Cost-effectiveness of pneumococcal vaccines among adults aged 65 years and older in China: A comparative study

We aimed to assess the cost-effectiveness and health benefits of 23-valent pneumococcal polysaccharide vaccine (PPSV23), 13-valent pneumococcal conjunctive vaccine (PCV13), and PCV13-PPSV23 sequential vaccination strategies in preventing pneumonia and other pneumococcal diseases among the senior citizens (≥ 65 years) in China. The cost-effectiveness of pneumococcal vaccines compared to no vaccination was estimated using a decision-tree Markov model from a societal perspective. Parameters including epidemiological data, vaccine efficacy and cost data were obtained from previous studies. Cases and deaths averted, quality-adjusted life years (QALYs) gained, and incremental cost-effectiveness ratios (ICERs) were presented as outcomes. Sensitivity analyses were performed to explore the uncertainty in the model. In the base-case analysis, compared with no pneumococcal vaccination, the ICERs of PPSV23, PCV13 and PCV13-PPSV23 are US$10,776.7/QALY, $9,193.2/QALY, and $15,080.0/QALY, respectively. PCV13 is the most cost-effective strategy and the only cost-effective strategy based on a threshold of the one-time national GDP per capita, whereas PPSV23 vaccine strategy is provided with the lowest cost, and PCV13-PPSV23 demonstrates the greatest impact on pneumococcal disease burden. Sensitivity analyses reveal that the results are greatly influenced by serotype coverage, vaccine efficacy, CAP incidence and vaccine prices. The PCV13 vaccination for Chinese seniors is more cost-effective than PPSV23 vaccination and PCV13-PPSV23 sequential vaccination.

Enhancing digital literacy with an intelligent conversational agent for senior citizens in Thailand

Intelligent conversational agents have been implemented as virtual assistants in mobile applications to facilitate, engage, and interact with users for optimal learning experiences. With 24/7 availability, providing instant and consistent responses, chatbots, as a type of intelligent conversational agent, will help benefit the learning communication, makes the entire learning experience more engaging for the learners. They have also been successfully used by the elderly to encourage behavioral change for their intended purpose. This study investigated baseline data on the use of digital platforms of senior citizens in Bangkok Metropolitan and the six regions of Thailand and developed a chatbot from the derived data. The chatbot contained learning media and service function, served as a platform to enhance digital literacy for the senior citizens in Thailand. The study was conducted in 3 phases, the baseline survey on the use of digital platforms of the senior citizens in Thailand, the development of the chatbot and learning media, and the pre-experimental expert validation. The samples were 422 senior citizens. The data were collected by questionnaires, focused group discussion, and interviews with experts, and analyzed by percentage, mean, standard deviation, and content analysis. Results were incorporated in the design and development of the chatbot innovation following the software development life cycle (SDLC) framework. Expert feedback revealed that this chatbot innovation was easy to access, convenient to request for operations, artistically appealing, and comprehensive in content and functionality for enhancing digital literacy skills, which are to access, analyze, evaluate, participate, and act. In the next research sequence, this innovation will subsequently be experimented with more senior citizens to prepare and improve their digital competence to consequently equip them with the necessary capacities to keep up with Thailand's transition towards a full-blown aging society.

COVID-19 pandemic-related changes in wellness behavior among older Americans

BACKGROUND

COVID-19 has taken its toll on citizens in all 50 states of the United States. The United States (U.S.) leads the world with 30,291,863 confirmed reported cases and 549,664 deaths as of March 29, 2021 compared to globally confirmed cases at 127,442,926 and 2,787,915 deaths as of March 29, 2021. The U.S. federal government primarily left the response to the virus to individual states, and each implemented varying measures designed to protect health of citizens and the state's economic well-being. Unintended consequences of the virus and measures to stop its spread may include decreased physical activity and exercise, shifting access and consumption of food, and lower quality-of-life. Therefore, our primary goal was to quantify the impact of COVID-19 on health and well-being by measuring changes in physical activity, mental health-quality of life, food security and nutrition in adults ages 40 and older. We believed shifts in health behaviors would be more prevalent in minorities, less educated, lower socio-economic status, older adults, and those with underlying health conditions, so a secondary goal was to determine the impact of COVID-19 on these sub-populations.

METHODS

We conducted an online survey with 9969 adults 40 years and older between 9 August and 15 September 2020 in urban areas across the four U.S. census regions. The survey included questions about demographic variables, pre-existing health conditions, physical activity, access to food, quality-of-life, and nutritional food status and asked participants to respond with information from pre-pandemic and pandemic conditions. We used paired-sample t-tests to detect changes in variables after the start of the pandemic and Cohen's d to determine effect sizes.

RESULTS

Our main findings showed a decrease in physical activity since the onset of COVID-19 for minorities and non-minorities. Food security also slightly increased for minorities during the pandemic, but we found no other changes in food security, quality-of-life indicators, or nutritional status of those who responded to this survey.

CONCLUSIONS

It is concerning that physical activity declined. Such activity helps maintain physical and mental health, and it is also an important time to socialize for many older adults. In many ways, our data indicate that the older adult population in U.S. cities may be more resilient than expected during the pandemic. However, the pandemic could have negative impacts that we did not detect, either due to the survey instrument or the timing of our survey, so the health and well-being of older adults should continue to be monitored in order to mitigate potential negative impacts.

Food insecurity among senior citizens in high out-migration areas: evidence from Western Nepal

Background

Food insecurity is a critical public health challenge, particularly in low- and middle-income countries such as Nepal. The demographic transition has resulted in a growing population of senior citizens. However, the determinants of food insecurity among Nepali senior citizens remain unknown. This study aims to fill this gap by assessing food insecurity among the older populations in the far-western region, one of the poorest regions of the country. Further, we also aim to assess the potential association between adult children's migration and the food insecurity status of the left behind older parents.

Methods

A community-based cross-sectional study was conducted among 260 randomly selected senior citizens in the Kanchanpur district in far-western Nepal. The short form of the household food security scale, originally developed by the United States Department of Agriculture, was used to measure household food security. Associations were examined by logistic regression.

Results

The prevalence of food insecurity in senior citizens' households was 41.1%. Senior citizen households with their adult children's migration (AOR = 0.47, 95% CI: 0.24-0.95) had lower odds of being food insecure whereas households with lower family income (<$100 compared to ≥ $100) had two times higher odds of being food insecure (AOR = 2.26, 95% CI: 1.08-4.76). Also, households owning a cultivable land/farm (AOR = 0.14, 95% CI: 0.05-0.40), primary source of income as service/pension (AOR = 0.26, 95% CI: 0.08-0.89) or business (AOR = 0.15, 95% CI: 0.03-0.59) and participants who received geriatric allowances (AOR = 0.05, 95% CI = 0.01-0.16) had lower odds of being food insecure.

Conclusion

The prevalence of food insecurity among households with a senior citizen in Kanchanpur district was high and associated with the migration status of adult children, and household socioeconomic status. This calls for a greater policy response focused specifically on households with older adults and the integration of gerontological evidence into the existing food security and nutrition strategies.

Unequal access: Applying Bourdieu's practice theory to illuminate the challenges of ICT use among senior citizens in Singapore

The following article examines the application of Pierre Bourdieu's Practice Theory in accounting for ongoing disparities in accessing information and communications technology (ICT) in Singapore among senior citizens. As the relevance of Practice Theory is increasingly recognized among both scholars of ICT and ageing studies in modern societies, this article seeks to further contextualize and demonstrate its theoretical relevance and explanatory potential within developed, multicultural and rapidly ageing societies such as Singapore. Qualitative data collected from focus group discussions and personal in-depth interviews are analyzed to gain insights into how older adults above the age of 55 in Singapore perceive and use ICT. While it is argued that unequal access to forms of capital - be they social, cultural, economic, symbolic or bodily - has an obvious role in impacting the construction of one's habitus within the field of ICT usage, our findings reveal that not all forms of capital exert a similar impact on the accessibility of ICT. The discussions and interviews suggest that social and cultural capital play a relatively more fundamental role. While the increasingly easy-to-use and economically affordable nature of ICT has made it more accessible, our findings indicate that many older persons in Singapore still lack the necessary educational backgrounds, linguistic skills and supportive social networks that facilitate easier access. Such insights ultimately have implications on the nature of efforts by the state to create a more digitally inclusive society in Singapore.

LDL-cholesterol Predicts a First CHD Event in Senior Citizens, Especially So in Those With Elevated Lipoprotein(a): Dubbo Study of the Elderly

OBJECTIVE

The analysis was designed to explore the combined effects of LDL-cholesterol and lipoprotein(a) (Lp(a)) in predicting incident coronary heart disease (CHD) in senior citizens without prior CHD.

METHODS

This is a prospective cohort study in Dubbo NSW which has followed 2805 men and women 60 years and older for 16 years since 1988-1989. Subjects with prior CHD (n=607) were excluded from this analysis. Incident CHD events were identified by hospital record linkage. The contributions of LDL and Lp(a) to CHD events and their combined effects were evaluated in proportional hazards regression models.

RESULTS

There were 689 CHD events over 16 years in a cohort of 2198 men and women without prior CHD. LDL-cholesterol (corrected for cholesterol content of Lp(a)) and Lp(a) modelled in quartile categories each independently predicted CHD, but exclusively in Quartile 4 (Q4) for each parameter. Using the combination of LDL Q1 and Lp(a) Q1 as a reference group, LDL Q4 (>4.90mmol/L) most clearly predicted CHD in combination with Lp(a) Q4 (>276mg/L), hazard ratio 1.95 (95%CI 1.31-2.90).

CONCLUSION

The present findings may have important practical implications in clinical management. If Lp(a) is assessed in senior citizens without prior CHD and found to be genuinely low, elevated LDL-cholesterol may not require active intervention.

Single-Camera-Based Method for Step Length Symmetry Measurement in Unconstrained Elderly Home Monitoring

OBJECTIVE

single-camera-based gait monitoring is unobtrusive, inexpensive, and easy-to-use to monitor daily gait of seniors in their homes. However, most studies require subjects to walk perpendicularly to camera's optical axis or along some specified routes, which limits its application in elderly home monitoring. To build unconstrained monitoring environments, we propose a method to measure step length symmetry ratio (a useful gait parameter representing gait symmetry without significant relationship with age) from unconstrained straight walking using a single camera, without strict restrictions on walking directions or routes.

METHODS

according to projective geometry theory, we first develop a calculation formula of step length ratio for the case of unconstrained straight-line walking. Then, to adapt to general cases, we propose to modify noncollinear footprints, and accordingly provide general procedure for step length ratio extraction from unconstrained straight walking.

RESULTS

Our method achieves a mean absolute percentage error (MAPE) of 1.9547% for 15 subjects' normal and abnormal side-view gaits, and also obtains satisfactory MAPEs for non-side-view gaits (2.4026% for 45°-view gaits and 3.9721% for 30°-view gaits). The performance is much better than a well-established monocular gait measurement system suitable only for side-view gaits with a MAPE of 3.5538%.

CONCLUSION

Independently of walking directions, our method can accurately estimate step length ratios from unconstrained straight walking.

SIGNIFICANCE

This demonstrates our method is applicable for elders' daily gait monitoring to provide valuable information for elderly health care, such as abnormal gait recognition, fall risk assessment, etc.

OBJECTIVE

single-camera-based gait monitoring is unobtrusive, inexpensive, and easy-to-use to monitor daily gait of seniors in their homes. However, most studies require subjects to walk perpendicularly to camera's optical axis or along some specified routes, which limits its application in elderly home monitoring. To build unconstrained monitoring environments, we propose a method to measure step length symmetry ratio (a useful gait parameter representing gait symmetry without significant relationship with age) from unconstrained straight walking using a single camera, without strict restrictions on walking directions or routes.

METHODS

according to projective geometry theory, we first develop a calculation formula of step length ratio for the case of unconstrained straight-line walking. Then, to adapt to general cases, we propose to modify noncollinear footprints, and accordingly provide general procedure for step length ratio extraction from unconstrained straight walking.

RESULTS

Our method achieves a mean absolute percentage error (MAPE) of 1.9547% for 15 subjects' normal and abnormal side-view gaits, and also obtains satisfactory MAPEs for non-side-view gaits (2.4026% for 45°-view gaits and 3.9721% for 30°-view gaits). The performance is much better than a well-established monocular gait measurement system suitable only for side-view gaits with a MAPE of 3.5538%.

CONCLUSION

Independently of walking directions, our method can accurately estimate step length ratios from unconstrained straight walking.

SIGNIFICANCE

This demonstrates our method is applicable for elders' daily gait monitoring to provide valuable information for elderly health care, such as abnormal gait recognition, fall risk assessment, etc.

Validation of Emotional Intelligence Measure (MIE) for the Portuguese population

Objective

To describe the process of validating Emotional Intelligence Measurement (MIE) Scale for Portuguese senior citizens.

Design

Observational, cross-sectional quantitative study.

Framework

Senior citizens attending senior universities and from the community in the district of Viseu.

Participants

1084 subjects participated with a mean age of 72.98 years, residing in the district of Viseu, no longer involved in formal activities (retired) and participating voluntarily in study.

Main measurements

the Emotional Intelligence Measuring (MIE) Scale, socio-demographic characteristics (age, gender, marital status, residence). An exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) of the MIE scale were performed.

Results

The MIE showed very good internal consistency (Cronbach's alpha = 0.952). The main component and rotation factor analysis varimax extracted 36 items and five factors which explain 54.78% of the total variance. After confirmatory factor analysis and re-specification of the model, the global indicator values of the adjustment model for the MIE revealed a quality of good fit (X²/df = 3.46; RMR = 0.025). The final version of the MIE was composed of 33 items and five factors that represent emotional intelligence skills: Factor 1 - Empathy (12 items); Factor 2 - Self-motivation (10 items); Factor 3 - Self-awareness (4 items); Factor 4 - Self-control (4 items); Factor 5 - Sociability (3 items).

Conclusion

The MIE scale is shown to be suitable to assess emotional intelligence in Portuguese senior citizens.

Barriers to Independent Living for Individuals with Disabilities and Seniors

Individuals with disabilities and seniors often lack the freedom to choose with whom they live and where they reside. Service options may involve moving consumers to large nursing facilities or other less-preferred settings rather than optimizing environmental supports in their own home or in less restrictive settings. Not only do adults usually enjoy greater choice when they live in their own homes relative to individuals living in congregate care or group home settings but independent and semi-independent settings are also associated with better outcomes and lower costs. Identifying variables that serve as barriers to independent living is especially important given estimates predicting that the numbers of seniors and individuals with disabilities will double in the next 20 years. This doubling will tax an already burdened and costly system of care. The present study queried consumers and other key stakeholders about potential barriers to independent living and their importance. Findings not only revealed a high degree of overlap between identified barriers and their importance ratings within groups but also showed clear differences in potential barriers across the groups assessed (individuals with disabilities and senior citizens).

ICT activity in later life: Internet use and leisure activities amongst senior citizens in Finland

The article examines the relationship between the Internet use and leisure activities amongst Finnish seniors. Traditionally, the young have been the most active users of the Internet and other information and communication technologies (ICTs). In recent years, however, older age groups have increasingly become more interested in ICT, yet a significant proportion of Finnish seniors rarely log on. Using data from a nationally representative survey (N = 542) conducted in the summer of 2010, we explored the connection between the frequent Internet use and general leisure activity. The basic socio-demographic variables were controlled in the analysis. The findings indicate that the active Internet use in old age has a strong positive correlation with the number of different leisure activities amongst Finnish seniors. As most European societies continue to age, it is clear that future research should focus on the implications and the role the Internet and other new ICTs will play in the everyday life amongst the ageing citizens.

Barriers to senior citizens' outdoor mobility in Europe

The aim of this study was to picture perceived problems amongst older citizens in the traffic environment. Moreover, answers to the question why measures that are known to be efficient concerning the mobility of senior citizens are often not implemented. Eight EU countries participated in the study, involving both senior citizens and experts (researchers, decision makers and practitioners who deal with all aspects of seniors' mobility). Focus group interviews and personal interviews involving 487 senior citizens and 225 experts were carried out in order to chart problems. These were followed by quantitative surveys with 3,309 senior citizens and 490 experts that had the scope to measure the distribution of charted problems in the population. Finally, five workshops were carried out in order to discuss results and to formulate assumptions why promising measures are not implemented, as it appears. Barriers to mobility are by both experts and senior citizens attributed to traffic and infrastructure characteristics, to legal issues, to vehicle design problems, to inter-personal and inter-generational frictions, to lacking lobby power, but also to individual health problems. In order to improve mobility it is suggested by both senior citizens and experts to enforce vehicle speeds. Both groups also agree that public transport vehicles should be brought into an appropriate standard (low floor vehicles, kneeling busses). Senior citizens more than the experts ask for measures to support the sense of security and safety in the public space (police should be visible, appropriate design of infrastructure, public lighting).