Social participation and functional disability trajectories in the last three years of life: The Japan Gerontological Evaluation Study

BACKGROUND

Functional disability has various patterns from onset until death. Although social participation is a known protective factor against functional disability among older individuals, it is unclear whether social participation is associated with the trajectory patterns of functional disability prior to death. This study assessed the association between social participation, specifically in horizontal and vertical groups, and the trajectories of functional disability prior to death.

METHODS

We used survey data from the 2010 Japan Gerontological Evaluation Study for functionally independent older adults combined with public long-term care insurance system data from 2010 to 2016 (n = 4,502). The outcome variables included five previously identified trajectory patterns using group-based trajectory modeling. As the explanatory variable, we used three definitions of social participation: any group, horizontal group (e.g., sports, hobbies), or vertical group (e.g., political, religious), at least once a month. We used a multinomial logistic regression analysis to calculate odds ratios with 95 % confidence intervals for the identified trajectory patterns.

RESULTS

Participation in any groups was significantly less likely to belong to "Accelerated disability" (OR=0.74 [95 % CIs 0.60-0.92]), "Persistently mild disability" (0.68 [0.55-0.84]), and "Persistently severe disability" (0.67 [0.50-0.83]) compared to "Minimum disability." Although participation in horizontal groups was similarly associated with trajectories regardless of gender, vertical groups was not associated with trajectories among males.

CONCLUSIONS

Social participation among older adults may be associated with an extended period of living without disabilities before death. This association may differ by gender and social participation group and requires further research.

Designing a tool ensuring older patients the right medication at the right time after discharge from hospital- the first step in a participatory design process

BACKGROUND

On average, older patients use five or more medications daily, increasing the risk of adverse drug reactions, interactions, or medication errors. Healthcare sector transitions increase the risk of information loss, misunderstandings, unclear treatment responsibilities, and medication errors. Therefore, it is crucial to identify possible solutions to decrease these risks. Patients, relatives, and healthcare professionals were asked to design the solution they need.

METHODS

We conducted a participatory design approach to collect information from patients, relatives, and healthcare professionals. The informants were asked to design their take on a tool ensuring that patients received the correct medication after discharge from the hospital. We included two patients using five or more medications daily, one relative, three general practitioners, four nurses from different healthcare sectors, two hospital physicians, and three pharmacists.

RESULTS

The patients' solution was a physical location providing a medication overview, including side effects and interactions. Healthcare professionals suggested different solutions, including targeted and timely information that provided an overview of the patient's diagnoses, treatment and medication. The common themes identified across all sub-groups were: (1) Overview of medications, side effects, and diagnoses, (2) Sharing knowledge among healthcare professionals, (3) Timely discharge letters, (4) Does the shared medication record and existing communication platforms provide relevant information to the patient or healthcare professional?

CONCLUSION

All study participants describe the need for a more concise, relevant overview of information. This study describes elements for further elaboration in future participatory design processes aimed at creating a tool to ensure older patients receive the correct medication at the correct time.

Impact of Age on Prescribing Patterns of Cardiovascular Medications in Older Japanese Patients with Non-Dialysis-Dependent Chronic Kidney Disease: A Cross-Sectional Study

AIM

Older patients with chronic kidney disease (CKD) are more likely to be excluded from clinical trials. This exclusion affects the quality of cardiovascular disease (CVD) prevention in this population.

METHODS

Baseline data from the Fukuoka Kidney Disease Registry (FKR) cohort, which included 4476 adult patients with CKD stages G1-G5, were cross-sectionally analyzed to compare the use of recommended drugs for preventing CVD in each age group.

RESULTS

Different prescribing patterns were observed according to age for the cardiovascular drug classes. Older patients with CKD were less likely to receive renin-angiotensin system (RAS) inhibitors and were more likely to receive calcium channel blockers. The proportion of anticoagulation prescriptions for patients with CKD and atrial fibrillation decreased in the older age group (≥ 75 years). However, the proportion of antiplatelet therapy in patients with ischemic CVD increased linearly with age, even in the very old group aged ≥ 85 years. These findings suggest a severe cardiovascular burden in patients with CKD. Notably, RAS inhibitor use was avoided in the older group despite a severe cardiovascular burden, such as a high prevalence of CVD history and massive albuminuria ＞300 mg/g creatinine. This finding indicates that an older age independently contributed to the non-use of RAS inhibitors, even after adjusting for other covariates.

CONCLUSIONS

This study suggests that age is a potential barrier to the treatment of patients with CKD and highlights the need to establish individualized treatment strategies for cardiovascular protection in this population.

Frailty and psychiatric disorders: A bidirectional Mendelian randomization study

BACKGROUND

The association between frailty and psychiatric disorders has been reported in observational studies. However, it is unclear whether frailty facilitates the appearance of psychiatric disorders or vice versa. Therefore, we conducted a bidirectional Mendelian randomization (MR) study to evaluate the causality.

METHODS

Independent genetic variants associated with frailty index (FI) and psychiatric disorders were obtained from large genome-wide association studies (GWAS). The inverse variance weighted method was utilized as the primary method to estimate causal effects, followed by various sensitivity analyses. Multivariable analyses were performed to further adjust for potential confounders.

RESULTS

The present MR study revealed that genetically predicted FI was significantly and positively associated with the risk of major depressive disorder (MDD) (odds ratio [OR] 1.79, 95 % confidence interval [CI] 1.48-2.15, P = 1.06 × 10-9), anxiety disorder (OR 1.61, 95 % CI 1.19-2.18, P = 0.002) and neuroticism (OR 1.38, 95 % CI 1.18-1.61, P = 3.73 × 10-5). In the reverse MR test, genetic liability to MDD (beta 0.232, 95 % CI 0.189-0.274, P = 1.00 × 10-26) and neuroticism (beta 0.128, 95 % CI 0.081-0.175, P = 8.61 × 10-8) were significantly associated with higher FI. Multivariable analyses results supported the causal association between FI and MDD and neuroticism.

LIMITATIONS

Restriction to European populations, and sample selection bias.

CONCLUSIONS

Our study suggested a bidirectional causal association between frailty and MDD neuroticism, and a positive correlation of genetically predicted frailty on the risk of anxiety disorder. Developing a deeper understanding of these associations is essential to effectively manage frailty and optimize mental health in older adults.

Social network and related factors in older people with sensory impairment in the community: Using principal component analysis

AIM

Older people with sensory impairment are more likely to have smaller and weaker social network due to their reduced ability, which lowers their quality of life. However, there is little research on the social network in older people with sensory impairment, especially the related factors. The aim of the study was to explore the related factors of social network and to provide evidence for the improvement of social network to promote successful aging in older people with sensory impairment.

METHODS

A cross-sectional study was conducted among 374 participants for hearing and vision assessment and questionnaire survey in a community, Beijing. Data were collected and analyzed by principal component analysis (PCA) and multiple logistic regression using IBM SPSS 25.0 software.

RESULTS

PCA showed that there were six risk factors whose eigenvalues >1 were extracted, with a total variance of 56.555%. Multiple logistic regression analysis of principal component indicated that five factors including physical health factor, social interaction factor, psychological status factor, lifestyle factor, and family condition factor, were statistically significant (p < 0.05).

CONCLUSIONS

The social network of older people with sensory impairment is relatively poor. Physical health factor, social interaction factor, psychological status factor, lifestyle factor, and family condition factor may be related factors. Medical staff should pay attention to physical, psychological and social characteristics of older people, especially with sensory impairment, to carry out necessary measures to improve social network and avoid social isolation.

Geriatrics and artificial intelligence in Spain (Ger-IA project): talking to ChatGPT, a nationwide survey

PURPOSE

The purposes of the study was to describe the degree of agreement between geriatricians with the answers given by an AI tool (ChatGPT) in response to questions related to different areas in geriatrics, to study the differences between specialists and residents in geriatrics in terms of the degree of agreement with ChatGPT, and to analyse the mean scores obtained by areas of knowledge/domains.

METHODS

An observational study was conducted involving 126 doctors from 41 geriatric medicine departments in Spain. Ten questions about geriatric medicine were posed to ChatGPT, and doctors evaluated the AI's answers using a Likert scale. Sociodemographic variables were included. Questions were categorized into five knowledge domains, and means and standard deviations were calculated for each.

RESULTS

130 doctors answered the questionnaire. 126 doctors (69.8% women, mean age 41.4 [9.8]) were included in the final analysis. The mean score obtained by ChatGPT was 3.1/5 [0.67]. Specialists rated ChatGPT lower than residents (3.0/5 vs. 3.3/5 points, respectively, P < 0.05). By domains, ChatGPT ​​scored better (M: 3.96; SD: 0.71) in general/theoretical questions rather than in complex decisions/end-of-life situations (M: 2.50; SD: 0.76) and answers related to diagnosis/performing of complementary tests obtained the lowest ones (M: 2.48; SD: 0.77).

CONCLUSION

Scores presented big variability depending on the area of knowledge. Questions related to theoretical aspects of challenges/future in geriatrics obtained better scores. When it comes to complex decision-making, appropriateness of the therapeutic efforts or decisions about diagnostic tests, professionals indicated a poorer performance. AI is likely to be incorporated into some areas of medicine, but it would still present important limitations, mainly in complex medical decision-making.

Conceptualizing Self-Harm through the Experiences of Psychogeriatric Experts

INTRODUCTION

Fewer studies thus far have focused on self-harm and its specific forms among older adults. Moreover, the limited available literature applies varying terminology. The categorization of self-harm used in younger populations may not be as appropriate for this population. This means that less is known about this phenomenon in older adults. The current study aimed to reduce this gap.

METHODS

Nine Flemish psychogeriatric experts participated in a semi-structured interview. Transcripts were thematically analyzed.

RESULTS

Themes emerging from the interviews suggest that self-harm in older adults may also include distinct elements, such as the omission of certain behaviours and engagement in indirect self-harm to cause bodily harm. According to the experts, self-harm may be engaged in to cope with emotions, express life fatigue, hasten death, and communicate a cry for help.

DISCUSSION

Self-harm is prevalent in older adults, and some characteristics may be specific to self-harm in an older age group. These findings may enable clinicians to be more alert to self-harm in older adults and consequently prevent serious suicidal behaviour. More research is needed to further uncover this phenomenon.

Cardiovascular risk reduction in older people with type 2 diabetes mellitus-a comprehensive narrative review

Metabolic targets are controversial in older people with type 2 diabetes due to functional heterogeneity and morbidity burden. Tight blood pressure and metabolic control appears beneficial in fit individuals who are newly diagnosed with type 2 diabetes and have fewer comorbidities. The benefits of low blood pressure and tight metabolic control is attenuated with the development of comorbidities, especially frailty. Guidelines consider frail older people as one category and recommend relaxed targets. However, sarcopenic obese frail individuals may benefit from tight targets and intensification of therapy due to their unfavourable metabolic profile, accelerated diabetes trajectory and high cardiovascular risk. In addition, the early use of sodium glucose transporter-2 inhibitors and glucagon like peptide-1 receptor agonists may be beneficial in this frailty phenotype due to their cardio-renal protection, which is independent of glycaemic control, provided they are able to engage in resistance exercise training to avoid loss of muscle mass. In the anorexic malnourished frail individual, early use of insulin, due to its weight gain and anabolic properties, is appropriate. In this phenotype, targets should be relaxed with deintensification of therapy due to significant weight loss, decelerated diabetes trajectory and increased risk of medication side effects.

A European survey of older peoples' preferences, and perceived barriers and facilitators to inform development of a medication-related fall-prevention patient portal

PURPOSE

Falls are a major and growing health care problem in older adults. A patient portal has the potential to provide older adults with fall-prevention advice to reduce fall-risk. However, to date, the needs and preferences regarding a patient portal in older people who have experienced falls have not been explored. This study assesses content preferences, potential barriers and facilitators with regard to using a patient portal, as perceived by older people who have experienced falls, and explores regional differences between European participants.

METHODS

We conducted a survey of older adults attending an outpatient clinic due to a fall or fall-related injury, to explore their content preferences, perceived barriers, and facilitators with respect to a fall-prevention patient portal. Older adults (N = 121, 69.4% female, mean age: 77.9) were recruited from seven European countries.

RESULTS

Almost two-thirds of respondents indicated they would use a fall-prevention patient portal. The portal would preferably include information on Fall-Risk-Increasing Drugs (FRIDs), and ways to manage other related/relevant medical conditions. Facilitators included a user-friendly portal, with easily accessible information and physician recommendations to use the portal. The most-commonly-selected barriers were privacy issues and usage fees. A family member's recommendation to use the portal was seemingly more important for Southern and Eastern European participants compared to the other regions.

CONCLUSION

The majority of older people with lived falls experience expressed an interest in a fall-prevention patient portal providing personalized treatment advice to prevent further falls. The results will be used to inform the development of a fall-prevention patient portal. The fall-prevention patient portal is intended to be used in addition to a consultation with a physician. Future research is needed to explore how to prevent falls in older patients who are not interested in a fall-prevention patient portal.

Partially supervised exercise programmes for fall prevention improve physical performance of older people at risk of falling: a three-armed multi-centre randomised controlled trial

BACKGROUND

Falls have a major impact on individual patients, their relatives, the healthcare system and related costs. Physical exercise programmes that include multiple categories of exercise effectively reduce the rate of falls and risk of falling among older adults.

METHODS

This 12-month, assessor-blinded, three-armed multicentre randomised clinical trial was conducted in adults aged ≥ 65 years identified as at risk of falling. Four hundred and five participants were randomly allocated into 3 groups: experimental group (n = 166) with the Test&Exercise partially supervised programme based on empowerment delivered with a tablet, illustrated manual and cards, reference group (n = 158) with the Otago partially supervised programme prescribed by a physiotherapist delivered with an illustrated manual and control group (n = 81) with the Helsana self-administrated programme delivered with cards. Experimental and reference groups received partially supervised programmes with 8 home sessions over 6 months. Control group received a self-administered program with a unique home session. The 3 groups were requested to train independently 3 times a week for 12 months. Primary outcome was the incidence rate ratio of self-reported falls over 12 months. Secondary outcomes were fear of falling, basic functional mobility and balance, quality of life, and exercise adherence.

RESULTS

A total of 141 falls occurred in the experimental group, 199 in the reference group, and 42 in the control group. Incidence rate ratios were 0.74 (95% CI 0.49 to 1.12) for the experimental group and 0.43 (95% CI 0.25 to 0.75) for the control group compared with the reference group. The Short Physical Performance Battery scores improved significantly in the experimental group (95% CI 0.05 to 0.86; P = 0.027) and in the reference group (95% CI 0.06 to 0.86; P = 0.024) compared with the control group.

CONCLUSION

The self-administered home-based exercise programme showed the lowest fall incidence rate, but also the highest dropout rate of participants at high risk of falling. Both partially supervised programmes resulted in statistically significant improvements in physical performance compared with the self-administered programme.

TRIAL REGISTRATION

NCT02926105.

CLINICALTRIALS

gov. Date of registration: 06/10/2016.

Supplementation with β-hydroxy-β-methylbutyrate after resistance training in post-acute care patients with sarcopenia: A randomized, double-blind placebo-controlled trial

OBJECTIVES

This study aimed to evaluate the efficacy of adding β-hydroxy-β- methylbutyrate (HMB) supplementation to a 12-week exercise-based rehabilitation program in older adults with sarcopenia after discharge from a post-acute geriatric rehabilitation unit.

STUDY DESIGN

A randomized, double-blind, placebo-controlled trial with two parallel groups. The intervention group received 3 g/day of Ca-HMB and participated in a 12- week resistance training program (3 sessions/week). The control group received a placebo and followed the same training program.

MAIN OUTCOME MEASURES

The primary outcomes were the improvements of handgrip strength and physical performance assessed through the Short Physical Performance Battery (SPPB) and 4-meter gait speed; and handgrip strength. All variables were assessed at baseline, post-intervention, and 1-year follow-up.

RESULTS

After completing the 12-week exercise program, the intervention group showed significant improvements in SPPB-Balance (1.3, 95 %CI 0.3 to 2.4) and total SPPB score (2.2, 95 %CI 0.4 to 4.0). Intra-group analysis demonstrated gains in the SPPB-Chair Stand (0.7 points, 95 %CI 0.0 to 1.4) and total SPPB score (2.1 points, 95 %CI 0.3 to 3.9) in the intervention group. Improvements in handgrip strength were observed in women (3.7 kg, 95 %CI: 0.2 to 7.3) at the end of the intervention, and persisted at the 1-year follow-up.

CONCLUSIONS

Our findings suggest that the supplementation of 3 g/day of Ca-HMB with resistance exercise may significantly enhance muscle strength and physical performance among older women with sarcopenia after recent hospitalization. Given this study's limitations, the intervention's effectiveness cannot be drawn, and further studies are needed.

Statins, ACE/ARBs drug use, and risk of pneumonia in hospitalized older patients: a retrospective cohort study

The aims of this study is to evaluate the association between angiotensin-converting enzyme inhibitor (ACE-I), angiotensin II receptor blocker (ARBs) and/or statin use with the risk of pneumonia, as well as and with in-hospital and short-term outpatient mortality in hospitalized older patients with pneumonia. Patients aged 65 years or older hospitalized in internal medicine and/or geriatric wards throughout Italy and enrolled in the REPOSI (REgistro Politerapuie SIMI-Società Italiana di Medicina Interna) register from 2010 to 2019 were screened to assess the diagnosis of pneumonia and classified on whether or not they were prescribed with at least one drug among ACE-I, ARBs, and/or statins. Further study outcomes were mortality during hospital stay and at 3 months after hospital discharge. Among 5717 cases included (of whom 18.0% with pneumonia), 2915 (51.0%) were prescribed at least one drug among ACE-I, ARBs, and statins. An inverse association was found between treatment with ACE-I or ARBs and pneumonia (OR = 0.79, 95% CI 0.65-0.95). A higher effect was found among patients treated with ACE-I or ARBs in combination with statins (OR = 0.67, 95% CI 0.52-0.85). This study confirmed in the real-world setting that these largely used medications may reduce the risk of pneumonia in older people, who chronically take them for cardiovascular conditions.

A brief version of the Attitudes to Ageing Questionnaire for older Chinese adults: development and psychometric evaluation

BACKGROUND

Positive attitudes toward aging are considered essential for achieving psychological well-being in later life. However, there is currently a lack of a concise and comprehensive measurement tool specifically designed to assess attitudes toward aging among the elderly population in China. To address this gap, the present study aimed to develop a brief version of the Attitudes to Ageing Questionnaire tailored to older Chinese individuals and evaluate its psychometric properties.

METHODS

Initially, a sample of community-dwelling older adults (Sample 1: n = 442, aged 60-88) was utilized to establish a new scale format. Subsequently, two convenience samples (Sample 2: n = 311, aged 60-90; Sample 3: n = 164, aged 60-89) were employed to evaluate the psychometric properties of this scale, including factor structure, internal consistency, test-retest reliability, convergent validity, and discriminant validity.

RESULTS

We selected 12 items from the original questionnaire to create the brief scale. The brief scale maintained the three-factor structure of the full-format version, encompassing psychosocial loss, physical change, and psychological growth, and demonstrated adequate psychometric properties.

CONCLUSIONS

This development process shortens the administration time of the questionnaire while avoiding excessive loss of information. The newly developed scale serves as a reliable and valid assessment tool for measuring attitudes toward aging among older Chinese individuals and is well-suited for implementation in large-scale surveys that utilize an extensive array of questionnaires. This tool can be applied to assessing the effectiveness of interventions aimed at eliminating ageism.

Living in public rental housing is healthier than private rental housing a 9-year cohort study from Japan Gerontological Evaluation Study

Housing tenure is an important aspect to determine health. However, even though renters tend to have more socioeconomic disadvantages than homeowners, mortality risk between private and public renters compared with homeowners remains unclear. Japanese public rented housing, such as the Urban Renaissance Agency, has been developed for supplying an adequate living environment since 1950s. This study aimed to examine the mortality risk among older Japanese residents living in private and public rented houses compared with those living in owner-occupied houses using 9-year follow-up data. This study drew upon a 9-year follow-up of participants in the Japan Gerontological Evaluation Study, a population-based cohort study of Japanese independent adults aged ≥ 65 years. Mortality from 2010 to 2019 was analyzed for 44,007 respondents. Housing tenure was defined by a questionnaire. Cox regression models were used for calculating the hazard ratio for mortality. Bonferroni correction was used to account for multiple testing between rental houses. Overall, 10,638 deaths occurred during the follow-up period. Compared with housing owners, all rental housing groups had a significantly higher risk of mortality. Among renters, participants who lived in public rental housing had the lowest risk of mortality even after adjusting for sociodemographic characteristics, health status, social status, and environmental status. Multiple testing among renters with Bonferroni correction showed that public renters had 0.80 times (95% CI 0.72-0.89) lower mortality risk than private renters. Although Japanese older adults living in public rental housing had a higher mortality risk than homeowners, this risk was lower than that among private renters. A positive neighborhood environment based on well-planned urban development may have contributed to this result. The results suggest that planned urban development lowers the risk of mortality in older renters in Japan.

Polypharmacy, drug-drug interactions, anticholinergic burden and cognitive outcomes: a snapshot from a community-dwelling sample of older men and women in northern Italy

Polypharmacy (PP) use is very common in older people and may lead to drug-drug interactions (DDIs) and anticholinergic burden (ACB) that may affect cognitive function. We aimed to determine the occurrence of PP, potential DDIs and ACB and their role in cognitive outcomes in an older population. Cross-sectional data from 636 community-dwelling adults (73.2 ± 6.0 SD, 58.6% women) participating in the NutBrain study (2019-2023) were analyzed. Participants were asked about their medication use, and data on potential DDIs and ACB were extracted. The associations of PP (≥ 5 drugs/day), potential DDIs, and ACB with mild cognitive impairment (MCI) and specific cognitive domains were assessed using logistic regression adjusted for confounders. Sex-stratified analysis was performed. Overall, 27.2% of the participants were exposed to PP, 42.3% to potential DDIs and 19% to cumulative ACB. Women were less exposed to PP and more exposed to ACB than men. In multivariate analysis, the odds of having MCI (24%) were three times higher in those with severe ACB (≥ 3) (OR 3.34, 95%CI 1.35-8.25). ACB was positively associated with poor executive function (OR 4.45, 95%CI 1.72-11.49) and specifically with the Frontal Assessment Battery and neuropsychological tests of phonological and semantic fluency. In sex-stratified analysis, ACB was statistically significantly associated with MCI and executive function in women and with memory in men. PP, potential DDIs and anticholinergics use are very common in community-dwelling older people. ACB exposure is associated with MCI, particularly with poor executive function. Clinicians are encouraged to be vigilant when prescribing anticholinergics.Trial registration: Trial registration number NCT04461951, date of registration July 7, 2020 (retrospectively registered, ClinicalTrials.gov).

What works to support carers of older people and older carers? an international evidence map of interventions and outcomes

BACKGROUND

Unpaid carers of older people, and older unpaid carers, experience a range of adverse outcomes. Supporting carers should therefore be a public health priority. Our understanding of what works to support carers could be enhanced if future evaluations prioritise under-researched interventions and outcomes. To support this, we aimed to: map evidence about interventions to support carers, and the outcomes evaluated; and identify key gaps in current evidence.

METHODS

Evidence gap map review methods were used. Searches were carried out in three bibliographic databases for quantitative evaluations of carer interventions published in OECD high-income countries between 2013 and 2023. Interventions were eligible if they supported older carers (50 + years) of any aged recipient, or any aged carers of older people (50 + years).

FINDINGS

205 studies reported across 208 publications were included in the evidence map. The majority evaluated the impact of therapeutic and educational interventions on carer burden and carers' mental health. Some studies reported evidence about physical exercise interventions and befriending and peer support for carers, but these considered a limited range of outcomes. Few studies evaluated interventions that focused on delivering financial information and advice, pain management, and physical skills training for carers. Evaluations rarely considered the impact of interventions on carers' physical health, quality of life, and social and financial wellbeing. Very few studies considered whether interventions delivered equitable outcomes.

CONCLUSION

Evidence on what works best to support carers is extensive but limited in scope. A disproportionate focus on mental health and burden outcomes neglects other important areas where carers may need support. Given the impact of caring on carers' physical health, financial and social wellbeing, future research could evaluate interventions that aim to support these outcomes. Appraisal of whether interventions deliver equitable outcomes across diverse carer populations is critical.

The relationship between healthy lifestyles and cognitive function in Chinese older adults: the mediating effect of depressive symptoms

BACKGROUND

Previous studies have proven the positive relationship between healthy lifestyles and cognitive function in older adults. However, the specific impacts and mechanisms require further investigation. Therefore, this study aimed to investigate whether healthy lifestyles and cognitive function were associated with Chinese older adults and whether depressive symptoms mediated their association.

METHODS

8272 valid samples were included using the latest data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Pearson's test was applied to investigate the relationship between the key variables. Regression models were employed to examine the mediating effects of healthy lifestyles, using Sobel's test and the bootstrap method to confirm path effects.

RESULTS

There was a significant correlation between healthy lifestyles, depressive symptoms, and cognitive function (p < 0.01). Healthy lifestyles directly impact cognitive function (β = 0.162, p < 0.01). Healthy lifestyles had a significant effect on depressive symptoms (β=-0.301, p < 0.01), while depressive symptoms have a significant impact on cognitive function (β=-0.108, p < 0.01). Depressive symptoms partially mediated the effect of healthy lifestyles on cognitive function (β = 0.032, p < 0.01). The Sobel and bootstrap tests confirmed the robustness of the regression analysis results.

CONCLUSION

Depressive symptoms mediate the relationship between healthy lifestyles and cognitive function. Our findings suggest that prevention strategies for cognitive impairment in older adults should focus on healthy lifestyles and mental health.

The ENJOY Seniors Exercise Park IMP-ACT project: IMProving older people's health through physical ACTivity: a hybrid II implementation design study protocol

INTRODUCTION

The health benefits of physical activity are well established; however, most older people are not sufficiently physically active. Despite the availability of various physical activity interventions and programs, implementation of effective prevention strategies to reduce older people's physical inactivity are lacking. The ENJOY IMP-ACT project is an implementation research project, based on a previous evidence-based physical and social activity program utilising specialised outdoor exercise equipment (the Seniors Exercise Park) for older people. The ENJOY IMP-ACT aims to increase participation in physical activity to improve health outcomes for older people in Victoria, Australia.

METHOD

The ENJOY IMP-ACT is a hybrid II implementation-effectiveness pre-post mixed method study design. Five local governments (6 public sites/parks) will undergo a 3-month control period followed by 9-months implementation intervention (TERM framework intervention: Training, Engagement, Resources development, Marketing and promotion), and a maintenance phase (3 months). Various methodologies will be employed throughout the project at each site and will include direct observations of park users, intercept surveys with park users, online access monitor platform (using an online app), interviews with stakeholders and exercise program leaders, a process evaluation of physical activity programs, a social return-on-investment analysis, and other related activities.

DISCUSSION

Through the implementation framework design, the ENJOY IMP-ACT is uniquely placed to translate an evidenced-based physical and social activity program into real world settings and increase physical activity among older people. If successful, this program will inform scale up across Australia with the goal of improving the health and wellbeing of older people.

TRIAL REGISTRATION

This registration trial is prospectively registered with the Australian New Zealand Clinical Trials Registry. Trial number ACTRN12622001256763 . Date registered 20/09/2022.

The association between physical activity and quality of life among people aged 60-89 living in own homes and nursing homes

BACKGROUND

The aim of the study was to obtain a response to the question of whether and how physical activity (PA) among people aged 60-89 years impacts quality of life and other sociodemographic characteristics (sex, age and place of living).

METHODS

Among 341 respondents aged 60 to 89, including 273 women (80%) and 68 men (20%) successfully completed IPAQ and WHOQOL AGE questionnaires. In the study were used International Physical Activity Questionnaire - IPAQ and World Health Organization Quality Of Life - Age - WHOQOL-AGE in Polish version.

RESULTS

The average total physical activity, including vigorous-intensity physical effort, moderate-intensity physical effort and walking amounts to 1381.87 ± 1978.60 MET-min/week. The average quality of life for the whole group of older people as evaluated with WHOQOL AGE scale was 64.79 (SD = 14.76; min:18.77-max: 98.07). Statistical analysis between physical activity and life quality proved significant dependence for the global life quality rating (p < 0.001).

CONCLUSIONS

Our research has shown that PA improves quality of life among older people. Higher scores of quality of life were obtained in the F1 subscale (satisfaction) than in the F2 subscale (meeting expectations) in both age groups. Age significantly affects quality of life for older people.

Feasibility of an oral health promotion program among older people in geriatric care facilities, Shanghai, China: a pre/post-implementation study

BACKGROUND

The oral health of older people is closely related to their overall health. Timely and effective intervention in oral issues is necessary to maintain their overall health. This study aimed to evaluate the feasibility and effectiveness of an Oral Health Promotion Program (OHPP) in Geriatric Care Facilities (GCFs).

METHODS

The OHPP was implemented in two GCFs and evaluated using a pre/post-design. Questionnaires on self-efficacy and attitude for providing oral care were sent to 42 nurse participants before and three months after the implementation of the OHPP. Outcomes of 295 patient participants were assessed at four time points (T1-baseline, T2-one month, T3-two months, and T4-three months post-implementation) including Activities of Daily Living (ADL), Mini-Mental State Examination (MMSE), and Oral Health Assessment Tool (OHAT).

RESULTS

The oral health and daily activity ability of patient participants showed an improving trend at four time points pre/post-implementation of the OHPP. The proportion of patients with healthy mouths (OHAT: 0-3 points) increased from 29.8 to 67.8% and their scores of OHAT and ADL were significantly better at T4 compared to T1, T2, and T3 (p < 0.001). Self-efficacy (SE-PMC: T1 = 18.93 ± 3.18, T4 = 28.83 ± 6.56, p < 0.001) and attitude (A-PMC: T1 = 18.78 ± 3.09, T4 = 28.20 ± 6.03, p < 0.001) for oral care among nurse participants improved after the implementation of the OHPP.

CONCLUSIONS

This study highlights the feasibility of implementing OHPP within GCFs, potentially enhancing the oral health and daily living activities of older individuals. Integrating the OHPP into routine care in geriatric settings is not only practical but also widely acceptable, offering a proactive approach to address oral health disparities among older residents. Stakeholders can maximize the impact of the OHPP by fostering collaboration among healthcare professionals, administrators, and residents, ultimately improving oral health outcomes and overall quality of life of older residents.

TRIAL REGISTRATION

ChiCTR2000035236 (registration date: 04/08/2020).

The association of low serum uric acid with mortality in older people is modified by kidney function: National Health and Nutrition Examination Survey (NHANES) 1999-2018

BACKGROUND

In older individuals, the role of low serum uric acid (SUA) as risk factor for mortality is debated. We therefore studied whether SUA levels, particularly low SUA concentrations, are associated with all-cause and cardiovascular (CV) mortality in older population, and to clarify potential effect modification of kidney function.

METHODS

We identified 14,005 older people in National Health and Nutrition Examination Survey (NHANES) data from 1999 to 2018. SUA was measured only at baseline. The relationship between SUA and mortality was assessed using Cox proportional hazards models and restricted cubic spline Cox regression stratified by the estimated glomerular filtration rate (eGFR).

RESULTS

During mean 8.3 years of follow-up, 4852 all-cause death and 1602 CV death were recorded. A significant U-shaped association was observed between SUA with all-cause mortality, with the lowest risk concentration of 5.5 mg/dL. Comparing to the reference group (5 to 7 mg/dL), the HR of 2 to < 5 mg/dL group was 1.11 (1.03-1.21) and 1.14 (1.00-1.30). This relationship was more pronounced in participants with an eGFR ≥ 60 ml/min/1.73m2 (HR, 1.16; 95%CI, 1.06-1.28). This situation similarly occurred in Urine protein negative group (HR, 1.14; 95%CI, 1.04-1.25).

CONCLUSIONS

Low SUA concentrations are associated with an increased risk in all-cause and CV mortality among older participants. Extremely low SUA concentrations are especially undesirable, especially in the older adults with normal kidney function.

Predictors of attitudes towards aging in elderly living in community care

BACKGROUND

Due to the aging of the population, the promotion of healthy aging is an important part of public health. Healthy aging of the population can be influenced by the attitudes of the elderly themselves towards old age and aging. The aim of this cross-sectional study was to find out the attitudes of older people living in a community environment toward old age and the predictors that influence these attitudes.

METHODS

The evaluation of attitudes towards old age using the WHO AAQ (Attitudes to Aging Questionnaire) questionnaire involved 1,174 elderly people living in the community. Age, sex, marital status, education, subjective health assessment, social support, depression (GDS-15), anxiety (GAI), sense of coherence (SOC-13) and self-esteem (RSES) were used to evaluate related factors.

RESULTS

As part of the exploratory factor analysis, a three-factor model (Psychosocial Loss, Physical Change, and Psychological Growth) was confirmed. The Cronbach alpha was found to be acceptable (α = 0.835). The predictors of better AAQ in the Psychological Loss domain were: subjective health, age, quality of life, self-esteem, sense of coherence, life satisfaction, anxiety, and social support; in the Physical Change domain: subjective health, quality of life, self-esteem, life satisfaction, cohabitation, and depression; and in the Psychological Growth domain: age, self-esteem, sense of coherence, life satisfaction, and social support.

CONCLUSION

Preventive and policy measures should aim to increase the satisfaction and self-assessment of the elderly, which can help them evaluate the period of old age more positively. It is also important to create a positive perspective of ageing and elderly in society.

The impact of residential environment on older people's capabilities to live independently: a survey in Beijing

BACKGROUND

Studies have shown how environmental factors influence older people's health and functional limitations, which are crucial for achieving healthy aging. However, such a healthy aging model has been criticized for defining health as an absence of disease, because chronic conditions cannot be reversed through medical treatments. In response to such critiques, this study refers to Huber's positive health definition, arguing that health should not be defined as the absence of disease but as the ability to adapt and self-manage in the face of social, physical, and emotional challenges. There is a need to develop a community-based approach to healthy aging that considers how the residential environment enables older people to adapt and self-manage. Drawing on Sen's capability approach, this study proposes that such a community-based approach should provide a supportive environment to enable older people's capabilities to live independently.

METHODS

Using hierarchical multiple regression analysis of data from 650 older people (60 years and older) surveyed in Beijing, we unravel which features of the residential environment support older people' s capabilities to live independently and how these impacts differ depending on older people's frailty levels.

RESULTS

The results show that four environmental factors, namely perceived accessibility (B = 0.238, p < 0.001 for physical capability, B = 0.126, p < 0.001 for social capability, B = 0.195, p < 0.001 for psychological capability), pleasant surroundings (B = 0.079, p < 0.05 for physical capability, B = 0.065, p < 0.05 for social capability), meeting opportunities (B = 0.256, p < 0.001 for social capability, B = 0.188, p < 0,001 for psychological capability, and life convenience B = 0.089, p < 0.05 for physical capability, B = 0.153, p < 0.001 for psychological capability) positively affect older people's capabilities to live independently. These four environmental factors cause differences in older people's capabilities between different neighborhood types. Moderation analysis shows that meeting opportunities are more relevant for frail older people (B = 0.090, p < 0.001 for social capability, B = 0.086, p < 0.01 for psychological capability).

CONCLUSIONS

This study contributes to the literature by emphasizing the role of supportive residential environments in enabling older people to live independently. Furthermore, we identify four environmental factors that support older people's capabilities. Results can be used to develop effective community-based environmental support to enable older people to live independently.

Knowledge, attitude, and practice of pre-diabetic older people regarding pre-diabetes

BACKGROUND

One of the risk factors of diabetes is the pre-diabetes stage which is significantly prevalent in older people. Knowledge, attitude, and practice of the pre-diabetic stage are of great importance and can decrease complications. The present study aimed to determine the knowledge, attitude, and practice of the pre-diabetic older people.

METHODS

This cross-sectional study was conducted from April 2022 to August 2022 on 219 pre-diabetic older people referring to Sina Hospital in Tabriz, one of the most populated cities in the northwest of Iran. Data were collected using questionnaires of Knowledge, Attitude, Practice-Prediabetes Assessment Questionnaire (KAP-PAQ). The data were analyzed by SPSS 21.

RESULTS

The mean scores of knowledge (in the range of 0-17), attitude (in the range of -10, + 10), and practice (in the range of 0-26) were 1.72 ± 1.0, 2.24 ± 1.92, and 5.76 ± 2.61, respectively. The older people's knowledge and practice levels in the pre-diabetes stage were low and about 50% of them had negative views. According to the Spearman correlation test, there was a positive significant relationship between the older people's knowledge and practice (p < 0.001, r = 0.234).

CONCLUSIONS

The older people in the pre-diabetes stage had low knowledge and attitude and a negative viewpoint towards correcting lifestyle on diet, exercising and physical activity, weight control, diagnostic and screening methods. Increased knowledge about pre-diabetes and strengthened positive attitude towards correcting lifestyle through counseling as well as empowering the pre-diabetic older people can increase the efficiency of pre-diabetes prevention and control programs and prevent its progression to the diabetes stage.

Effects of oral oligopeptide preparation and exercise intervention in older people with sarcopenia: a randomized controlled trial

BACKGROUND

Nutrition and exercise are important interventions for sarcopenia. There were few studies on oral oligopeptide nutrition preparations combined with exercise to intervene in the older people with sarcopenia. The aim of this study was to verify the effectiveness of oligopeptide nutrition preparation combined with exercise intervention on the older people with sarcopenia in community.

METHODS

A total of 219 subjects aged 65 years or older with sarcopenia were randomly divided into 4 groups. The nutrition group (n = 58) was given individualized nutrition education and oral oligopeptide nutrition preparation. The exercise group (n = 50) received exercise intervention. The combined group (n = 52) received both oral nutrition preparation and exercise interventions. The control group (n = 59) only received individualized nutrition education. The nutrition preparation can provide energy 185kcal and protein 24.2g per day. The exercise intervention including warm-up exercise, resistance exercise and aerobic exercise, the training time was 60min for 5 times every week. The intervention lasted for 16 weeks. Hand grip strength, gait speed, body composition and hematology parameters were measured before and after intervention.

RESULTS

A total of 159 subjects completed the study. Compared with baseline, the left grip strength and 6-m walking speed of the subjects in nutrition group increased significantly after the intervention, and the grip strength of both hands in exercise group and combined group increased significantly. The body weight of the subjects in nutrition group, exercise group and combined group increased significantly after intervention, but no increase in soft lean mass (SLM) and skeletal muscle mass (SMM) was observed in any of the four groups. The fat-free mass (FFM) of the legs of the control group, exercise group and nutrition group decreased after intervention, and only the FFM of the legs of the combined group maintained the level before the intervention.

CONCLUSION

Both oral peptide nutrition and exercise interventions can improve the muscle strength or function of the older people with sarcopenia. However, there were no increases in muscle mass observed.

TRIAL REGISTRATION

ChiCTR, ChiCTR2100052135. Registered 20 October 2021, https://www.chictr.org.cn/showproj.html?proj=135743.

Characterization of social frailty domains and related adverse health outcomes in the Asia-Pacific: a systematic literature review

Background

Frailty is a significant healthcare challenge worldwide, increasing interest in developing more assessment tools covering for frailty. Recently, there has been a growing awareness of a correlation between social variables and frailty in older people. However, there is a lack of understanding of the social domains of frailty and the related adverse outcomes, particularly in the Asia-Pacific settings. This study aimed to characterize the social frailty domains and their health outcomes by overviewing the frailty screening tools in older people living in the Asia-Pacific region.

Methodology

A systematic review, using the PRISMA guideline, was conducted on articles published between 2002 and 2023 from three electronic databases: PubMed, Scopus, and ScienceDirect. A manual search was conducted for the references of the included articles using Google Scholar. Included articles must be in English and were based on empirical evidence published in peer-reviewed journals and focus on the assessment of domains of social frailty in older people aged 60 or over in the Asia-Pacific (East Asia, Southeast Asia, and Oceania).

Result

A total of 31 studies were included in the thematic analysis, from which 16 screening tools measuring six social domains were reviewed. The six domains were: social networks, followed by social activities, social support, financial difficulties, social roles, and socioeconomic, arranged in four categories: social resources, social needs, social behaviors (or social activities), and general resources. The six social domains predicted mortality, physical difficulties, and disability incidence. Other adverse health outcomes were also associated with these social domains, including cognitive disorders, mental illness, and nutritional disorders (n = 5 domains each), dementia (n = 4 domains), and oral frailty, hearing loss, obesity, and chronic pain (n = 3 domains each).

Conclusion

Overall, social frailty is a complex construct with multiple dimensions, including the frailty of social and general resources, social behaviors, and social needs, leading to several health disorders. The findings contribute to understanding the conceptual framework of social frailty in older people and its related health outcomes. Therefore, it could facilitate professionals and researchers to monitor and reduce the risks of adverse health outcomes related to each domain of social frailty, contributing to a better aging process.

Resilience improvement through a multicomponent physical and cognitive intervention for older people: the DanzArTe emotional well-being technology project

BACKGROUND

Resilience is a crucial component of successful aging. However, which interventions might increase resilience in older adults is yet unclear.

AIMS

This study aims to assess the feasibility and the physical and psychological effects of a technology-based multicomponent dance movement intervention that includes physical, cognitive, and sensory activation in older people living in community-dwelling and nursing home.

METHODS

DanzArTe program consists of four sessions on a weekly basis, using a technological platform that integrates visual and auditory contents in real time. 122 participants (mean age = 76.3 ± 8.8 years, 91 females = 74.6%) from seven nursing homes and community-dwelling subjects were assessed, before and after the intervention, with the Resilience Scale-14 items (RES-14), the Multidimensional Prognostic Index (MPI), the Psychological General Well-Being Index (PGWBI-S), and the Client Satisfaction Questionnaire-8 (CSQ-8). Mann-Whitney and Wilcoxon signed-ranks tests were used for statistical analyses.

RESULTS

At baseline significant differences in MPI and RES-14 between community-dwelling and nursing home residents were observed (p < 0.001 for both analyses). After the intervention, resilience significantly increased in total sample (RES-14 mean T1 = 74.6 Vs. T2 = 75.7) and in the nursing home residents (RES-14 mean T1 = 68.1 Vs. T2 = 71.8). All participants showed high overall satisfaction for DanzArTe program (CSQ-8 mean = 23.9 ± 4.4). No differences in MPI and PGWBI-S were observed.

DISCUSSION

DanzArTe was a feasible intervention and high appreciated by all older adults. Nursing home residents revealed improvements in resilience after DanzArTe program.

CONCLUSION

The DanzArTe technology-based multi-component intervention may improve resilience in older people living in nursing homes.

Intrinsic capacity and hospitalization among older adults: a nationally representative cross-sectional study

PURPOSE

Monitoring intrinsic capacity (IC) in community-dwelling older people can be potentially used to alert for adverse health outcomes. However, whether there is an association between IC and hospitalization has yet to be fully explored. This study aimed to investigate the association of the IC composite measure and its 5 domains with hospitalization in the previous year and length of hospital stay.

METHODS

We conducted cross-sectional analyses using data from a representative sample of community-dwelling adults (≥ 65 years). We assessed the IC domains (vitality, locomotor, cognitive, sensory, and psychological) using validated self-reported information and performance tests. We calculated standardized estimated scores (z scores) for IC composite measure and domains and conducted multivariate logistic and ordinal regressions. The primary outcomes were hospitalizations in the previous year and length of hospital stay.

RESULTS

In a sample of 5354 participants (mean age = 73 ± 6 years), we found that participants with high IC composite z scores were less likely to have experienced hospitalization in the previous year (OR = 0.51; 95% CI = 0.44-0.58). Among those who were hospitalized, high IC scores were associated with short stays (OR = 0.87; 95% CI = 0.80-0.95). Cognitive and psychological domains were associated with hospitalizations, and the locomotor domain was related to length of hospital stay. The vitality domain was associated with both outcomes.

CONCLUSION

IC as a composite measure was associated with previous hospitalizations and length of stay. IC can help clinicians identify older people prone to adverse outcomes, prompting preventive integrated care interventions.

Impact of age on the prevalence of poor-quality dietary variety, associated lifestyle factors, and body composition profile (low body muscle mass and high body fat mass) in older people residing in Colombo district, Sri Lanka

Aims

To assess the impact of age on the prevalence of poor-quality dietary variety, associated lifestyle factors, and body composition profile (low body muscle mass and high-fat mass) in older Sri Lankans.

Methods

In this population-based cross-sectional study, older people of 60 years or above were selected using a multistage cluster sampling technique probability proportionate to the size. They were classified into 3 groups; 60-64, 65-69 and > 70-years. The poor-quality dietary variety was defined based on food variety, dietary diversity and dietary serving scores assessed using 24-h dietary recall. Body composition was measured using bio-electrical impedance. The impact of age on determinants of poor-quality dietary variety and being at risk of low muscle mass and high-fat mass were assessed by using multivariable logistic regression models.

Results

Eight hundred older participants with a mean (SD) 68.1(5.8) years were included. There were 28.4%(n = 227), 36.2%(n = 290) and 35.4%(n = 283) in the 60-64, 65-69 and ≥ 70-year age groups, respectively. The prevalence of poor-quality dietary variety was similar across age groups. The urban living environment, and getting nutritional advice from the GP/hospital were found to have a significant negative association only in the 60-64 age group. A poor-quality dietary variety was significantly associated with no education or up to the primary level in the 65-69 age group and having diabetes or hypertension in the ≥70-year group. Odds of low muscle mass and high-fat mass were 2.43(1.46-4.03) and 2.17(1.30-3.63) respectively among the≥70-year age group compared to the 60-64-year group, after controlling for confounders.

Conclusions

The prevalence of poor-quality dietary variety was similarly high in all age groups. Increasing age was associated with higher odds of low body muscle and high body fat mass despite similar dietary variety, indicating the need for special dietary attention.

The implementation of a perioperative medicine for older people undergoing surgery service: a qualitative case study

BACKGROUND

The international scale and spread of evidence-based perioperative medicine for older people undergoing surgery (POPS) services has not yet been fully realised. Implementation science provides a structured approach to understanding factors that act as barriers and facilitators to the implementation of POPS services. In this study, we aimed to identify factors that influence the implementation of POPS services in the UK.

METHODS

A qualitative case study at three UK health services was undertaken. The health services differed across contextual factors (population, workforce, size) and stages of POPS service implementation maturity. Semi-structured interviews with purposively sampled clinicians (perioperative medical, nursing, allied health, and pharmacy) and managers (n = 56) were conducted. Data were inductively coded, then thematically analysed using the Consolidated Framework for Implementation Research (CFIR).

RESULTS

Fourteen factors across all five CFIR domains were relevant to the implementation of POPS services. Key shared facilitators included stakeholders understanding the rationale of the POPS service, with support from their networks, POPS champions, and POPS clinical leads. We found substantial variation and flexibility in the way that health services responded to these shared facilitators and this was relevant to the implementation of POPS services.

CONCLUSIONS

Health services planning to implement a POPS service should use health service-specific strategies to respond flexibly to local factors that are acting as barriers or facilitators to implementation. To support implementation of a POPS service, we recommend health services prioritise understanding local networks, identifying POPS champions, and ensuring that stakeholders understand the rationale for the POPS service. Our study also provides a structure for future research to understand the factors associated with 'unsuccessful' implementation of a POPS service, which can inform ongoing efforts to implement evidence-based perioperative models of care for older people.

Measuring the quality of transitional care based on elderly patients' experiences with the partners at care transitions measure: a cross-sectional survey

BACKGROUND

The quality of transitional care is closely related to the health outcomes of patients, and understanding the status of transitional care for patients is crucial to improving the health outcomes of patients. Therefore, this study aims to investigate the quality of transitional care in elderly patients with chronic diseases and analyze its influencing factors, to provide a basis for improving transitional care services.

METHODS

This is a cross-sectional study. We used the Chinese version of the Partners at Care Transitions Measure (PACT-M) to survey patients with chronic diseases aged 60 years and older who were about to be discharged from five tertiary hospitals in Henan and Shanxi provinces. We used the mean ± standard deviation to describe the quality of transitional care, t-test or one-way ANOVA, and regression analysis to explore the factors affecting the quality of transitional care for patients.

RESULTS

182 elderly patients with chronic diseases aged ≥ 60 years completed the PACT-M survey. The scores of PACT-M1 and PACT-M2 were (30.69 ± 7.87) and (25.59 ± 7.14) points, respectively. The results of the t-test or one-way ANOVA showed that the patient's marital status, ethnicity, religion, educational level, preretirement occupation, residence, household income per month, and living situation had an impact on the quality of transitional care for elderly patients with chronic diseases (P < 0.05). The results of regression analyses showed that patients' preretirement occupation, social support, and health status were the main influences on the quality of transitional care for elderly patients with chronic diseases (P < 0.05), and they explained 63.1% of the total variance.

CONCLUSIONS

The quality of transitional care for older patients with chronic illnesses during the transition from hospital to home needs further improvement. Factors affecting the quality of transitional care included patients' pre-retirement occupation, social support, and health status. We can improve the hospital-community-family tertiary linkage service to provide coordinated and continuous transitional care for patients based on their occupation, health status, and social support to enhance the quality of transitional care and the patient's health.

Spontaneous retropharyngeal abscess presenting as delirium in a frail older woman

INTRODUCTION

Retropharyngeal abscess (RPA) is an uncommon infection in older people, which usually presents with localized upper airway symptoms.

CASE PRESENTATION

We present a case of RPA in a 69-year-old frail woman with co-morbidities, who presented atypically with delirium. She initially complained of general symptoms of malaise, body aches and general decline. Her symptoms progressed to hypoactive delirium before she started to localize her complaints to the upper airway. The delirium presentation of RPA is not commonly reported in the literature. Co-morbidities and frailty are likely to be the underlying risk factors for delirium presentation in this case. Most of the RPA cases reported in older people in the literature presented typically with localized symptoms, however these cases had lower burden of morbidities and reported no frailty. In our case report, poor mouth hygiene and dental caries were thought to be the source of infection. Early intervention with antibiotic treatment for a total of four weeks resulted in a full recovery.

CONCLUSION

RPA may present with delirium in older people with frailty and co-morbidities. Poor oral hygiene and dental caries, if left untreated, may progress into serious deep space neck infection.

Understanding Pathways into Care-homes using Data (UnPiCD study): a two-part model to estimate inpatient and care-home costs using national linked health and social care data

BACKGROUND

Pathways into care-homes have been under-researched. Individuals who move-in to a care-home from hospital are clinically distinct from those moving-in from the community. However, it remains unclear whether the source of care-home admission has any implications in term of costs. Our aim was to quantify hospital and care-home costs for individuals newly moving-in to care homes to compare those moving-in from hospital to those moving-in from the community.

METHODS

Using routinely-collected national social care and health data we constructed a cohort including people moving into care-homes from hospital and community settings between 01/04/2013-31/03/2015 based on records from the Scottish Care-Home Census (SCHC). Individual-level data were obtained from Scottish Morbidity Records (SMR01/04/50) and death records from National Records of Scotland (NRS). Unit costs were identified from NHS Scotland costs data and care-home costs from the SCHC. We used a two-part model to estimate costs conditional on having incurred positive costs. Additional analyses estimated differences in costs for the one-year period preceding and following care-home admission.

RESULTS

We included 14,877 individuals moving-in to a care-home, 8,472 (57%) from hospital, and 6,405 (43%) from the community. Individuals moving-in to care-homes from the community incurred higher costs at £27,117 (95% CI £ 26,641 to £ 27,594) than those moving-in from hospital with £24,426 (95% CI £ 24,037 to £ 24,814). Hospital costs incurred during the year preceding care-home admission were substantially higher (£8,323 (95% CI£8,168 to £8,477) compared to those incurred after moving-in to care-home (£1,670 (95% CI£1,591 to £1,750).

CONCLUSION

Individuals moving-in from hospital and community have different needs, and this is reflected in the difference in costs incurred. The reduction in hospital costs in the year after moving-in to a care-home indicates the positive contribution of care-home residency in supporting those with complex needs. These data provide an important contribution to inform capacity planning on care provision for adults with complex needs and the costs of care provision.

Longitudinal assessment of the relationship between frailty and social relationships among Japanese older adults: a random intercept cross-lagged panel model

OBJECTIVES

This study aimed to explore the bidirectional association between frailty and social relationships in older adults while distinguishing between interpersonal and intrapersonal effects.

METHODS

A prospective cohort study of community-dwelling older adults was conducted in Japan in three waves spanning six years with follow-ups in every three years. Random intercept cross-lagged panel model was used to explore temporal associations between frailty and social relationships.

RESULTS

Data for 520 participants (mean age 73.02 [SD 6.38] years, 56.7% women) were analyzed. Across individuals, frailty was associated with social relationships (β = -0.514, p < 0.001). At the interpersonal level, frailty was cross-sectionally associated with social relationships separately at T1(β = -0.389, p < 0.01), T2 (β = -0.343, p < 0.001) and T3 (β = -0.273, p < 0.05). Moreover, social relationships were associated with subsequent increases in symptoms of frailty in all measurement waves (β = -0.332, p < 0.001; β = -0.169, p < 0.01) and vice versa (β = -0.149, p < 0.05; β = -0.292, p < 0.001).

CONCLUSIONS

The results suggest that frailty was associated with lower levels of social relationships. Frailty improvement programs can be combined with interventions to enhance social relationships, which will be beneficial in preventing frailty. The results emphasize the importance of combining clinical treatments of frailty with interventions to improve social relationships.

Towards a core outcome set (COS) for intrinsic capacity (IC) intervention studies in adults in midlife and beyond: a scoping review to identify frequently used outcomes and measurement tools

This scoping review was conducted to identify the outcomes and measurement tools used in IC intervention studies, as first step towards the development of a core outcome set (COS) for IC trials. PRISMA-ScR and COS-STAD were followed. The review considered randomized controlled trials targeting IC published in Medline, Scopus, Embase, Cochrane Central Register of Controlled Trials, and clinicaltrials.gov, until June 2023. Of 699 references, 534 studies were screened once duplicates were removed, 15 were assessed for eligibility, and 7 (4 articles and 3 protocols) met eligibility criteria. Twenty-eight outcomes were identified (19 related to IC and its domains and 9 unrelated). The most reported primary outcome was the change in IC levels postintervention (5 over 7 studies) and the most reported outcomes (either as primary and/or secondary) were the changes in physical performance and in depressive symptoms (6 over 7 studies). Fifty-five tools used to construct the domains' z-scores and/or assess the effect of interventions were identified (47 related to IC and its domains and 8 unrelated). The most reported tool was an IC Z-score, calculated by 4 domains' z-scores: locomotor, vitality, cognitive, and psychological (5 over 7 studies). The tools differed among studies (10 locomotor related, 6 vitality related, 16 cognitive related, 8 psychological related, 6 sensorial related, 8 unrelated tools). The vast heterogeneity (28 outcomes and 55 tools within 7 studies) highlighted the need of a COS. These outcomes and tools will be presented to experts in a future step, to select the ones that should be taken into consideration in IC trials.

Caring for people with dementia from culturally and linguistically diverse backgrounds in nursing homes: A scoping review

BACKGROUND

With continued increase in global migration, older people population in most countries is culturally diverse. Despite lesser preference for nursing home placement, people with dementia from culturally diverse backgrounds with higher needs and acuity do access nursing homes, however, little is known about care provision.

OBJECTIVE

The aims of this review were to map and synthesise available literature on care provision amongst people with dementia from culturally and linguistically diverse backgrounds in nursing homes and identify literature gaps that could inform future research.

DESIGN

A scoping review was conducted guided by the six-step scoping review methodology of Levac and colleagues.

METHODS

A literature search was conducted from August to September 2022 and updated in June 2023 using six databases: Medline, CINAHL, Embase, Cochrane Library, PsycINFO, and Scopus. Screening of articles, data extraction, and quality appraisal was performed independently by two authors. Articles included were primary empirical studies that explored care provision to people with dementia from culturally and linguistically diverse backgrounds living in nursing homes. Critical appraisal was conducted using the Joanna Briggs Institute Critical Appraisal Tool. Data were analysed using thematic analysis. Results were presented in a table and narrative format.

RESULTS

Of the 1149 articles identified, 25 were included. A majority of the articles were qualitative (n = 17) and conducted in Western countries such as those in Europe (n = 11), as well as Australia (n = 5) and the United States (n = 4). Data analysis led to the development of three themes: (1) maintaining a sense of home; (2) fostering communication and interaction; (3) barriers and facilitators to providing care. Most articles did not specify the model underpinning the approaches to care provision.

CONCLUSIONS

Care provision for people with dementia from culturally and linguistically diverse backgrounds living in nursing homes entails an environment which enables them to live up to the standards of what "home" means to them, communicate their needs, and engage in meaningful interactions. Predominant barriers to care provision relate to language and the facility's resources and capacity to deliver culture-specific care. Methodological quality of the studies that explored care provision for people with dementia from culturally and linguistically diverse backgrounds in the nursing home context is mostly limited. To strengthen the evidence base, there is a need for more rigorous research that informs care provision approaches and development of an inclusive model of culturally appropriate care to people with dementia from culturally diverse backgrounds in the nursing home context.

TWEETABLE ABSTRACT

A scoping review synthesised evidence on care provision amongst people with dementia from CALD backgrounds in nursing homes.

Improving balance in community-dwelling elders using trained volunteers within faith-based institutions: a mixed methods feasibility study

PURPOSE

To investigate the feasibility and acceptability of a volunteer-led balance programme for older adults.

METHODS

A feasibility cluster RCT with focus groups were conducted in faith-based institutions. Eligibility criteria were: participants were ≥65 years, able to do five times sit -to-stand, had no falls in the previous six months and had good mental capacity. The intervention included supervised group exercises and exercise booklets for six months, education and a fall poster. Assessments included, TUG, MCTSiB, FTST, FES, mABC, OPQoL and DGLS at baseline, 6 weeks, and 6 months. Feasibility measures included numbers of volunteers, sessions, and volunteers" time commitment, views of participants about sustainability of program using qualitative focus groups and volunteers' ability to deliver programme.

RESULTS

Three churches participated with 31 participants in each group. Participants had a mean age of 77.3 years, were 100% British, and 79% female. The sample size estimate for a future trial using TUG, was 79 per group. Focus groups showed perceived social and physical improvements in participants, need to extend the programme to the wider community, and increased confidence, participation and socialisation.

CONCLUSION

The community-based balance training in faith-based institutions, was feasible and acceptable in one geographical area and requires evaluation in cohesive diverse communities.Implications for RehabilitationIf an institution or a community is united through faith, culture, national roots, or tradition, then these groups are ideal for such balance rehabilitation programmes, because of the familiarity of the location and people, cohesive culture or their ideology to help their communities.Participants and volunteers perceived improved participation, confidence and socialisation and were keen to continue programme.It is important to develop community-based falls prevention programmes that the National Health Service (NHS) can partially support using volunteers to reduce the burden of falls in the community and for the NHS.

Strategies used during the cognitive evaluation of older adults with dual sensory impairment: a scoping review

BACKGROUND

Dual sensory impairment (DSI), the combination of visual and hearing impairments, is associated with increased risk for age-related cognitive decline and dementia. Administering cognitive tests to individuals with sensory impairment is challenging because most cognitive measures require sufficient hearing and vision. Considering sensory limitations during cognitive test administration is necessary so that the effects of sensory and cognitive abilities on test performance can be differentiated and the validity of test results optimized.

OBJECTIVE

To review empirical strategies that researchers have employed to accommodate DSI during cognitive testing of older adults.

METHODS

Seven databases (MEDLINE, Embase, Web of Science, CINAHL, PsycINFO, Global Health and the Evidence-Based Medicine Reviews databases) were searched for relevant articles integrating the three concepts of cognitive evaluation, aging, and DSI. Given the inclusion criteria, this scoping review included a total of 67 papers.

RESULTS

Twenty-eight studies reported five categories of strategies for cognitive testing of older adult participants with DSI: the assistance of experts, the modification of standardized test scoring procedures, the use of communication strategies, environmental modifications, and the use of cognitive tests without visual and/or auditory items.

CONCLUSIONS

The most used strategy reported in the included studies was drawing on the assistance of team members from related fields during the administration and interpretation of cognitive screening measures. Alternative strategies were rarely employed. Future research is needed to explore the knowledge-to-practice gap between research and current clinical practice, and to develop standardized testing strategies.

Relation Between Ultrasonographic Measurements of the Biceps Brachii and Total Muscle Mass in Older Hospitalized Persons: A Pilot Study

Objectives

To assess the link between ultrasonographic measurements of the biceps brachii and total muscle mass measured by bio-impedancemetry in hospitalized older patients.

Methods

A prospective observational study was conducted. The study included patients older than 65 years admitted in internal medicine, acute geriatrics, orthogeriatrics and rehabilitation departments. All measurements, ultrasonographic measurements and muscle mass and function by bio-impedancemetry and dynamometry, were taken within the first 48 hours of admission.

Results

In total 19 patients were included, the mean age was 85.4 ± 3.9 years and 7 (36.8%) were females. Very strong direct correlations were obtained in the entire cohort in both biceps brachii cross-sectional area and muscle thickness with skeletal muscle mass displayed in kilograms.

Conclusion

Biceps brachii looks like a very good muscle measuring tool: easy, comfortable, fast, good correlated with total body muscle mass. This muscle could effectively be used for the assessment of muscle mass in the diagnosis of sarcopenia since it reflects muscle mass precisely, however more studies are needed to provide reference values in all age cohorts.

Heart Rate Variability in Surgical Patients Experiencing Live Bedside Music; An Explorative Study

It's known that surgery elicits a stress response involving the autonomic nervous system (ANS) which is important in general recovery but can also have detrimental effects in older patients. Music seems to positively effect postoperative recovery, although the mechanism requires further unravelling. Our objective was to explore the response of the ANS to live bedside music in older surgical patients, by using heart rate variability (HRV) as a proxy. This explorative prospective non-randomized controlled cohort study included 101 older non-cardiac surgical patients, with a median age of 70 (range 60-88 years). HRV was measured in a cohort receiving live bedside music provided by professional musicians and in a control group that did not receive music. HRV was measured pre-intervention, during the intervention, 30 min after the intervention, and again after three hours. Mixed linear modelling was used to assess the effect of the intervention compared to the control group over time. A significant change in both the low and high frequency bands (p = 0.041) and (p = 0.041) respectively, was found over time in the music group compared to the control group indicating relaxation and increased parasympathetic activity in the music group. Other measures revealed a trend but no significant effect was shown. These results provide a first glance and contribute to a better understanding of the effect of music on the recovery of older surgical patients.

Conceptualisations of "good care" within informal caregiving networks for older people in rural South Africa

Good care in social policy statements is commonly implied as familial and person-centred, provided by family members and focused on upholding the autonomy, dignity and respect of the care recipient. Policy consideration of the relational nature of caregiving, the sociomaterial determinants of good care, the practical knowledge of caregivers and responsibilities of the state, is limited. Drawing on the ethics of care theory and a care ecology framework, which conceptualises the dynamic interactions between formal and informal care "systems," we analysed ethnographic data of the interactions of 21 caregivers and their older care recipients in South Africa to understand how they conceptualised good care. Conceptualisations of good care included: having the right, altruistic and reciprocal, motivations; providing care frequently and consistently; and demonstrating hope for a better future through practical action. Caregivers also considered restricting autonomy a feature of good care, when doing so was perceived to be in the care recipient's best interest. Conceptualisations of good care were influenced by but also countered policy and cultural ideals. When they subverted policy values and practices, by overriding autonomy, for instance, caregivers' conceptualisations reflected their practical experiences of caregiving amidst gross material inadequacies, underpinned by deficiencies in the formal care system. We highlight the need for policies, interventions and theories of care that focus broadly on the care ecology and particularly on the "carescape" (formal care system). We advocate relational approaches that consider and balance the needs, desires and rights of caregivers and care recipients, and recognise caregivers' experiential knowledge, rather than person-centred approaches that focus exclusively on the care recipient.

Hair cortisol and dehydroepiandrosterone and their associations with optimism and pessimism in older people

The cumulative negative effects of prolonged Hypothalamic-Pituitary-Adrenal axis (HPA axis) activation are associated with several age-related diseases. Some psychological traits such as optimism and pessimism have been shown to be related to both health and the stress response, although their relationship with the HPA axis is inconclusive. More stable HPA axis biomarkers, such as hair samples of cortisol (HC) and dehydroepiandrosterone (HDHEA), would help to clarify the association between these psychological traits and HPA axis functioning. The main aim of this study was to test the relationships between optimism and pessimism and chronic stress biomarkers measured in hair (HC and HDHEA). Additionally, a secondary objective was to explore sex differences in HC and HDHEA levels and their relationship with these psychological traits. We measured optimism, pessimism, and their combination (dispositional optimism) using the Life Orientation Test Revised (LOT-R) and chronic stress biomarkers (HC and HDHEA) in 119 healthy participants (46 men and 73 women) between 56 and 81 years old who belonged to a university program. Regression analyses controlling for perceived stress and BMI indicated that higher dispositional optimism was related to lower HC and HC:HDHEAratio (β = -0.256, p = .008 and β = -0.300, p = .002, respectively). More specifically, higher pessimism was related to higher HC (β = 0.235; p = .012) and HC:HDHEAratio (β = 0.240; p = .011), whereas higher optimism was associated with a lower HC:HDHEAratio(β = -0.205; p = .031). Moderation analyses showed no sex differences. To date, this is the first study to investigate the link between these traits and HC and HDHEA in older people. Our results confirm that positive and negative expectations about the future (i.e. optimism and pessimism) may play an important role in health due to their relationship with the HPA axis. They also strengthen the idea that the negative effects of pessimism have a greater weight than the protective effects of optimism in their relationship with HPA axis regulation.

Relationship between respiratory muscle strength and dynamic balance in older persons requiring care or support: Focusing on the maximal single step length test and maximal double step length test as dynamic balance indices

BACKGROUND

Falls are a major health problem. The relationship between dynamic balance related to falls and respiratory muscle strength related to sarcopenia and frailty is poorly understood.

RESEARCH QUESTION

How do dynamic balance measures, such as maximal single step length test (MSL) and maximal double step length test (MDST), and respiratory muscle strength measures, such as maximal inspiratory (PImax) and maximal expiratory (PEmax), related to the requirement for long-term care or support in older people who live in the community?

METHODS

This was a cross-sectional study of 39 older people (17 men, 22 women) aged ≥ 65 years community-dwelling who were certified as requiring long-term care or support under the Japanese system. The participants' PImax, PEmax, MSL, and MDST results were recorded. The measurement data were evaluated using Pearson's correlation coefficients and multiple regression analysis.

RESULTS

MDST showed a positive correlation with PImax (r = 0.430, p = 0.006) but no correlation with PEmax. MSL showed no correlation with PImax or PEmax. A positive correlation was found between MDST and MSL (r = 0.851, p < 0.001), and multiple regression analysis with MDST as the dependent variable and PImax and MST as independent variables showed significant differences for MSL (p < 0.001) and PImax (p = 0.027).

SIGNIFICANCE

In older people requiring long-term care or support, MDST had a greater association with inspiratory muscle strength compared with MSL. These results suggest the importance of inspiratory muscle strength training and MDST assessment in the prevention of falls in older people requiring long-term care or support.

Individual, family, job, and organizational factors associated with retirement intentions among older long-term care workers: A systematic review

This systematic review synthesized prior quantitative research on individual, family, job, and organizational factors associated with retirement intentions (RI) among older long-term care (LTC) workers. Seven databases were searched for peer-reviewed studies. RI were defined as early (<65 years) or late (>65 years). To assess the methodological quality, we used JBI's checklists. The PRISMA statement guided this review. After duplicates were removed, 4 489 records were identified. A final sample of six articles was selected as eligible for inclusion. Current findings show weak social support, high physical job demands, and type of LTC occupation as important determinants for early RI. Strong social support and good job resources are important determinants fore late RI. In contrast to earlier research on other groups of older workers, this review shows no statistically associations between health nor emotional job demands and early RI for LTC workers. The results are discussed using the JD-R theory.

Types, predictors, and consequences of medicines related problems (MRPs) in frail older adults admitted to hospital from primary care - A retrospective cohort study

Introduction

Medicines related problems (MRPs) can be common in frail older people due to age-compromised body systems and a propensity to be on multiple drugs concurrently. This group of people can also succumb to a rapid deterioration in health. Thus, it is important to investigate MRPs in frail older people. The objectives of the study were to evaluate prevalence of MRPs, types of MRPs, risk factors and deterioration that can be associated with MRPs in frail older people admitted to an English teaching hospital from primary care.

Methods

Included in the sample were frail older adults, aged 65 years and over, admitted from primary care. Data was retrieved from the hospital's electronic patient record system, anonymised, and reviewed for MRPs. MRPs which were retrospectively identified at admission were coded with the WHO-ICD10,2016 (World Health Organisation-International Classification of Diseases version 10, 2016). Descriptive and inferential statistics were performed on the data using SPSS Version 25. Primary outcome was the prevalence of MRPs in frail older patients. Secondary outcome was the association of deterioration indicated as fall, delirium, or NEWs ≥3 with presence of MRPs.

Results

Among the 507 frail older people (≥4 on Rockwood scale) that met criteria for inclusion, 262 (51.8%) were patients with MRPs and 244 (48.2%) without. The Median age of sample as a whole was 85 years (IQR = 80-89). Prevalence of MRPs was 33.28%. Types of MRPs were adverse drug reaction (ADR-20%), non-compliance (9.1%), unintentional poisoning (3.3%) and inappropriate polypharmacy (0.8%). In logistic regression, potentially inappropriate medicines (PIM), social support, number of comorbidities and winter were significant predictors of MRPs. Risk of deteriorating with delirium was two times higher in patients with MRPs than in patients without MRPs, RR 2.613 (95% CI, 1.049 to 6.510).

Conclusion

MRPs and risks of deterioration associated with MRPs in frail older people can be reduced. This is because factors associated with MRPs can be modified.

Associations between the built environment and physical activity in children, adults and older people: A narrative review of reviews

BACKGROUND

Physical activity is essential for promoting public health, and it is affected by the built environment at population level. Extensive evidence exists on the associations between the built environment and physical activity, but results are inconclusive for different age groups. Therefore, we conducted a narrative review summarizing existing reviews on the associations between the built environment and physical activity for children, adults and older people and synthesized their findings.

METHODS

We followed the PRISMA 2020 review procedure and searched for systematic reviews published between January 2010 and April 2022 in seven databases (Scopus, Web of Science, Medline, PsycINFO, EMBASE, SocIndex and Cochrane Library) using keywords related to the built environment, urban interventions, physical activity and health.

RESULTS

The selection process yielded 29 reviews with moderate to high quality. From these reviews, we identified 21 built environment characteristics, several of which were positively related to physical activity. For example, children and older people's physical activity was positively associated with pedestrian-friendly features and general safety. Furthermore, adults and older people's physical activity was positively related to the availability and accessibility of shops/commercial services and parks/open spaces. Lastly, the walkability index was positively associated with physical activity in every age group.

CONCLUSION

Our findings provide valuable information on creating health-promoting urban environments for practitioners. Further research is needed to understand which characteristics make urban environments age friendly for physical activity. Special attention should be paid to less explored promising characteristics such as street lighting and the quality of green spaces.

Effect of acupressure on pain among older female patients undergoing extracorporeal shock wave lithotripsy: A randomized controlled clinical trial

BACKGROUND AND AIM

Urinary stones are highly prevalent among older people. Extracorporeal lithotripsy is one of the commonly used treatment methods, but it causes pain. Acupressure is a non-pharmacological therapeutic method that is effective in relieving pain among patients with various health conditions. This study aimed to investigate the effect of acupressure on pain among female older people undergoing extracorporeal lithotripsy.

METHOD

This randomized controlled clinical trial was conducted on 66 older female patients undergoing extracorporeal lithotripsy. They were enrolled in the study through convenient sampling and were assigned to the intervention and control groups through the block randomization method. The intervention group underwent acupressure for 16 min which was repeated twice with an interval of 20 min, but the control group received only touch without any pressure for the same period. The McGill Pain Questionnaire and Visual Analogue Scale were completed 60 min before the intervention and immediately after lithotripsy.

FINDINGS

Before the intervention, no statistically significant difference in the quality and intensity of pain between the two groups was observed (p > 0.05). However, after acupressure, the mean scores of quality and intensity of pain decreased significantly (p < 0.001) in the intervention group compared with the control group.

CONCLUSION

Acupressure as a complementary and alternative medicine can reduce pain and suffering among older people undergoing extracorporeal lithotripsy. It can be included in the routine therapeutic measures for relieving pain and suffering during noninvasive methods for older people and reducing their need for medication use and avoiding related pharmacological side effects.

End-of-life expenditure on health care for the older population: a scoping review

BACKGROUND

The existing evidence shows that the pattern of health expenditure differs considerably between people at the end-of-life and people in other periods of their lives. The awareness of these differences, combined with a detailed analysis of future mortality rates is one of the key pieces of information needed for health spending prognoses. The general objective of this review was to identify and map the existing empirical evidence on end-of-life expenditure related to health care for the older population.

METHODS

To achieve the objective of the study a systematic scoping review was performed. There were 61 studies included in the analysis. The project has been registered through the Open Science Framework.

RESULTS

The included studies cover different kinds of expenditure in terms of payers, providers and types of services, although most of them include analyses of hospital spending and nearly 60% of analyses were conducted for insurance expenditure. The studies provide very different results, which are difficult to compare. However, all of the studies analyzing expenditure by survivorship status indicate that expenditure on decedents is higher than on survivors. Many studies indicate a strong relationship between health expenditure and proximity to death and indicate that proximity to death is a more important determinant of health expenditure than age per se. Drawing conclusions on the relationship between end-of-life expenditure and socio-economic status would be possible only by placing the analysis in a broader context, including the rules of a health system's organization and financing. This review showed that a lot of studies are focused on limited types of care, settings, and payers, showing only a partial picture of health and social care systems in the context of end-of-life expenditure for the older population.

CONCLUSION

The results of studies on end-of-life expenditure for the older population conducted so far are largely inconsistent. The review showed a great variety of problems appearing in the area of end-of-life expenditure analysis, related to methodology, data availability, and the comparability of results. Further research is needed to improve the methods of analyses, as well as to develop some analysis standards to enhance research quality and comparability.

Delirium is more common and associated with worse outcomes in Parkinson's disease compared to older adult controls: results of two prospective longitudinal cohort studies

BACKGROUND

Inpatient prevalence of Parkinson's disease (PD) delirium varies widely across the literature. Delirium in general older populations is associated with adverse outcomes, such as increased mortality, dementia, and institutionalisation. However, to date there are no comprehensive prospective studies in PD delirium. This study aimed to determine delirium prevalence in hospitalised PD participants and the association with adverse outcomes, compared to a control group of older adults without PD.

METHODS

Participants were hospitalised inpatients from the 'Defining Delirium and its Impact in Parkinson's Disease' and the 'Delirium and Cognitive Impact in Dementia' studies comprising 121 PD participants and 199 older adult controls. Delirium was diagnosed prospectively using the Diagnostic and Statistical Manual of Mental Disorders 5th Edition criteria. Outcomes were determined by medical note reviews and/or home visits 12 months post hospital discharge.

RESULTS

Delirium was identified in 66.9% of PD participants compared to 38.7% of controls (p < 0.001). In PD participants only, delirium was associated with a significantly higher risk of mortality (HR = 3.3 (95% confidence interval [CI] = 1.3-8.6), p = 0.014) and institutionalisation (OR = 10.7 (95% CI = 2.1-54.6), p = 0.004) 12 months post-discharge, compared to older adult controls. However, delirium was associated with an increased risk of developing dementia 12 months post-discharge in both PD participants (OR = 6.1 (95% CI = 1.3-29.5), p = 0.024) and in controls (OR = 13.4 (95% CI = 2.5-72.6), p = 0.003).

CONCLUSION

Delirium is common in hospitalised PD patients, affecting two thirds of patients, and is associated with increased mortality, institutionalisation, and dementia. Further research is essential to understand how to accurately identify, prevent and manage delirium in people with PD who are in hospital.