 levels (r = -0.17; p = 0.04).

CONCLUSION

A folate-rich diet could have the effect of lowering circulating IGF-1 levels in elderly women.