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Sample records for at-risk older people

  1. Optimizing footwear for older people at risk of falls.

    PubMed

    Menant, Jasmine C; Steele, Julie R; Menz, Hylton B; Munro, Bridget J; Lord, Stephen R

    2008-01-01

    Footwear influences balance and the subsequent risk of slips, trips, and falls by altering somatosensory feedback to the foot and ankle and modifying frictional conditions at the shoe/floor interface. Walking indoors barefoot or in socks and walking indoors or outdoors in high-heel shoes have been shown to increase the risk of falls in older people. Other footwear characteristics such as heel collar height, sole hardness, and tread and heel geometry also influence measures of balance and gait. Because many older people wear suboptimal shoes, maximizing safe shoe use may offer an effective fall prevention strategy. Based on findings of a systematic literature review, older people should wear shoes with low heels and firm slip-resistant soles both inside and outside the home. Future research should investigate the potential benefits of tread sole shoes for preventing slips and whether shoes with high collars or flared soles can enhance balance when challenging tasks are undertaken. PMID:19235118

  2. Considering the benefits of egg consumption for older people at risk of sarcopenia.

    PubMed

    Smith, Alison; Gray, Juliet

    2016-06-01

    Sarcopenia is an important health issue for older people. It is closely linked with frailty and malnutrition and can significantly reduce both health and quality of life for those affected. Sarcopenic decline in muscle mass can start as early as the fourth and fifth decade of life, so the maintenance of muscle mass throughout adulthood, through regular physical activity and a balanced diet, should be an important consideration in reducing the risk of sarcopenia in older age. Maintaining regular exercise throughout older age remains key to the treatment of sarcopenia, as does an adequate intake of nutrients, including high-quality protein and vitamin D. A significant proportion of older people fail to meet the recommended requirements for protein; it has also been suggested that the requirements in existing recommendations could be higher. Evidence is emerging that an adequate intake of protein at each meal may be required to optimise muscle synthesis in older people. Eggs are an inexpensive, widely available and easily digestible source of high-quality protein and contain a significant proportion of leucine, an amino acid that is important for muscle synthesis, as well as many other nutrients of significance for older people, including vitamin D and omega-3 fatty acids. For many older people, eggs are a familiar and acceptable protein food at breakfast and other meals. Encouraging both those approaching older age and older people to include eggs more frequently, as part of a healthy, balanced diet and in addition to physical activity, could help them maintain their muscle strength and function, thereby preserving their functional capacity and reducing morbidity, mortality and healthcare costs associated with sarcopenia. PMID:27270199

  3. Napping in older people 'at risk' of dementia: relationships with depression, cognition, medical burden and sleep quality.

    PubMed

    Cross, Nathan; Terpening, Zoe; Rogers, Naomi L; Duffy, Shantel L; Hickie, Ian B; Lewis, Simon J G; Naismith, Sharon L

    2015-10-01

    Sleep disturbance is prevalent in older adults, particularly so in those at a greater risk of dementia. However, so far the clinical, medical and neuropsychological correlates of daytime sleep have not been examined. The aims of this study were to investigate the characteristics and effects of napping using actigraphy in older people, particularly in those 'at risk' of dementia. The study used actigraphy and sleep diaries to measure napping habits in 133 older adults 'at risk' of dementia (mean age = 65.5 years, SD = 8.4 years), who also underwent comprehensive medical, psychiatric and neuropsychological assessment. When defined by actigraphy, napping was present in 83.5% (111/133) of participants; however, duration and timing varied significantly among subjects. Nappers had significantly greater medical burden and body mass index, and higher rates of mild cognitive impairment. Longer and more frequent naps were associated with poorer cognitive functioning, as well as higher levels of depressive symptoms, while the timing of naps was associated with poorer nocturnal sleep quality (i.e. sleep latency and wake after sleep onset). This study highlights that in older adults 'at risk' of dementia, napping is associated with underlying neurobiological changes such as depression and cognition. Napping characteristics should be more routinely monitored in older individuals to elucidate their relationship with psychological and cognitive outcomes. PMID:26096839

  4. Older People and HIV

    MedlinePlus

    ... Many older people believe that HIV only affects younger people Most older people get little training in ... diseases among older people, as they do for younger people. Physicians may not diagnose HIV infection in ...

  5. Pilot study to investigate the feasibility of the Home Falls and Accidents Screening Tool (HOME FAST) to identify older Malaysian people at risk of falls

    PubMed Central

    Romli, Muhammad Hibatullah; Mackenzie, Lynette; Lovarini, Meryl; Tan, Maw Pin

    2016-01-01

    Objective The relationship between home hazards and falls in older Malaysian people is not yet fully understood. No tools to evaluate the Malaysian home environment currently exist. Therefore, this study aimed to pilot the Home Falls and Accidents Screening Tool (HOME FAST) to identify hazards in Malaysian homes, to evaluate the feasibility of using the HOME FAST in the Malaysian Elders Longitudinal Research (MELoR) study and to gather preliminary data about the experience of falls among a small sample of Malaysian older people. Design A cross-sectional pilot study was conducted. Setting An urban setting in Kuala Lumpur. Participants 26 older people aged 60 and over were recruited from the control group of a related research project in Malaysia, in addition to older people known to the researchers. Primary outcome measure The HOME FAST was applied with the baseline survey for the MELoR study via a face-to-face interview and observation of the home by research staff. Results The majority of the participants were female, of Malay or Chinese ethnicity and living with others in a double-storeyed house. Falls were reported in the previous year by 19% and 80% of falls occurred at home. Gender and fear of falling had the strongest associations with home hazards. Most hazards were detected in the bathroom area. A small number of errors were detected in the HOME FAST ratings by researchers. Conclusions The HOME FAST is feasible as a research and clinical tool for the Malaysian context and is appropriate for use in the MELoR study. Home hazards were prevalent in the homes of older people and further research with the larger MELoR sample is needed to confirm the validity of using the HOME FAST in Malaysia. Training in the use of the HOME FAST is needed to ensure accurate use by researchers. PMID:27531736

  6. Older People and HIV

    MedlinePlus

    ... common than they were before the use of anti-HIV drugs. It is difficult to know what is causing mental problems in older people with HIV. Is it normal aging, or is it HIV disease? Research studies have ...

  7. Older Women: A Population at Risk for Mental Health Problems.

    ERIC Educational Resources Information Center

    Wisniewski, Wendy; Cohen, Donna

    The expanding population of older women relative to older men or the "feminization of aging" is a significant demographic trend with important implications for the future. Older women are at risk for extended years of widowhood, living alone, institutionalization, poverty, and mental health problems. Although the dementias of late life appear to…

  8. Deprescribing in older people.

    PubMed

    Page, Amy Theresa; Potter, Kathleen; Clifford, Rhonda; Etherton-Beer, Christopher

    2016-09-01

    Older people with chronic disease have great potential to benefit from their medications but are also at high risk of harm from their medications. The use of medications is particularly important for symptom control and disease progression in older people. Under-treatment means older people can miss out on the potential benefits of useful medications, while over-treatment (polypharmacy) puts them at increased risk of harm. Deprescribing attempts to balance the potential for benefit and harm by systematically withdrawing inappropriate medications with the goal of managing polypharmacy and improving outcomes. The evidence base for deprescribing in older people is growing. Studies to reduce polypharmacy have used a range of methods. Most evidence for deprescribing relates to the withdrawal of specific medications, and evidence supports attempts to deprescribe potentially inappropriate medicines (such as long-term benzodiazepines). There is also evidence that polypharmacy can be reduced by withdrawing specific medications using individualised interventions. More work is needed to identify the sub-groups of older people who may most benefit from deprescribing and the best approaches to undertaking the deprescribing interventions. PMID:27451330

  9. Oral health for older people.

    PubMed

    2016-08-01

    Compared with previous generations, more older people have retained some or all of their teeth, but more than 40% of community-dwelling older people aged 75 and over have unmet oral health needs. However, the importance of oral health can be undervalued by healthcare professionals and older people. Three studies relating to oral health for older people are summarised. PMID:27573957

  10. Diabetes in older people.

    PubMed

    Bennett, Katie

    2015-10-01

    The management of diabetes in older people is often challenging and poorly researched. The prevalence of cognitive impairment, chronic kidney disease and other co-existing comorbidities increase with age and have a significant impact on glycaemic control targets and treatment options. This conference examined current clinical practice, highlighted differences in the management of diabetes in the older person and suggested potential areas of future research. PMID:26430187

  11. Learning Opportunities for Older People.

    ERIC Educational Resources Information Center

    MacKeracher, Dorothy

    1980-01-01

    The author summarizes a conference on learning opportunities for older people by discussing six issues: (1) perspectives of older people and service providers; (2) categorization of older learners; (3) learning needs of older people; (4) participation rates; (5) government policies; and (6) curriculum concerns. (SK)

  12. Gastrointestinal care for older people.

    PubMed

    Tremayne, Penny; Harrison, Penny

    2016-07-01

    This article discusses gastrointestinal (GI) healthcare in older people. It outlines the physiological changes that occur in the GI tract as a result of ageing, and discusses common GI disorders in older people. These GI disorders include dysphagia, gastrointestinal reflux disease, colorectal cancer, diverticular disease, constipation and anaemia. Healthcare professionals should be aware of the factors that may influence gastrointestinal health in older people, including nutrition, hydration and alcohol use, which are important considerations when delivering person-centred care. PMID:27380703

  13. Improving Medication Management among At-risk Older Adults

    PubMed Central

    Martin, Delinda; Kripalani, Sunil; DuPapau, V.J.

    2013-01-01

    Low health literacy is common among Medicare recipients and affects their understanding of complex medication regimens. Interventions are needed to improve medication use among older adults, while addressing low health literacy. Community-dwelling older adults in this study were enrolled in an inner-city adult day center. They completed a baseline measure of health literacy, medication self-efficacy, and medication adherence. They were provided with a personalized, illustrated daily medication schedule (PictureRx™). Six weeks later, their medication self-efficacy and adherence were assessed. Among the 20 participants in this pilot project, 70% had high likelihood of limited health literacy and took an average of 13.2 prescription medications. Both self-efficacy and medication adherence increased significantly after provision of the PictureRx cards (p<0.001 and p<0.05, respectively). Al participants rated the PictureRx cards as very helpful in terms of helping them remember the medication’s purpose and dosing. Illustrated daily medication schedules improve medication self-efficacy and adherence among at-risk, community-dwelling older adults. PMID:22587641

  14. Clinical Trials and Older People

    MedlinePlus

    ... have a much wider applicability. Researchers need the participation of older people in their clinical trials so ... contact with questions about the study or your participation. Control group —the group of participants who get ...

  15. Esperanto and Older People.

    ERIC Educational Resources Information Center

    Gal, Ilona

    1978-01-01

    Research has indicated that the elderly retain the ability to learn, and specifically to learn new languages. Furthermore, the increasingly greater proportion of old people in the population demands that their need for continued intellectual stimulation be met. In the absence of explicit motives for learning an ethnic language, Esperanto is a good…

  16. PTSD in older bereaved people.

    PubMed

    O'Connor, Maja

    2010-08-01

    Late life bereavement has been associated with psychological problems, mainly depression. A few studies indicated that posttraumatic stress disorder (PTSD) was an important issue in late life bereavement reactions. This study aimed to assess the prevalence of PTSD in recently bereaved older people compared with married controls and to investigate whether the loss of a spouse in old age, in contrast with earlier assumptions, could lead to PTSD. Two hundred and ninety-six Danish older bereaved people (mean age 73 years, 113 males) were chosen from national registers and assessed two months postbereavement. They were compared with a control group of 276 married older people. The prevalence of PTSD and depression were measured through a self-report questionnaire. Results showed that 16% of the bereaved and 4% of the control group had a PTSD diagnosis (ES = 0.35; Cohen's d = 0.74). Additionally, 37% of the bereaved and 22% of the control group had mild to severe depression (ES = 0.19; Cohen's d = 0.37). The results suggested that late life spousal bereavement result in PTSD with equal frequency to general samples of bereaved persons. Furthermore, the prevalence of PTSD in the first months after bereavement was more elevated than the level of depression. This makes PTSD an important factor when studying late life bereavement reactions. PMID:20686978

  17. Interface Design and Engagement with Older People

    ERIC Educational Resources Information Center

    Hawthorn, D.

    2007-01-01

    The current paper examines the design process that led to an unusually successful interactive tutorial for older people. The paper describes the issues that make designing for older people different. These include differences between the designer and the target population and the difficulty that older people have in interacting with low-fidelity…

  18. Lived experiences of self-care among older, home-dwelling individuals identified to be at risk of undernutrition

    PubMed Central

    Tomstad, Solveig T; Söderhamn, Ulrika; Espnes, Geir Arild; Söderhamn, Olle

    2012-01-01

    Introduction In a society where most older people live in their own homes, it may be expected of older individuals to exercise their potential to take care of themselves in daily life. Nutrition is a central aspect of self-care, and groups of older, home-dwelling people are at risk of undernutrition. Aim The aim of this study was to describe the lived experiences of self-care and features that influence health and self-care among older, home-dwelling individuals identified to be at risk of undernutrition. Methods Qualitative interviews were performed with eleven home-dwelling individuals who had been identified as being at risk of undernutrition. The interviews were recorded, transcribed verbatim, and analyzed with a descriptive phenomenological method. Findings Self-care as a lived experience among older, home-dwelling individuals identified to be at risk of undernutrition is about being aware of food choices and making decisions about taking healthy steps or not. In the presence of health problems, the appetite often decreases. Being able to take care of oneself in daily life is important, as is receiving help when needing it. Working at being physically and socially active and engaged may stimulate the appetite. Having company at meals is important and missed when living alone. Being present and taking each day by day, as well as considering oneself in the light of past time and previous experiences and looking ahead, is central, even when having fears for the future and the end of life. Conclusion Health care professionals should be aware of these findings in order to support self-care in older people, and they should pay attention to the social aspects at meals. PMID:23271914

  19. Advice on healthy eating for older people.

    PubMed

    Fisher, Karen

    As part of its Food and Health Action Plan, the Department of Health is working with the food industry, and with other stakeholders, to establish a coherent national plan to help people in England improve their diets. Maintaining a healthy diet is important for all age groups, but healthy older people have particular needs. Karen Fisher describes the specific nutritional issues affecting healthy older people and suggests advice that nurses can offer people during opportunistic consultations in primary care. PMID:16350521

  20. Youth "At Risk"? Young People, Sexual Health and Consent

    ERIC Educational Resources Information Center

    Powell, Anastasia

    2007-01-01

    In Australia, there is a growing expectation that sexuality education should reduce the risks associated with youth sex by providing young people with information on protecting their sexual health. However, this information may be insufficient to ensure that young people make choices that support their sexual safety and autonomy. This paper…

  1. Prevalence and Correlates of At-Risk Drinking Among Older Adults: The Project SHARE Study

    PubMed Central

    Moore, Alison A.; Xu, Haiyong; Ang, Alfonso; Tallen, Louise; Mirkin, Michelle; Ettner, Susan L.

    2010-01-01

    ABSTRACT BACKGROUND At-risk drinking, excessive or potentially harmful alcohol use in combination with select comorbidities or medication use, affects about 10% of elderly adults and is associated with higher mortality. Yet, our knowledge is incomplete regarding the prevalence of different categories of at-risk drinking and their associations with patient demographics. OBJECTIVE To examine the prevalence and correlates of different categories of at-risk drinking among older adults. DESIGN Cross-sectional analysis of survey data. SUBJECTS Current drinkers ages 60 and older accessing primary care clinics around Santa Barbara, California (n = 3,308). MEASUREMENTS At-risk drinkers were identified using the Comorbidity Alcohol Risk Evaluation Tool (CARET). At-risk alcohol use was categorized as alcohol use in the setting of 1) high-risk comorbidities or 2) high-risk medication use, and 3) excessive alcohol use alone. Adjusted associations of participant characteristics with at-risk drinking in each of the three at-risk categories and with at-risk drinking of any kind were estimated using logistic regression. RESULTS Over one-third of our sample (34.7%) was at risk. Among at-risk individuals, 61.9% had alcohol use in the context of high-risk comorbidities, 61.0% had high-risk medication use, and 64.3% had high-risk alcohol behaviors. The adjusted odds of at-risk drinking of any kind were decreased and significant for women (odds ratio, OR = 0.41; 95% confidence interval: 0.35-0.48; p-value < 0.001), adults over age 80 (OR = 0.55; CI: 0.43-0.72; p < 0.001 vs. ages 60-64), Asians (OR = 0.40; CI: 0.20-0.80; p = 0.01 vs. Caucasians) and individuals with higher education levels. Similar associations were observed in all three categories of at-risk drinking. CONCLUSIONS High-risk alcohol use was common among older adults in this large sample of primary care patients, and male Caucasians, those ages 60-64, and those with lower levels of education

  2. Suicide in older people: Revisioning new approaches.

    PubMed

    Deuter, Kate; Procter, Nicholas; Evans, David; Jaworski, Katrina

    2016-04-01

    This discussion paper identifies and examines several tensions inherent in traditional approaches to understanding older people's suicide. Predicted future increases in the absolute number of elderly suicides are subject to careful interpretation due to the underreporting of suicides in older age groups. Furthermore, a significant number of studies of older people's death by suicide examine risk factors or a combination of risk factors in retrospect only, while current approaches to suicide prevention in the elderly place disproportionate emphasis on the identification and treatment of depression. Taken together, such tensions give rise to a monologic view of research and practice, ultimately limiting our potential for understanding older people's experience of suicide and suicidal behaviour. New approaches are necessary if we are to move beyond the current narrow focus that prevails. Fresh thinking, which draws on older people's experience of attempting to die by suicide, might offer critical insight into socially-constructed meanings attributed to suicide and suicidal behaviour by older people. Specifically, identification through research into the protective mechanisms that are relevant and available to older people who have been suicidal is urgently needed to effectively guide mental health nurses and health-care professionals in therapeutic engagement and intervention. PMID:26762697

  3. A One-to-One Programme for At-Risk Readers Delivered by Older Adult Volunteers

    ERIC Educational Resources Information Center

    Fives, Allyn; Kearns, Noreen; Devaney, Carmel; Canavan, John; Russell, Dan; Lyons, Rena; Eaton, Patricia; O'Brien, Aoife

    2013-01-01

    This paper is based on a randomized controlled trial (RCT) evaluation of a reading programme delivered by older adult volunteers for at-risk early readers. Wizards of Words (WoW) was targeted at socially disadvantaged children in first and second grade experiencing delays in reading but who were not eligible for formal literacy supports. The…

  4. Improving nutrition in older people in acute care.

    PubMed

    Best, Carolyn; Hitchings, Helen

    2015-07-22

    Older people have an increased risk of becoming malnourished when they are ill. Admission to hospital may affect their nutritional intake and nutritional status. Nutrition screening and implementation of nutrition care plans can help minimise the risk of malnutrition in acute care settings, if used effectively. The nutritional care provided to older inpatients should be timely, co-ordinated, reviewed regularly and communicated effectively between healthcare professionals and across shifts. This article explores what malnutrition means, why older people in hospital might be at risk of malnutrition and the effect hospital admission might have on nutrition and fluid intake. It makes suggestions for addressing these issues, encourages nurses to look at the nutritional care provided in their clinical area, to reflect on what they do well and consider what can be done to improve patients' experiences. PMID:26198529

  5. Intergenerational Talk and Communication with Older People.

    ERIC Educational Resources Information Center

    Giles, Howard; And Others

    1992-01-01

    Overviews evolving program of interdisciplinary, multimethod research concerned with intergenerational communication. Concludes from studies that young people process and respond to speech of older people in stereotypical ways. Uses lifespan and intercultural perspectives to argue that communicative patterns observed in studies are sometimes…

  6. Brief Report: Young People at Risk for Eating Disorders in Southeast Brazil

    ERIC Educational Resources Information Center

    Moya, Tatiana; Fleitlich-Bilyk, Bacy; Goodman, Robert

    2006-01-01

    A representative sample of 7-14-year-old young people in southeast Brazil (N=1251) was assessed using standardized parent and youth interviews, thereby identifying an "at-risk" group of young people who met one or more DSM-IV criteria for anorexia and/or bulimia nervosa. These young people were compared with an age and gender matched comparison…

  7. How Many People Are Affected by or at Risk for Endometriosis?

    MedlinePlus

    ... people are affected by or at risk for endometriosis? Skip sharing on social media links Share this: ... menstruates. Factors that May Increase the Risk of Endometriosis Studies show that women are at higher risk ...

  8. How Many People Are Affected by or at Risk for Down Syndrome?

    MedlinePlus

    ... people are affected by or at risk for Down syndrome? Skip sharing on social media links Share this: ... ethnicity. 4 , 5 Maternal Age and Risk for Down Syndrome Because the likelihood that an egg will contain ...

  9. Chronic foot pain in older people.

    PubMed

    Menz, Hylton B

    2016-09-01

    Foot pain is a common accompaniment of advancing age, affecting at least one in four older people. However, management of foot pain is a largely undervalued aspect of geriatric health care, resulting in many older people needlessly enduring chronic foot pain and related disability. The aim of this review is to provide an overview of (i) the prevalence and risk factors for foot pain, (ii) the impact of foot pain on mobility and quality of life, and (iii) the conservative management of foot pain. The available evidence indicates that although foot pain is common and disabling in older people, conservative interventions such as routine foot care, footwear advice and foot orthoses are effective at reducing foot pain and may also assist in maintaining mobility and independence in this age group. PMID:27451329

  10. The Right to Health of Older People.

    PubMed

    Baer, Britta; Bhushan, Anjana; Taleb, Hala Abou; Vasquez, Javier; Thomas, Rebekah

    2016-04-01

    A focus on the right to the enjoyment of the highest attainable standard of health (hereinafter, "the right to health") draws attention to the health needs of older people, including the most marginalized among them. Many factors that influence vulnerability or impede the enjoyment of health and access to quality services result from an inability to freely exercise these human rights. A human rights approach can help to address the legal, social, and structural barriers to good health for older persons, clarifying the legal obligations of State and non-State actors to uphold and respect these rights. However, despite growing impetus for action, this area has historically received limited attention. Drawing on practice examples from different regions, this article unpacks the meaning of the right to health and other related human rights of older people in practice, covering both health care and underlying determinants of their health. Questions of availability, accessibility, acceptability, and quality are highlighted from the perspective of older people's health and well-being. The article brings together knowledge, principles, norms, and standards from the human rights law, health, and ageing arenas. By making links between these arenas, it is hoped that the article fills a gap in thinking on how to achieve the progressive realization of the right to health of older people and the effective promotion and protection of their other related human rights, which are crucial for the enjoyment of health. PMID:26994261

  11. Pressure ulcer prevention in frail older people.

    PubMed

    Barry, Maree; Nugent, Linda

    2015-12-16

    Pressure ulcers are painful and cause discomfort, have a negative effect on quality of life, and are costly to treat. The incidence and severity of preventable pressure ulcers is an important indicator of quality of care; it is essential that healthcare providers monitor prevalence and incidence rates to ensure that care strategies implemented are effective. Frail older people are at increased risk of developing pressure ulcers. This article discusses the complexities of preventing pressure ulcers in frail older people and emphasises the importance of structured educational programmes that incorporate effective clinical leadership and multidisciplinary teamwork. PMID:26669407

  12. Caring for Older People. Public transport.

    PubMed Central

    Roper, T. A.; Mulley, G. P.

    1996-01-01

    Most older people are mobile and able to use public transport without any problems. Those who are hard of hearing or have poor vision and those with mobility problems need not be deterred from using public transport. Though the design and provision of suitable buses, taxis, and trains is not always optimum, many now have imaginative features to help older passengers. Travel by air and sea needs extra planning for disabled elderly people, but helpful advice is available and much can be done to enable even the most disabled traveller to make long journeys confidently and in comfort. Images p415-a Fig 1 Fig 2 Fig 3 PMID:8761236

  13. Detecting dehydration in older people: useful tests.

    PubMed

    Hooper, Lee; Bunn, Diane

    Dehydration is common in older people, leading to longer hospital stays and increased disability and mortality. Health professionals can diagnose water-loss dehydration by taking a blood sample and measuring serum osmolality, but a less-invasive test would be useful. Evidence that tests, clinical signs or questions tested to date are useful when screening for dehydration in older people is limited. This article looks at known risk factors, signs and test for dehydration, and outlines evidence on how useful they have proven to be. Part 2 describes how a care home has used a multicomponent strategy to improve hydration. PMID:26455128

  14. Can we improve clinical prediction of at-risk older drivers?

    PubMed Central

    Bowers, Alex R.; Anastasio, R. Julius; Sheldon, Sarah S.; O’Connor, Margaret G.; Hollis, Ann M.; Howe, Piers D.; Horowitz, Todd S.

    2013-01-01

    Objectives To conduct a pilot study to evaluate the predictive value of the Montreal Cognitive Assessment test (MoCA) and a brief test of multiple object tracking (MOT) relative to other tests of cognition and attention in identifying at-risk older drivers, and to determine which combination of tests provided the best overall prediction. Methods Forty-seven currently-licensed drivers (58 to 95 years), primarily from a clinical driving evaluation program, participated. Their performance was measured on: (1) a screening test battery, comprising MoCA, MOT, MiniMental State Examination (MMSE), Trail-Making Test, visual acuity, contrast sensitivity, and Useful Field of View (UFOV); and (2) a standardized road test. Results Eighteen participants were rated at-risk on the road test. UFOV subtest 2 was the best single predictor with an area under the curve (AUC) of .84. Neither MoCA nor MOT was a better predictor of the at-risk outcome than either MMSE or UFOV, respectively. The best four-test combination (MMSE, UFOV subtest 2, visual acuity and contrast sensitivity) was able to identify at-risk drivers with 95% specificity and 80% sensitivity (.91 AUC). Conclusions Although the best four-test combination was much better than a single test in identifying at-risk drivers, there is still much work to do in this field to establish test batteries that have both high sensitivity and specificity. PMID:23954688

  15. Destination memory impairment in older people.

    PubMed

    Gopie, Nigel; Craik, Fergus I M; Hasher, Lynn

    2010-12-01

    Older adults are assumed to have poor destination memory-knowing to whom they tell particular information-and anecdotes about them repeating stories to the same people are cited as informal evidence for this claim. Experiment 1 assessed young and older adults' destination memory by having participants tell facts (e.g., "A dime has 118 ridges around its edge") to pictures of famous people (e.g., Oprah Winfrey). Surprise recognition memory tests, which also assessed confidence, revealed that older adults, compared to young adults, were disproportionately impaired on destination memory relative to spared memory for the individual components (i.e., facts, faces) of the episode. Older adults also were more confident that they had not told a fact to a particular person when they actually had (i.e., a miss); this presumably causes them to repeat information more often than young adults. When the direction of information transfer was reversed in Experiment 2, such that the famous people shared information with the participants (i.e., a source memory experiment), age-related memory differences disappeared. In contrast to the destination memory experiment, older adults in the source memory experiment were more confident than young adults that someone had shared a fact with them when a different person actually had shared the fact (i.e., a false alarm). Overall, accuracy and confidence jointly influence age-related changes to destination memory, a fundamental component of successful communication. PMID:20718537

  16. Destination Memory Impairment in Older People

    PubMed Central

    Gopie, Nigel; Craik, Fergus I. M.; Hasher, Lynn

    2012-01-01

    Older adults are assumed to have poor destination memory— knowing to whom they tell particular information—and anecdotes about them repeating stories to the same people are cited as informal evidence for this claim. Experiment 1 assessed young and older adults’ destination memory by having participants tell facts (e.g., “A dime has 118 ridges around its edge”) to pictures of famous people (e.g., Oprah Winfrey). Surprise recognition memory tests, which also assessed confidence, revealed that older adults, compared to young adults, were disproportionately impaired on destination memory relative to spared memory for the individual components (i.e., facts, faces) of the episode. Older adults also were more confident that they had not told a fact to a particular person when they actually had (i.e., a miss); this presumably causes them to repeat information more often than young adults. When the direction of information transfer was reversed in Experiment 2, such that the famous people shared information with the participants (i.e., a source memory experiment), age-related memory differences disappeared. In contrast to the destination memory experiment, older adults in the source memory experiment were more confident than young adults that someone had shared a fact with them when a different person actually had shared the fact (i.e., a false alarm). Overall, accuracy and confidence jointly influence age-related changes to destination memory, a fundamental component of successful communication. PMID:20718537

  17. Older People as Consumers of Education.

    ERIC Educational Resources Information Center

    Knox, Alan

    Socio-psychological variables that influence the extent to which older people (age: 50+) will be consumers of education are examined to arrive at criteria for programs appropriate to the developmental needs of this group. Research indicates that two primary influences are changes in learning abilities and interests. Secondary influences include…

  18. Frail Older People as Participants in Research

    ERIC Educational Resources Information Center

    Peel, Nancye M.; Wilson, Cecilia

    2008-01-01

    This article describes the experience of interviewing frail older people in a research project investigating hip fracture risk factors. Specific methodological strategies to maximize participation and data quality and to facilitate the interview process related to participant inclusion criteria, initial approach, questionnaire format, and…

  19. Prevention of Dehydration in Independently Living Elderly People at Risk: A Study Protocol of a Randomized Controlled Trial

    PubMed Central

    Konings, Francis J. C. M.; Mathijssen, Jolanda J. P.; Schellingerhout, Jasper M.; Kroesbergen, Ike H. T.; Goede de, Joyce; Goor de, Ien A. M.

    2015-01-01

    Background: Dehydration of elderly people living independently is a very important public health issue. This study compares two interventions to prevent dehydration in elderly people at risk: an educational intervention and an educational intervention in combination with a drink reminder device. Methods: This is an experimental two-armed parallel study. A Public Health Service develops the interventions and will be partnering with a general practice and a university to evaluate the effects. Two groups – all people aged 80 years and older, and people of 65 years and older who have cardiovascular disease – receive a letter from the general practice in which they are asked whether they want to participate in the study and if so to return the form. People who want to participate and whose daily fluid intake is insufficient are randomized to receive either the educational intervention or the educational intervention in combination with a drink reminder device. The participants are asked to fill in a questionnaire before the intervention, 6 weeks after the start of the intervention and 6 months after the start (or after the end) of the intervention. Changes between the two groups in fluid intake, knowledge, awareness of the risks of dehydration, and quality-of-life will be tested by Linear Mixed Model analyses. Conclusions: This study will improve the knowledge of the effectiveness of interventions designed to prevent dehydration in elderly people. PMID:26644904

  20. Dietary factors and depression in older people.

    PubMed

    Williamson, Claire

    2009-10-01

    Depression is one of the most prevalent mental health conditions and can affect people of all ages, but it is becoming more common among the older population with increasing life expectancy. Observational studies have found poor micronutrient status (particularly folate and vitamin B12) to be associated with an increased risk of depression in older people. Supplementation with folic acid has been shown to enhance anti-depressant drug treatment and there is preliminary evidence that supplementation with certain micronutrients may help improve depressive symptoms in older patients. There has also been a lot of interest in the role of long-chain omega-3 fatty acids in depression. However, the evidence from randomized controlled trials is limited and difficult to evaluate owing to considerable variability between studies. The research highlights the importance of a healthy diet and lifestyle to help maintain good mental health into old age and health professionals should try to support older people in trying to achieve this. PMID:19966681

  1. Helicobacter pylori infection in older people

    PubMed Central

    Pilotto, Alberto; Franceschi, Marilisa

    2014-01-01

    Since the discovery of Helicobacter pylori (H. pylori) infection as the major cause of gastroduodenal disorders three decades ago, H. pylori has been the focus of active research and debate in the scientific community. Its linkage to several diseases, such as peptic ulcer disease, gastritis and gastric malignancy is incontestable. In particular, it has been noticed that, as the aged population is increasing worldwide, older people are at increased risk of developing several gastroduodenal diseases and related complications. At the same time, gastric cancer is definitely more frequent in elderly than in adult and young people. In addition, it has been showed that peptic ulcer and related complications occur much more commonly in aged individuals than in young people, resulting in a significantly higher mortality. Although this infection plays a crucial role in gastrointestinal disorders affecting all age groups and in particular older people, only a few studies have been published regarding the latter. This article presents an overview of the epidemiology, diagnosis, clinical manifestations and therapy of H. pylori infection in elderly people. PMID:24914358

  2. Correlates of Physical Activity Among Middle-Aged and Older Korean Americans at Risk for Diabetes

    PubMed Central

    Han, Benjamin; Sadarangani, Tina; Wyatt, Laura C.; Zanowiak, Jennifer M.; Kwon, Simona C.; Trinh-Shevrin, Chau; Lee, Linda; Islam, Nadia S.

    2016-01-01

    Purpose To explore correlates of meeting recommended physical activity (PA) among middle-aged and older Korean Americans at risk for diabetes mellitus (DM). Design and Methods PA patterns and their correlates were assessed among 292 middle-aged and older Korean Americans at risk for DM living in New York City (NYC) using cross-sectional design of baseline information from a diabetes prevention intervention. PA was assessed by self-report of moderate and vigorous activity, results were stratified by age group (45-64 and 65-75), and bivariate analyses compared individuals performing less than sufficient PA and individuals performing sufficient PA. Logistic regression was used to calculate adjusted odds ratios predicting sufficient PA. Findings After adjusting for sex, age group, years lived in United States, marital status, health insurance and body mass index (BMI), sufficient PA was associated with male sex, older age, lower BMI, eating vegetables daily, and many PA-specific questions (lack of barriers, confidence, and engagement). When stratified by age group, male sex and eating vegetables daily was no longer significant among Koreans age 65 to 75 years of age, and BMI was not significant for either age group. Conclusions PA interventions targeting this population may be beneficial and should consider the roles of sex, age, physical and social environment, motivation, and self-efficacy. Clinical Relevance Clinical providers should understand the unique motivations for PA among Korean Americans and recognize the importance of culturally driven strategies to enable lifestyle changes and support successful aging for diverse populations. PMID:26641597

  3. Pathways between stigma and suicidal ideation among people at risk of psychosis.

    PubMed

    Xu, Ziyan; Müller, Mario; Heekeren, Karsten; Theodoridou, Anastasia; Metzler, Sibylle; Dvorsky, Diane; Oexle, Nathalie; Walitza, Susanne; Rössler, Wulf; Rüsch, Nicolas

    2016-04-01

    Mental illness stigma may contribute to suicidality and is associated with social isolation and low self-esteem among young people at risk of psychosis. However, it is unclear whether mental illness stigma contributes to suicidality in this population. We therefore examined the associations of self-labeling and stigma stress with suicidality among young people at risk. Self-labeling as "mentally ill", stigma stress, social isolation, self-esteem, symptoms and suicidal ideation were assessed in 172 individuals at risk of psychosis. Self-labeling and stigma stress were examined as predictors of suicidality by path analysis. Increased self-labeling as "mentally ill" was associated with suicidality, directly as well as indirectly mediated by social isolation. More stigma stress was related to social isolation which in turn was associated with low self-esteem, depression and suicidal ideation. Social isolation fully mediated the link between stigma stress and suicidal ideation. Interventions to reduce the public stigma associated with risk of psychosis as well as programs to facilitate non-stigmatizing awareness of at-risk mental state and to reduce stigma stress among young people at risk of psychosis might strengthen suicide prevention in this population. PMID:26843510

  4. How Many People Are Affected by or at Risk for Cushing's Syndrome?

    MedlinePlus

    ... Small Business Programs Activities and opportunities geared toward small businesses Peer Review Review of the scientific & technical merit of grant applications Contacts for NICHD Funding Information ... at risk for Cushing’s syndrome? Skip sharing on social media links Share this: Page Content The risk of developing Cushing’s syndrome is small; only two to three people per million are ...

  5. Access to Vocational Guidance for People at Risk of Social Exclusion.

    ERIC Educational Resources Information Center

    Clayton, Pamela M., Ed.; Fojcik, Vavrinec; Greco, Silvana; Hulkko, Johanna; Kelly, Eimer; Kostka, Miroslav; McGill, Paul; Machackova, D.; Maiello, Marco; Makela, Eija; Sinorova, Lenka; Troska, Robert; Ward, Mary

    This document contains 7 papers that evolved from 44 case studies of access to vocational guidance for people at risk of social exclusion in 5 European countries. The following papers are included: "Introduction" (Pamela Clayton); "Access to Vocational Guidance in Italy" (Silvana Greco, Marco Maiello); "Access to Vocational Guidance in Ireland"…

  6. Perceptions of older people on disaster response and preparedness.

    PubMed

    Duggan, Seana; Deeny, Pat; Spelman, Ruth; Vitale, Catherine T

    2010-03-01

    Most disasters occur in developing countries but in the last decade due to the increasing threat of floods, air disasters and terrorist threat, disaster response and preparedness is a growing global concern. Due to an ageing population across the world, older people now constitute a significant proportion of those at risk from disasters. This paper reports on a qualitative study carried out in Sri Lanka and in the United States where a group of older people were asked about aspects of disaster response and preparedness. The group from Sri Lanka (n=9) who had direct experience of the 2004 Indian Ocean Tsunami were asked how they perceived international aid relief and a group of white Caucasians from East Coast USA (n=8) were asked about disaster preparedness. Findings indicate that both groups had similar issues albeit that they were looking at different phases of the disaster cycle and from different cultural perspectives. Both groups identified issues related to, protecting the rights of the older person and preventing loss of independence in responding and preparing for a disaster, mistrust of government and access to resources and all expressed strong feelings of self-responsibility. PMID:20925760

  7. Stigma and suicidal ideation among young people at risk of psychosis after one year.

    PubMed

    Xu, Ziyan; Mayer, Benjamin; Müller, Mario; Heekeren, Karsten; Theodoridou, Anastasia; Dvorsky, Diane; Metzler, Sibylle; Oexle, Nathalie; Walitza, Susanne; Rössler, Wulf; Rüsch, Nicolas

    2016-09-30

    Suicidality is common among individuals at risk of psychosis. Emerging findings suggest that mental illness stigma contributes to suicidality. However, it is unclear whether stigma variables are associated with suicidality among young people at risk of psychosis. This longitudinal study assessed perceived public stigma and the cognitive appraisal of stigma as a stressor (stigma stress) as predictors of suicidal ideation among individuals at risk of psychosis over the period of one year. One hundred and seventy-two participants between 13 and 35 years of age were included who were at high or ultra-high risk of psychosis or at risk of bipolar disorder. At one-year follow-up, data were available from 73 completers. In multiple logistic regressions an increase of stigma stress (but not of perceived stigma) over one year was significantly associated with suicidal ideation at one-year follow-up, controlling for age, gender, symptoms, comorbid depression and suicidal ideation at baseline. Interventions to reduce public stigma and stigma stress could therefore improve suicide prevention among young people at risk of psychosis. PMID:27419651

  8. Self reported rates of criminal offending and victimization in young people at-risk for psychosis.

    PubMed

    Purcell, R; Harrigan, S; Glozier, N; Amminger, G P; Yung, A R

    2015-08-01

    A significant relationship exists between experiencing psychosis and both engaging in criminal offending and being a victim of crime. A substantial proportion of violence and offending occurs during the first episode of psychosis, but it is unclear whether such behaviour is also evident in the earlier pre-psychotic stage of illness. As part of a prospective study of young people who were seeking help for mental health problems, we enquired about participants' experiences of being charged and/or convicted of a criminal offence and being a victim of crime. This paper uses cross-sectional baseline data to compare the rates of these forensic outcomes in participants at-risk of psychosis (n=271) with those not at-risk (n=440). Univariate logistic regression showed that the at-risk for psychosis group was significantly more likely than the not at-risk participants to report having been charged by police (11.1% vs 5.9%; p=.015) and convicted by the courts (4.4% vs. 1.6%; p=0.028) with a non-violent offence, as well as to have been convicted of any criminal offence (6.3% vs. 3.0%; p=0.037). The at-risk were also more likely to report having been a victim of crime (23.7% vs 14.0%; p=.002), particularly violent victimization (16.5% vs 8.2%; p=.001). In multivariate logistic regression analyses, being at-risk for psychosis remained a significant predictor of three of the four outcome measures after controlling for other known covariates such as gender, age, substance misuse and unemployment. This is the first study to demonstrate that, relative to their non-psychotic help-seeking counterparts, young people at-risk for psychosis are at higher risk of forensic outcomes, particularly violent crime victimization. PMID:26036816

  9. Evidence-based review of interventions for medically at-risk older drivers.

    PubMed

    Classen, Sherrilene; Monahan, Miriam; Auten, Beth; Yarney, Abraham

    2014-01-01

    OBJECTIVE. To conduct an evidence-based review of intervention studies of older drivers with medical conditions. METHOD. We used the American Occupational Therapy Association's classification criteria (Levels I-V, I = highest level of evidence) to identify driving interventions. We classified studies using letters to represent the strength of recommendations: A = strongly recommend the intervention; B = recommend intervention is provided routinely; C = weak evidence that the intervention can improve outcomes; D = recommend not to provide the intervention; I = insufficient evidence to recommend for or against the intervention. RESULTS. For clients with stroke, we recommend a graded simulator intervention (A) and multimodal training in traffic theory knowledge and on-road interventions (B); we make no recommendation for or against Dynavision, Useful Field of View, or visual-perceptual interventions (I). For clients with visual deficits, we recommend educational intervention (A) and bioptic training (B); we make no recommendation for or against prism lenses (I). For clients with dementia, we recommend driving restriction interventions (C) and make no recommendation for or against use of compensatory driving strategies (I). CONCLUSION. Level I studies are needed to identify effective interventions for medically at-risk older drivers. PMID:25005514

  10. Evidence-Based Review of Interventions for Medically At-Risk Older Drivers

    PubMed Central

    Monahan, Miriam; Auten, Beth; Yarney, Abraham

    2014-01-01

    OBJECTIVE. To conduct an evidence-based review of intervention studies of older drivers with medical conditions. METHOD. We used the American Occupational Therapy Association’s classification criteria (Levels I–V, I = highest level of evidence) to identify driving interventions. We classified studies using letters to represent the strength of recommendations: A = strongly recommend the intervention; B = recommend intervention is provided routinely; C = weak evidence that the intervention can improve outcomes; D = recommend not to provide the intervention; I = insufficient evidence to recommend for or against the intervention. RESULTS. For clients with stroke, we recommend a graded simulator intervention (A) and multimodal training in traffic theory knowledge and on-road interventions (B); we make no recommendation for or against Dynavision, Useful Field of View, or visual–perceptual interventions (I). For clients with visual deficits, we recommend educational intervention (A) and bioptic training (B); we make no recommendation for or against prism lenses (I). For clients with dementia, we recommend driving restriction interventions (C) and make no recommendation for or against use of compensatory driving strategies (I). CONCLUSION. Level I studies are needed to identify effective interventions for medically at-risk older drivers. PMID:25005514

  11. Managing agitated behaviour in older people.

    PubMed

    King, Camille

    2012-09-01

    Older people diagnosed with dementia can have complex needs, especially when they exhibit agitated behaviour. Patients with agitated behaviour challenge the delivery of health care. Often the behaviour is a symptom of unmet needs in this population (Dewing 2010). It is important for nurses to understand the underlying causes and apply evidence-based interventions in their nursing practice to promote health, safety and the highest quality of life possible. This article defines and classifies agitated behaviours, discusses implications for their management and then presents evidence-based interventions nurses can use. The interventions are categorised according to each of the five senses. PMID:23008918

  12. Screening for Malnutrition in Older People.

    PubMed

    Guyonnet, Sophie; Rolland, Yves

    2015-08-01

    Malnutrition risk increases with age and level of care. Despite significant medical advances, malnutrition remains a significant and highly prevalent public health problem of developed countries. Earlier identification and appropriate nutrition support may help to reverse or halt the malnutrition trajectory and the negative outcomes associated with poor nutritional status. A nutrition screening process is recommended to help detect people with protein-energy malnutrition (PEM) or at malnutrition risk. Evidence supports that oral nutritional supplements and dietary counseling can increase dietary intake and improve quality of life in elderly with PEM or at malnutrition risk. This article examines nutritional screening and assessment tools designated for older adults. PMID:26195101

  13. The Market for Community Services for Older People.

    ERIC Educational Resources Information Center

    Hereford, Russell W.

    The Supportive Services Program for Older Persons is designed to demonstrate that a private market for home and community-based health related services can be developed in response to the demand expressed by older people and their families. The objective of the program is to expand the service options available to older people by letting market…

  14. Perceptions of disaster preparedness among older people in South Korea.

    PubMed

    Yoo, Myoungran; Lee, Mijung; Tullmann, Dorothy

    2016-03-01

    Older people are a major vulnerable population. During disasters, given their physical frailty, lower social status, loss of medications and medical care, the vulnerability of older people increases. The purpose of this study was to examine the perceptions of older people in Korea on various aspects of disaster preparedness to better understand their special needs and to facilitate appropriate disaster planning. The study was qualitative and used focus group interviews with 12 older people in one major city and one rural area of South Korea. Four themes were identified by the analysis of the interviews: defenceless state, reality of accepting limitations, strong will to live, importance of disaster preparedness governmental efforts for the older people. Findings indicated that preparation of shelters and transportation was critical to help older people survive in times of disasters and suggested that there should be active involvement of the government in terms of disaster planning, managing and preparing older people for disasters. In addition, healthy older people can be assets to disaster relief efforts by providing practical and emotional support for the most fragile older people. Older people can also provide knowledge of their special needs to the government to improve their disaster response policy. PMID:26179452

  15. An integrated practice approach to mobility care for older people.

    PubMed

    Taylor, Janice; Hill, Heather; Kay, Kate

    2016-03-16

    Mobility is important to older people in nursing homes and residential facilities since it contributes to their health and quality of life. Many residents in such facilities require some form of assistance to move and accomplish activities of daily living. Therefore, nurses and healthcare assistants should have the knowledge and skills to provide effective mobility care. This article discusses three important aspects of mobility care: safety, mobility optimisation and person-centred approaches to care. Safety is important as residents and staff are at risk of injury during mobility care. Mobility optimisation is essential to ensure residents maintain their independence. Person-centred approaches to care are central to providing an integrated approach to mobility care. PMID:26982868

  16. Attitudes and stereotypes: nurses' work with older people.

    PubMed

    Pursey, A; Luker, K

    1995-09-01

    The study reported here sought to describe the differences between nurses' attitudes towards work with older people in the collective sense and their attitudes towards the individuals with whom they work. A convenience sample of 136 community nurses was obtained. Data were collected by means of a questionnaire incorporating the report of two critical incidents--one of effective practice and one of ineffective practice with older people. In addition in-depth qualitative interviews were conducted with 22 respondents. The findings lead the authors to challenge the common assumption that an identified lack of desire in nurses to work with older people is due solely to negative attitudes which nurses hold towards older people themselves. The paper concludes that the high dependency levels of older people and structure of nursing work with older people in hospitals means that fewer nurses make this area a positive career choice. PMID:7499623

  17. Carotenoids and health in older people.

    PubMed

    Woodside, Jayne V; McGrath, Alanna J; Lyner, Natalie; McKinley, Michelle C

    2015-01-01

    As the proportion of older people increases, so will chronic disease incidence and the proportion of the population living with disability. Therefore, new approaches to maintain health for as long as possible in this age group are required. Carotenoids are a group of polyphenolic compounds found predominantly in fruit and vegetables that have been proposed to have anti-inflammatory and antioxidant effects. Such properties may impact on the risk diseases which predominate in older people, and also ageing-related physiological changes. Working out the effect of carotenoid intake versus fruit and vegetable intake is difficult, and the strong correlation between individual carotenoid intakes also complicates any attempt to examine individual carotenoid health effects. Similarly, research to determine whether carotenoids consumed as supplements have similar benefits to increased dietary intake through whole foods, is still required. However, reviewing the recent evidence suggests that carotenoid intake and status are relatively consistently associated with reduced CVD risk, although β-carotene supplementation does not reduce CVD risk and increases lung cancer risk. Increased lycopene intake may reduce prostate cancer progression, with a potential role for carotenoids at other cancer sites. Lutein and zeaxanthin have a plausible role in the maintenance of eye health, whilst an association between carotenoid intake and cognitive and physical health appears possible, although research is limited to date. Given this accruing evidence base to support a specific role for certain carotenoids and ageing, current dietary advice to consume a diet rich in fruit and vegetables would appear prudent, and efforts maintained to encourage increased intake. PMID:25466302

  18. Controlling joint pain in older people.

    PubMed

    Paisley, Peter; Serpell, Mick

    2016-01-01

    Jont pain in oldder people The prevalence of chronic pain in older people in the community ranges from 25 to 76% and for those in residential care, it is even higher at 83 to 93%. The most common sites affected are the back, hip, or knee, and other joints. There is increased reporting of pain in women (79%) compared with men (53%). Common conditions include osteoarthritis and, to a lesser extent, the inflammatory arthropathies such as rheumatoid arthritis. The differential diagnosis includes non-articular pain such as vascular limb pain and nocturnal cramp, some neuropathic pain conditions (such as compressive neuropathies and postherpetic neuralgia), soft tissue disorders such as fibromyalgia and myofascial pain syndromes. In addition to an assessment of pain intensity, a biopsychosocial model should be adopted to ascertain the effect of the pain on the patient's degree of background pain at rest. The disease is often localised to the large load-bearing joints, predominantly the hips and knees. In contrast to osteoarthritis, the inflammatory arthritides typically present with symmetrical swollen, stiff, and painful small joints of the hands and feet, usually worse in the morning. PMID:27180497

  19. Newer Drugs Helping Older People with Eye Disease

    MedlinePlus

    ... People With Eye Disease Treatments keeping those with macular degeneration reading and driving longer, study finds To use ... life for many older people with age-related macular degeneration (AMD), a new study indicates. The drugs Avastin ...

  20. Seniors-on-line: introducing older people to technology.

    PubMed

    Irizarry, C; Downing, A; Elford, C

    1997-03-01

    Retired Engineers are playing an important role in ensuring that older people are not excluded from the benefits of technological advances. Technology is playing an increasingly important role in the lives of older people as it is incorporated into assistive devices, home security, access to health care, banking, communication and many other areas. However, if older people are unfamiliar with new technologies and find them daunting, they may not benefit fully from these advances. In order to minimize difficulties arising from unfamiliarity with technology, an introductory computer course was offered to people aged 55 and over. Teaching methods appropriate to the needs of older people were used: small classes, students and instructors from same age cohort, slow pace of presentation and ample opportunity to ask questions. Retired Engineers make up the majority of instructors. Three hundred and sixty nine older people have participated in the course and most plan to continue using a computer. PMID:9141312

  1. Hand-Grip Strength Cut-Points to Screen Older Persons at Risk for Mobility Limitation

    PubMed Central

    Sallinen, Janne; Stenholm, Sari; Rantanen, Taina; Heliövaara, Markku; Sainio, Päivi; Koskinen, Seppo

    2010-01-01

    Objectives To determine optimal hand-grip strength cut-points for increased likelihood for mobility limitation among older people and to study whether these cut-points differ according to body mass index (BMI). Design and setting Cross-sectional analysis of data collected in the Finnish population-based Health 2000 Survey. Participants and measurements 1 084 men and 1 562 women aged 55 years and older with complete data on anthropometry, hand-grip strength and self-reported mobility. Mobility limitation was defined as difficulties in walking 0.5-km or climbing stairs. Receiver Operating Characteristics analysis was used to estimate hand-grip strength cut-points for increased likelihood for mobility limitation. Results The overall hand-grip strength cut-points for increased likelihood for mobility limitation were 37 kg (sensitivity 62% and specificity 76%) for men and 21 kg (67% and 73%) for women. Hand-grip strength by BMI interaction on mobility limitation was significant among men (p = 0.022), while no such interaction was observed among women (p = 0.156). Among men, most optimal cut-offs were 33 kg (73% and 79%) for normal-weight men, 39 kg (67% and 71%) for overweight men and 40 kg (57% and 68%) for obese men. Among women, BMI-specific hand-grip strength cut-off values did not markedly increase accuracy over the overall cut-off value. Conclusion Hand-grip strength test is a useful tool to identify persons with increased risk for mobility limitation. Among men, the hand-grip strength cut-points for mobility increased along with BMI, while among women only one hand-grip strength threshold was identified. PMID:20863331

  2. Impact of prescribed medications on patient safety in older people

    PubMed Central

    Anathhanam, Sujo; Powis, Rachel A.; Robson, Jeremy

    2012-01-01

    Appropriate prescribing for older adults presents unique challenges to the prescriber. An understanding of the scale of the problems and contributing factors is essential when designing interventions to improve patient safety. The altered pharmacology of ageing, the existence of multiple medical conditions and the exclusion of elderly patients from many trials render this subgroup of the population particularly vulnerable to underprescribing and overprescribing. Adverse drug events are common, causing significant morbidity and mortality as well as having economic implications. ‘High-risk’ medications such as opioids, anticoagulants and antipsychotics can have benefits in this group of patients but strategies to optimize their safety are required. Tools exist that help to identify those at risk of adverse drug reactions and to screen for inappropriate prescribing. Developments in information technology are ongoing, and it is hoped that these may enhance the process of medication reconciliation across healthcare transitions and alert the prescriber to potential adverse drug events. This review addresses commonly encountered issues when prescribing for older people, considers strategies to improve medication safety and offers a list of ‘top tips’ to aid the clinician. PMID:25083234

  3. Taking older people's rights seriously: the role of international law.

    PubMed

    Tang, Kwong-leung

    2008-01-01

    Older people face many difficult challenges that amount to a deplorable violation of their basic human rights (poverty, discrimination, denial of social services, etc.). However, the world has been slow to react. Factors that limit global responses to the challenges of aging include: limited political will, the prevalence of neo-liberalism, and NGOs' longstanding advocacy for other seemingly "more" disadvantaged groups. Such oppression of and discrimination against older people require a concerted world-wide response. We contend that the introduction of an international convention on the human rights of older people is most relevant. Reinforced by a potent international monitoring system, the convention should contain comprehensive and legally binding provisions that require participating states to promote older people's rights. It is argued that international law would be a powerful force in defending and protecting older persons, operating as a baseline for establishing underlying values for national aging policies and linking older persons' concerns with other segments of society. PMID:18198162

  4. EXECUTIVE DYSFUNCTION IN HOMEBOUND OLDER PEOPLE WITH DIABETES MELLITUS

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The objective of this study was to describe patterns of cognitive deficits and activities of daily living (ADLs) in older people with diabetes mellitus. We conducted a cross-sectional, population-based study on two hundred ninety-one homebound people aged 60 and older, 40% with diabetes mellitus, in...

  5. Media portrayal of older people as illustrated in Finnish newspapers

    PubMed Central

    Koskinen, Sanna; Salminen, Leena; Leino-Kilpi, Helena

    2014-01-01

    Media portrayals of older people, such as those in newspapers, both inform and reflect public attitudes. By becoming aware of culturally influenced attitudes about older people, and how these attitudes are reflected in the ways older people are viewed, treated, and cared for in society, the healthcare profession can better understand how to provide high-quality care. By applying an ethnographic approach in textual reality, this paper explores how newspaper articles focusing on health portray older people in society, using Finland as an example. The data consist of articles selected from three of the main Finnish daily newspapers during a 3-month period in the spring of 2012. The findings show that, overall, the society regards older people and their care as important. However, there were suggestions of paternalistic attitudes towards older people. Furthermore, the perceptions regarding different groups of older people could lead to the possibility of inequality. The media portrayals of older people worldwide seem to share similarities, although the findings of this study are particularly in accordance with the cultural attributes of the Nordic countries and societies. PMID:25261872

  6. Media portrayal of older people as illustrated in Finnish newspapers.

    PubMed

    Koskinen, Sanna; Salminen, Leena; Leino-Kilpi, Helena

    2014-01-01

    Media portrayals of older people, such as those in newspapers, both inform and reflect public attitudes. By becoming aware of culturally influenced attitudes about older people, and how these attitudes are reflected in the ways older people are viewed, treated, and cared for in society, the healthcare profession can better understand how to provide high-quality care. By applying an ethnographic approach in textual reality, this paper explores how newspaper articles focusing on health portray older people in society, using Finland as an example. The data consist of articles selected from three of the main Finnish daily newspapers during a 3-month period in the spring of 2012. The findings show that, overall, the society regards older people and their care as important. However, there were suggestions of paternalistic attitudes towards older people. Furthermore, the perceptions regarding different groups of older people could lead to the possibility of inequality. The media portrayals of older people worldwide seem to share similarities, although the findings of this study are particularly in accordance with the cultural attributes of the Nordic countries and societies. PMID:25261872

  7. Psychosocial barriers to sexual intimacy for older people.

    PubMed

    Garrett, Dawne

    A review of the literature relating to the psychosocial barriers to sexual intimacy in older people reveals wide-ranging influences on people aged 75-85 years. These influences include: a lack of positive social policy, a lack of research, partner availability, negative media portrayals, psychological factors, relationship factors, and difficulties in interactions with health professionals. Stereotypical attitudes about sexual intimacy and older people remain a cultural norm. A high value is placed on a gold standard of sexual performance, which can reinforce negative esteem and set unrealistic expectations and measures for older people. This article focuses on the majority of the older population who do not require residential care. It examines major influences emerging from a review of the literature from 1995 to 2013, which informs a working definition for sexual intimacy in people over the age of 75 years. The article concludes with key recommendations for nurses working with older adults. PMID:24690929

  8. Involving older people in improving general hospital care.

    PubMed

    Hayes, Nicky; Dearnley, Barbara

    2007-05-01

    User involvement is high on the NHS agenda. At King's College Hospital, London, older people helped to develop the Improving Hospital Care for Older People project by producing teaching and learning materials for staff using e-learning. The project was set up by holding focus groups with older people. Staff surveys were also conducted to explore views and identify issues to be addressed. Older people's representatives were selected and directly involved in developing learning materials. This article describes the process of working together and includes the personal reflections of some of the key players. It discusses barriers to effective user involvement work between staff and older people, and identifies some benefits and opportunities presented by this approach. PMID:17518196

  9. Intersectoral interagency partnerships to promote financial capability in older people.

    PubMed

    Hean, Sarah; Fenge, Lee Ann; Worswick, Louise; Wilkinson, Charlie; Fearnley, Stella

    2012-09-01

    From the second quarter of 2008, the UK economy entered a period of economic decline. Older people are particularly vulnerable during these times. To promote ways in which older people can be better supported to maintain their financial well-being, this study explored the sources older people utilize to keep themselves financially informed. Interviews with older people (n = 28) showed that older people access trusted sources of information (e.g. healthcare professionals) rather than specialist financial information providers (e.g. financial advisors) which highlighted the need for interagency working between financial services in the private, public and voluntary sectors. An example of how such interagency partnerships might be achieved in practice is presented with some recommendations on directions for future research into interagency working that spans public, private and voluntary sectors. PMID:22734939

  10. Mental health issues and discrimination among older LGBTI people.

    PubMed

    Tinney, Jean; Dow, Briony; Maude, Phillip; Purchase, Rachel; Whyte, Carolyn; Barrett, Catherine

    2015-09-01

    LGBT is an acronym used to describe people from diverse sexual orientation or gender identity, people that are gay, lesbian, bisexual, or transgender. LGBT people do not constitute a single group nor does each individual "group" constitute a homogeneous unity. However, as higher rates of depression and/or anxiety have been observed in older LGBT people, compared to their heterosexual counterparts (Guasp, 2011) there is a need to raise the profile of mental health issues amongst these groups. The additional letter I is also often included in the acronym LGBTI as intersex people are often included as another gender diverse group. However, there is very little research that includes intersex people and none on older intersex people's mental health so this editorial is restricted to consideration of older LGBT people. PMID:26223452

  11. Circadian temperature rhythms of older people

    NASA Technical Reports Server (NTRS)

    Monk, T. H.; Buysse, D. J.; Reynolds, C. F. 3rd; Kupfer, D. J.; Houck, P. R.

    1995-01-01

    This collection of studies had the aim of exploring whether older (77+ years) men and women have circadian body temperature rhythms different from those of younger adults. A total of 20 older men and 28 older women were compared with either 22 young men or 14 middle-aged men in four protocols; all but the first protocol using a subset of the sample. The four protocols were: 1) 24 h, and 2) 72 h data collections on a normal laboratory routine (sleeping at night); 3) between 36 h and 153 h of field data collection at home; and 4) 36 h of a constant conditions routine (wakeful bedrest under temporal isolation) in the laboratory. There was some evidence for an age-related phase advance in temperature rhythm, especially for the older men on a normal routine, though this was not present in the constant conditions protocol, where 5 of the older subjects showed major delays in the timing of the body temperature trough (10:00 or later). There was no statistically significant evidence from any of the protocols that older subjects generally had lower temperature rhythm amplitudes than younger adults. Only when older men were compared with younger men in 24-h rhythm amplitude by simple t-test did any comparison involving amplitude achieve statistical significance (p < 0.05).

  12. Intrinsic Brain Activity of Cognitively Normal Older Persons Resembles More That of Patients Both with and at Risk for Alzheimer's Disease Than That of Healthy Younger Persons

    PubMed Central

    Pasquini, Lorenzo; Tonch, Annika; Plant, Claudia; Zherdin, Andrew; Ortner, Marion; Kurz, Alexander; Förstl, Hans; Zimmer, Claus; Grimmer, Timo; Wohlschäger, Afra; Riedl, Valentin

    2014-01-01

    Abstract In Alzheimer's disease (AD), recent findings suggest that amyloid-β (Aβ)-pathology might start 20–30 years before first cognitive symptoms arise. To account for age as most relevant risk factor for sporadic AD, it has been hypothesized that lifespan intrinsic (i.e., ongoing) activity of hetero-modal brain areas with highest levels of functional connectivity triggers Aβ-pathology. This model induces the simple question whether in older persons without any cognitive symptoms intrinsic activity of hetero-modal areas is more similar to that of symptomatic patients with AD or to that of younger healthy persons. We hypothesize that due to advanced age and therefore potential impact of pre-clinical AD, intrinsic activity of older persons resembles more that of patients than that of younger controls. We tested this hypothesis in younger (ca. 25 years) and older healthy persons (ca. 70 years) and patients with mild cognitive impairment and AD-dementia (ca. 70 years) by the use of resting-state functional magnetic resonance imaging, distinct measures of intrinsic brain activity, and different hierarchical clustering approaches. Independently of applied methods and involved areas, healthy older persons' intrinsic brain activity was consistently more alike that of patients than that of younger controls. Our result provides evidence for larger similarity in intrinsic brain activity between healthy older persons and patients with or at-risk for AD than between older and younger ones, suggesting a significant proportion of pre-clinical AD cases in the group of cognitively normal older people. The observed link of aging and AD with intrinsic brain activity supports the view that lifespan intrinsic activity may contribute critically to the pathogenesis of AD. PMID:24689864

  13. [Dissertations 25 year after date 41. Older people's adaptability].

    PubMed

    de Baat, C; Gerritsen, A E; van der Putten, G J; van der Maarel-Wierink, C D

    2015-09-01

    In 1990, the thesis 'Removable complete dentures in older people, an issue dealing with adaptability?' was published. Among other things, this thesis aimed at finding a method of measuring older people's adaptability to removable complete dentures. Its conclusion was that a subscale of the "Beoordelingsschaal voor Oudere Patiënten" (Rating scale for older patients) had predictive value. Subsequently, only a few research projects on this topic have been carried out. They dealt with demonstrated adaptation achieved after treatment, the realised adaptation. The results were disappointing. Ever since the availability of endosseous oral implants, research into adaptability to conventional removable complete dentures seems less relevant. During the last decades, inquiries into a method of measuring treatment effectiveness has focused on older people's quality of life and general health condition. However, to assess with respect to oral health care an older person's general health condition and load-taking capacity adequately, some experience is indispensable. PMID:26397105

  14. Minimising barriers to dental care in older people.

    PubMed

    2016-08-01

    Uptake of dental care is low among older people, and declines with age and deprivation. In this UK-based study researchers aimed to identify barriers to dental service use and suggest strategies to minimise these barriers. PMID:27573954

  15. Hymns and arias: musical hallucinations in older people in Wales.

    PubMed

    Warner, Nick; Aziz, Victor

    2005-07-01

    This is a phenomenological study of 30 consecutive referrals of older people with musical hallucinations concentrating on the names of the melodies heard. Hymns and Christmas carols were the most common experience with 'Abide with Me' particularly frequent. PMID:16021667

  16. How to Plan a College Program for Older People.

    ERIC Educational Resources Information Center

    Scanlon, John

    Recommendations are offered in this manual for planning, organizing, and financing academic programs for older people, based on the experience of institutions already conducting programs for older students, on current thinking in gerontology, and on knowledge and experience of staff and consultants of the Academy for Educational Development. Three…

  17. Older People as a Developing Market for Cultural Heritage Sites

    ERIC Educational Resources Information Center

    Hansen, Anna; Zipsane, Henrik

    2014-01-01

    Is it morally acceptable for the heritage sector to see the growing population of senior citizens as a developing market? Jamtli is an open air museum in the north of Sweden. The main target group is families with children, but an increasing number of activities for older adults are being offered. The growing population of older people is a…

  18. The Meaning of "Aging in Place" to Older People

    ERIC Educational Resources Information Center

    Wiles, Janine L.; Leibing, Annette; Guberman, Nancy; Reeve, Jeanne; Allen, Ruth E. S.

    2012-01-01

    Purpose: This study illuminates the concept of "aging in place" in terms of functional, symbolic, and emotional attachments and meanings of homes, neighbourhoods, and communities. It investigates how older people understand the meaning of "aging in place," a term widely used in aging policy and research but underexplored with older people…

  19. A Drama Project about Older People's Intimacy and Sexuality

    ERIC Educational Resources Information Center

    Hafford-Letchfield, Trish; Couchman, Wendy; Webster, Maxine; Avery, Peter

    2010-01-01

    This paper describes an intergenerational project developed in partnership between a social work degree program and an Older People's Theatre group. Bringing together a small group of students, older actors, and film makers, methods from drama and the arts were utilised to explore the topic of intimacy and sexuality in later life. The project…

  20. Who Is at Risk for Arrhythmia?

    MedlinePlus

    ... on Twitter. Who Is at Risk for an Arrhythmia? Arrhythmias are very common in older adults. Atrial fibrillation (a common type of arrhythmia that can cause problems) affects millions of people, ...

  1. People with Intellectual Disabilities Living in Generic Residential Services for Older People in the UK

    ERIC Educational Resources Information Center

    Thompson, D. J.; Ryrie, I.; Wright, S.

    2004-01-01

    Background: As part of a UK programme of work focusing on older people with intellectual disabilities, the circumstance of those who reside in generic services for older people were investigated. Materials and methods: Questionnaires were sent to 2570 residential and nursing homes in 53 local authorities across the UK. Results: Five hundred and…

  2. ICT and Older People: Beyond Usability

    ERIC Educational Resources Information Center

    Hernandez-Encuentra, Eulalia; Pousada, Modesta; Gomez-Zuniga, Beni

    2009-01-01

    This study examined the use that older, regular users of computers make of information and computer technology in their daily lives. Opinions from such users were obtained regarding what they want these technologies to offer them in the future. By means of a discussion group and an online questionnaire, our critical case examined a group of mature…

  3. Finding professional fulfilment in caring for older people.

    PubMed

    Perry, Beth

    2007-03-01

    This paper describes the findings of a phenomenological study of professional fulfilment in nurses who care for older people. The author sought to uncover what brings career satisfaction to nurses who care for older people and subsequently what motivates these caregivers to continue to care. The findings have implications for clinical nurses who may see reflections of their own approaches to care in the narratives presented. The examples of care reported may inspire nurses who work with older adults by affirming their own nursing interventions. PMID:17402532

  4. Counseling Older Adults at Risk of Suicide: Recognizing Barriers, Reviewing Strategies, and Exploring Opportunities for Intervention

    ERIC Educational Resources Information Center

    Sawyer, Patricia; Williams, Beverly Rosa

    2012-01-01

    Age-related challenges to health and well-being among older adults give rise to a distinctive array of risk factors for suicide, calling for a unique approach to suicide interventions. Americans over the age of 65 are disproportionally overrepresented in the number of completed suicides. This paper examines the epidemiology of geriatric suicide,…

  5. Physical activity in older people: a systematic review

    PubMed Central

    2013-01-01

    Background Physical activity (PA) in older people is critically important in the prevention of disease, maintenance of independence and improvement of quality of life. Little is known about the physical activity of the older adults or their compliance with current physical activity guidelines. Methods A systematic literature search of the published literature was conducted. Included were published reports of original research that independently reported: the PA level of non-institutional older adults (aged 60 years and over); and the proportion of older adults in the different samples who met PA recommendations or guidelines. The review was restricted to studies published since 2000 to provide a current picture of older adults’ PA levels. Results Fifty three papers were included in the review. The percentage of older adults meeting recommended physical activity ranged from 2.4 – 83.0% across the studies. Definitions of “recommended” physical activity in older adults varied across the studies as did approaches to measurement which posed methodological challenges to data analysis. Older age groups were less likely than the reference group to be regularly active, and women were less likely than men to achieve regular physical activity, especially leisure time physical activity, when measured by both subjective and objective criteria. Conclusion The review highlights the need for studies which recruit representative random samples of community based older people and employ validated measurement methods consistently to enable comparison of PA levels over time and between countries. PMID:23648225

  6. Physical Activity among Older People and Related Factors

    ERIC Educational Resources Information Center

    Persson, Ann; While, Alison

    2012-01-01

    Objective: To investigate the duration, intensity and type of physical activity undertaken by people aged 60 years and over in relation to their reported levels of participation in social activities and their perceptions of their neighbourhood. Design: A cross-sectional questionnaire survey of older people attending two luncheon and eight social…

  7. Physical Activity among Older People Living Alone in Shanghai, China

    ERIC Educational Resources Information Center

    Chen, Yu; While, Alison E; Hicks, Allan

    2015-01-01

    Objective: To investigate physical activity among older people living alone in Shanghai, People's Republic of China, and key factors contributing to their physical activity. Methods: A cross-sectional questionnaire survey was administered in nine communities in Shanghai, using a stratified random cluster sample: 521 community-dwelling older…

  8. Developing Methods of Repurposing Electronic Health Record Data for Identification of Older Adults at Risk of Unintentional Falls

    PubMed Central

    Baus, Adam; Zullig, Keith; Long, Dustin; Mullett, Charles; Pollard, Cecil; Taylor, Henry; Coben, Jeffrey

    2016-01-01

    Nationally, nearly 40 percent of community-dwelling adults age 65 and older fall at least once a year, making unintentional falls the leading cause of both fatal and nonfatal injuries among this age group. Addressing this public health problem in primary care offers promise. However, challenges in incorporating fall risk screening into primary care result in a problem of missed opportunities for screening, counseling, intervention, and ultimately prevention. Given these barriers, this study examines the potential for the innovative use of routinely collected electronic health record data to provide enhanced clinical decision support in busy, often resource-thin primary care environments. Using de-identified data from a sample of West Virginia primary care centers, we find that it is both feasible and worthwhile to repurpose routinely collected data for the purpose of identification of older adults at risk of falls. Searching of both free-text and semistructured data was particularly valuable. PMID:27134607

  9. Communicating Science to Officials and People at Risk During a Slow-Motion Lava Flow Crisis

    NASA Astrophysics Data System (ADS)

    Neal, C. A.; Babb, J.; Brantley, S.; Kauahikaua, J. P.

    2015-12-01

    From June 2014 through March 2015, Kīlauea Volcano's Púu ´Ō´ō vent on the East Rift Zone produced a tube-fed pāhoehoe lava flow -the "June 27th flow" - that extended 20 km downslope. Within 2 months of onset, flow trajectory towards populated areas in the Puna District caused much concern. The USGS Hawaiian Volcano Observatory (HVO) issued a news release of increased hazard on August 22 and began participating in public meetings organized by Hawai`i County Mayor and Civil Defense two days later. On September 4, HVO upgraded the volcano alert level to WARNING based on an increased potential for lava to reach homes and infrastructure. Ultimately, direct impacts were modest: lava destroyed one unoccupied home and one utility pole, crossed a rural roadway, and partially inundated a waste transfer station, a cemetery, and agricultural land. Anticipation that lava could reach Pāhoa Village and cross the only major access highway, however, caused significant disruption. HVO scientists employed numerous methods to communicate science and hazard information to officials and the at-risk public: daily (or more frequent) written updates of the lava activity, flow front locations and advance rates; frequent updates of web-hosted maps and images; use of the 'lines of steepest descent' method to indicate likely lava flow paths; consistent participation in well-attended community meetings; bi-weekly briefings to County, State, and Federal officials; correspondence with the public via email and recorded phone messages; participation in press conferences and congressional briefings; and weekly newspaper articles (Volcano Watch). Communication lessons both learned and reinforced include: (1) direct, frequent interaction between scientists and officials and at-risk public builds critical trust and understanding; (2) images, maps, and presentations must be tailored to audience needs; (3) many people are unfamiliar with maps (oblique aerial photographs were more effective); (4

  10. Attitudes toward Older People and Coworkers' Intention to Work with Older Employees: A Taiwanese Study

    ERIC Educational Resources Information Center

    Lu, Luo

    2010-01-01

    The aim of this research was to examine attitudinal barriers to the employment of Taiwanese older workers (aged 60 and above). Face-to-face interviews were conducted to collect data using structured questionnaires from a sample of full-time employees (N = 258). We found that: (1) positive attitudes toward older people in general, perceived…

  11. Attitudes towards Older People and Managers' Intention to Hire Older Workers: A Taiwanese Study

    ERIC Educational Resources Information Center

    Lu, Luo; Kao, Shu-Fang; Hsieh, Ying-Hui

    2011-01-01

    The aim of this research was to examine attitudinal barriers to the managerial intention to hire older workers (aged 60 and above). Structured questionnaires were used to collect data from a sample of managers with hiring power (N = 305). We found that (a) positive attitudes towards older people in general, perceived subjective norm, personal…

  12. The disaster flood experience: Older people's poetic voices of resilience.

    PubMed

    Miller, Evonne; Brockie, Lauren

    2015-08-01

    This paper explores the experiences of older community-dwelling Australians evacuated from their homes during the 2011 and 2013 Queensland floods, applying the novel creative methodology of poetic inquiry as an analysis and interpretative tool. As well as exploring how older adults managed during a natural disaster, the paper documents the process and potential of poetic inquiry in gerontological research. The first and second poems highlight the different social resources older people have to draw on in their lives, especially during a crisis. Poem 1 ("Nobody came to help me") illustrates how one older resident felt all alone during the flood, whereas Poem 2 ("They came from everywhere"), Poem 3 ("The Girls") and Poem 5 ("Man in Blue Shirt") shows how supported--from both family and the wider community--other older residents felt. Poem 4 ("I can't swim") highlights one participant's fear as the water rises. To date, few studies have explicitly explored older adult's disaster experience, with this paper the first to utilise a poetic lens. We argue that poetic presentation enhances understanding of older residents' unique experiences during a disaster, and may better engage a wider audience of policy-makers, practitioners, the general community and older people themselves in discussion about, and reflection on, the impact and experience of disasters. PMID:26162730

  13. Protein Requirements and Recommendations for Older People: A Review

    PubMed Central

    Nowson, Caryl; O’Connell, Stella

    2015-01-01

    Declines in skeletal muscle mass and strength are major contributors to increased mortality, morbidity and reduced quality of life in older people. Recommended Dietary Allowances/Intakes have failed to adequately consider the protein requirements of the elderly with respect to function. The aim of this paper was to review definitions of optimal protein status and the evidence base for optimal dietary protein. Current recommended protein intakes for older people do not account for the compensatory loss of muscle mass that occurs on lower protein intakes. Older people have lower rates of protein synthesis and whole-body proteolysis in response to an anabolic stimulus (food or resistance exercise). Recommendations for the level of adequate dietary intake of protein for older people should be informed by evidence derived from functional outcomes. Randomized controlled trials report a clear benefit of increased dietary protein on lean mass gain and leg strength, particularly when combined with resistance exercise. There is good consistent evidence (level III-2 to IV) that consumption of 1.0 to 1.3 g/kg/day dietary protein combined with twice-weekly progressive resistance exercise reduces age-related muscle mass loss. Older people appear to require 1.0 to 1.3 g/kg/day dietary protein to optimize physical function, particularly whilst undertaking resistance exercise recommendations. PMID:26287239

  14. Protein Requirements and Recommendations for Older People: A Review.

    PubMed

    Nowson, Caryl; O'Connell, Stella

    2015-08-01

    Declines in skeletal muscle mass and strength are major contributors to increased mortality, morbidity and reduced quality of life in older people. Recommended Dietary Allowances/Intakes have failed to adequately consider the protein requirements of the elderly with respect to function. The aim of this paper was to review definitions of optimal protein status and the evidence base for optimal dietary protein. Current recommended protein intakes for older people do not account for the compensatory loss of muscle mass that occurs on lower protein intakes. Older people have lower rates of protein synthesis and whole-body proteolysis in response to an anabolic stimulus (food or resistance exercise). Recommendations for the level of adequate dietary intake of protein for older people should be informed by evidence derived from functional outcomes. Randomized controlled trials report a clear benefit of increased dietary protein on lean mass gain and leg strength, particularly when combined with resistance exercise. There is good consistent evidence (level III-2 to IV) that consumption of 1.0 to 1.3 g/kg/day dietary protein combined with twice-weekly progressive resistance exercise reduces age-related muscle mass loss. Older people appear to require 1.0 to 1.3 g/kg/day dietary protein to optimize physical function, particularly whilst undertaking resistance exercise recommendations. PMID:26287239

  15. Transforming Practice with Older People through an Ethic of Care

    PubMed Central

    Ward, Lizzie; Barnes, Marian

    2016-01-01

    This article explores the relevance of deliberative practices framed by feminist care ethics to social work practice with older people. It draws on two connected projects which brought together older people: practitioners and academics. The first was a participatory research project in which the significance of care to well-being in old age emerged. The second was a knowledge exchange project which generated learning resources for social care practice based on the research findings of the first project. Here we analyse selected transcripts of recordings from meetings of both projects to consider the ways that discussions about lived experiences and everyday lives demonstrate care through this dialogue. Using this analysis, we propose that care ethics can be useful in transforming relationships between older people and those working with them through the creation of hybrid spaces in which ‘care-full deliberation’ can happen. We argue that such reflective spaces can enable transformative dialogue about care and its importance to older people and offer a counterbalance to the procedurally driven environments in which much social work practice takes place and can support practice more attuned to the circumstances and concerns of older people. PMID:27559205

  16. Emergency care of older people who fall: a missed opportunity

    PubMed Central

    Snooks, Helen A; Halter, Mary; Close, Jacqueline C T; Cheung, Wai‐Yee; Moore, Fionna; Roberts, Stephen E

    2006-01-01

    Introduction A high number of emergency (999) calls are made for older people who fall, with many patients not subsequently conveyed to hospital. Ambulance crews do not generally have protocols or training to leave people at home, and systems for referral are rare. The quality and safety of current practice is explored in this study, in which for the first time, the short‐term outcomes of older people left at home by emergency ambulance crews after a fall are described. Results will inform the development of care for this population. Methods Emergency ambulance data in London were analysed for patterns of attendance and call outcomes in 2003–4. All older people who were attended by emergency ambulance staff after a fall in September and October 2003, within three London areas, were identified. Those who were not conveyed to hospital were followed up; healthcare contacts and deaths within the following 2 weeks were identified. Results During 2003–4, 8% of all 999 calls in London were for older people who had fallen (n = 60 064), with 40% not then conveyed to hospital. Of 2151 emergency calls attended in the study areas during September and October 2003, 534 were for people aged ⩾65 who had fallen. Of these, 194 (36.3%) were left at home. 86 (49%) people made healthcare contacts within the 2‐week follow‐up period, with 83 (47%) people calling 999 again at least once. There was an increased risk of death (standard mortality ratio 5.4) and of hospital admission (4.7) compared with the general population of the same age in London. Comment The rate of subsequent emergency healthcare contacts and increased risk of death and hospitalisation for older people who fall and who are left at home after a 999 call are alarming. Further research is needed to explore appropriate models for delivery of care for this vulnerable group. PMID:17142584

  17. Older People and Their Responsible Others.

    ERIC Educational Resources Information Center

    Kulys, Regina; Tobin, Sheldon S.

    1980-01-01

    Although the elderly in this country are often thought of as isolated and forgotten by family and friends, the study reported here found that this image differs significantly from reality in most cases. The authors discuss the various aspects of the support systems on which most elderly people rely. (Author)

  18. Alcohol use, socioeconomic deprivation and ethnicity in older people

    PubMed Central

    Rao, Rahul; Schofield, Peter; Ashworth, Mark

    2015-01-01

    Objectives This study explores the relationship between alcohol consumption, health, ethnicity and socioeconomic deprivation. Participants 27 991 people aged 65 and over from an inner-city population, using a primary care database. Primary and Secondary Outcome Measures Primary outcome measures were alcohol use and misuse (>21 units per week for men and >14 for units per week women). Results Older people of black and minority ethnic (BME) origin from four distinct ethnic groups comprised 29% of the sample. A total of 9248 older drinkers were identified, of whom 1980 (21.4%) drank above safe limits. Compared with older drinkers, older unsafe drinkers contained a higher proportion of males, white and Irish ethnic groups and a lower proportion of Caribbean, African and Asian groups. For older drinkers, the strongest independent predictors of higher alcohol consumption were younger age, male gender and Irish ethnicity. Independent predictors of lower alcohol consumption were Asian, black Caribbean and black African ethnicity. Socioeconomic deprivation and comorbidity were not significant predictors of alcohol consumption in older drinkers. For older unsafe drinkers, the strongest predictor variables were younger age, male gender and Irish ethnicity; comorbidity was not a significant predictor. Lower socioeconomic deprivation was a significant predictor of unsafe consumption whereas African, Caribbean and Asian ethnicity were not. Conclusions Although under-reporting in high-alcohol consumption groups and poor health in older people who have stopped or controlled their drinking may have limited the interpretation of our results, we suggest that closer attention is paid to ‘young older’ male drinkers, as well as to older drinkers born outside the UK and those with lower levels of socioeconomic deprivation who are drinking above safe limits. PMID:26303334

  19. Attitudes toward older people and coworkers' intention to work with older employees: a Taiwanese study.

    PubMed

    Lu, Luo

    2010-01-01

    The aim of this research was to examine attitudinal barriers to the employment of Taiwanese older workers (aged 60 and above). Face-to-face interviews were conducted to collect data using structured questionnaires from a sample of full-time employees (N= 258). We found that: (1) positive attitudes toward older people in general, perceived subjective norm, and traditional Chinese cultural values were all related to stronger intentions to work with older employees; (2) the model derived from the theory of reasoned action emerged the best model accounting for behavioral intention among competing structural models. The associations of positive attitudes and subjective norm with intention were found after controlling for demographics, cultural values, and personal contact experiences with older people. Our results highlight the importance and urgency of more concerted research to inform public and organizational policies to better promote and manage the careers of older employees in an aging, economically developing society. PMID:21261137

  20. Improving the knowledge base in older people's care.

    PubMed

    Lomas, Clare

    2016-02-01

    The UK has a rapidly ageing population, and the number of people aged over 75 is projected to double in the next 30 years. In November 2014, King's College London introduced the Older Person's Nurse Fellowship, a pioneering programme designed to give senior nurses the knowledge and skills to optimise quality of life for older people, and lead the way in transforming care and services. This article examines the fellowship programme, its aims and intended effect on practice. It also highlights a series of case study articles by four of the first cohort of fellows beginning in the March issue of Nursing Older People, which will show how the programme is helping senior nurses to improve care in a variety of settings. PMID:26938606

  1. The meaning of vulnerability to nurses caring for older people.

    PubMed

    Stenbock-Hult, Bettina; Sarvimäki, Anneli

    2011-01-01

    Research concerning work on caring for older people shows that care providers experience a variety of consuming emotions and stress. They can be said to be in a vulnerable position. It is not known, however, how the care providers themselves understand vulnerability. The aim of this study was to illuminate the meaning of vulnerability to care providers caring for older people. A qualitative interpretive approach was adopted. Data were collected through tape-recorded interviews with 16 female registered and practical nurses who were experienced in caring for older people. Qualitative analysis resulted in one core theme and six themes with subthemes. The core theme showed that, for the participating nurses, vulnerability essentially meant being human. The meanings of being human were illustrated by the six themes: having feelings; experiencing moral indignation; being harmed; having courage; protecting oneself; and maturing and developing. Analysis showed that vulnerability was a resource as well as a burden. PMID:21285195

  2. Longitudinal assessment of medical student attitudes toward older people.

    PubMed

    De Biasio, Justin C; Parkas, Valerie; Soriano, Rainier P

    2016-08-01

    Delivering adequate care to older people requires an increasing number of physicians competent in the treatment of this expanding subpopulation. Attitudes toward older adults are important as predictors of the quality of care of older people and of medical trainee likelihood to enter the geriatrics field. This study assessed the attitudes of 404 US medical students (MS) from the start of medical school to graduation using the University of California, Los Angeles (UCLA) Geriatrics Attitude Scale. It is the first study to utilize a longitudinal design to assess attitudes among students in a medical school with a longitudinal geriatrics clinical experience in the first two years and a required geriatrics clerkship in the third year. Participants' attitude scores toward older people were found to significantly decrease from 3.9 during the first two years to 3.7 during the final two. Significant differences existed between MS1 and MS3, MS1 and MS4, MS2 and MS3, and MS2 and MS4. Women and older students held significantly more positive attitudes than men and younger students. These results show that planned clinical exposures to older adults may not be sufficient to halt the decline in attitudes in medical school. A comprehensive empathy-building intervention embedded in the curriculum may better prevent this decline. PMID:26619339

  3. Predicting Ecstasy Use among Young People at Risk: A Prospective Study of Initially Ecstasy-Naive Subjects

    ERIC Educational Resources Information Center

    Vervaeke, Hylke K.E.; Benschop, Annemieke; Van Den Brink, Wim; Korf, Dirk J.

    2008-01-01

    Our aim is to identify predictors of first-time ecstasy use in a prospective study among young people at risk. As part of the multidisciplinary Netherlands XTC Toxicity Study (NeXT), we monitored 188 subjects aged up to 18 years who were ecstasy-naive at baseline but seemed likely to start taking ecstasy in the near future. After an 11- to…

  4. Students' ideals for nursing older people in practice.

    PubMed

    Alabaster, Erica S

    2006-06-01

    Aim.  Drawing on research exploring nursing students' experiences of working with older people, this paper aims to demonstrate how context and culture can impact on the realization of their ideals. Background.  The principles underpinning individualized and person-centred approaches to care resonate with those focal to gerontologic nursing. Restrictive contexts of care and pervasive workplace cultures render nurses unable to deliver care in accord with these. Design and method.  This interpretive study was informed by phenomenological-hermeneutic theory. A purposive sample (n = 10) was recruited from a single educational institution. Data were generated in two phases using loosely structured interviews and supplementary activity. Themes explicating their experiences were identified via systematized detailed analysis and issues pertaining to nursing students' orientation towards older people cut across these. Findings and discussion.  Students perceived that older people were prone to depersonalization and marginalization, so sought to show respect by coming to know individuals, form human connections with them and personalize care accordingly. Giving respect, promoting personhood, asserting reciprocal identity and maintaining dignity were prominent features of this but were often frustrated by practices and cultures encountered in mainstream settings. Conclusions.  Nursing students' approaches to older people are contextual and reflect elements of person-centred ideology. Their attempts upholding their ideals are liable to be subverted by workplace norms. Preparatory education should address these, assist students to learn how to attend to personhood in restrictive environments and offer targeted placements in age-specific and non-acute services. Relevance to clinical practice.  Demographic trends mean that working with older people has increased significance for nurses in most settings. Person-centredness is seen as beneficial for older people but

  5. How Many People Are Affected By or Are at Risk for Neural Tube Defects?

    MedlinePlus

    ... are affected by or are at risk for neural tube defects? Skip sharing on social media links Share this: ... with spina bifida. 1 The other types of neural tube defects are less common. About 340 infants are born ...

  6. Guide to providing mouth care for older people.

    PubMed

    Bissett, Susan; Preshaw, Philip

    2011-12-01

    The authors provide an overview of oral health, why it is important for older people and how poor oral health can affect nutritional status and quality of life. Practical advice is given on assessment of oral health; cleaning of natural teeth and dentures; and care of oral problems that commonly affect older people. An oral healthcare education session is recommended to provide hands-on advice to caregivers. The article is not intended as an exhaustive reference and the reader should always ask for professional dental advice and assistance if in doubt about any aspect of oral care. PMID:22256725

  7. Developing advanced nursing skills for frail older people.

    PubMed

    Goldberg, Sarah; Cooper, Jo; Russell, Catherine

    2014-05-01

    Improving hospital care for frail older people requires expertise, leadership and resources as these patients have multiple complex needs. One innovative solution to providing the skilled care necessary is to train experienced nurses to become advanced nurse practitioners (ANPs). Such roles encompass activity previously undertaken by medical staff, together with leadership, teaching, research and service development. Skills specific to caring for older people, such as comprehensive geriatric assessment, are also required. This article discusses the need for ANPs in this clinical area, a pilot that is under way in one acute trust to develop these roles, and the potential benefits and challenges that may accompany this development. PMID:24787943

  8. Resilience and vision impairment in older people.

    PubMed

    Thetford, Clare; Bennett, Kate M; Hodge, Suzanne; Knox, Paul C; Robinson, Jude

    2015-12-01

    Some people fare better than others when faced with adversity; they appear to be more 'resilient'. This article explores the concept of resilience in the context of vision impairment using two linked sets of narrative interview data from 2007 to 2010. Three case studies were analysed in detail using a framework approach based upon a social-ecological model of resilience and vision impairment. Within the model a range of assets and resources are identified which influence an individual's capacity for resilience. A set of criteria were used to establish the extent to which each individual appeared to be resilient at each point in time. Analysis revealed that it is not merely the presence or absence of individual, social, and community resources - but how these resources interact with each other - that influences resilience and can create a risk to wellbeing. To possess only some of these resources is not sufficient; there is a co-dependency between these resources which requires the presence of other resources for resilience to be achieved. Resilience is not a fixed state; individuals can become more or less resilient as their circumstances and resources change over time. We suggest that the concept of resilience has much to offer the field of vision impairment as it allows the identification of enablers as well as areas of barriers to improving people's health and wellbeing and suggests further opportunities for service providers to engage with clients, even those who appear to be supported, as people's social, economic and emotional landscapes continue to change over time, rather than identifying deficit. PMID:26568213

  9. Dementia in older people: an update.

    PubMed

    LoGiudice, D; Watson, R

    2014-11-01

    Dementia is a common condition of the elderly characterised by multiple cognitive deficits resulting in a decline from previous level of function. In the older person, multiple pathologies contribute, including changes commonly seen in Alzheimer disease, dementia with Lewy bodies in addition to vascular changes. Comorbid factors, such as depression, delirium and polypharmacy can contribute to cognitive decline. Novel biomarkers and neuroimaging techniques may assist in the near future to improve accuracy of diagnosis. To date, pharmacological therapies have been largely unsuccessful and provide symptomatic relief only. The timely diagnosis of dementia can facilitate important discussions regarding personal and financial planning and introduce education and supports to the person with dementia and their carers. The person with dementia commonly experiences behavioural and psychological symptoms of dementia that may cause much distress, including to families and carers. Clinical guidelines indicate non-pharmacological approaches as first line measures, including attention to pain, nutrition and the environment. Dementia is recognised as a National Health Priority in Australia, and efforts to target risk factors as preventative measures to delay onset of dementia require further urgent consideration. PMID:25367725

  10. Guidance on the management of pain in older people.

    PubMed

    Abdulla, Aza; Adams, Nicola; Bone, Margaret; Elliott, Alison M; Gaffin, Jean; Jones, Derek; Knaggs, Roger; Martin, Denis; Sampson, Liz; Schofield, Pat

    2013-03-01

    This guidance document reviews the epidemiology and management of pain in older people via a literature review of published research. The aim of this document is to inform health professionals in any care setting who work with older adults on best practice for the management of pain and to identify where there are gaps in the evidence that require further research. The assessment of pain in older people has not been covered within this guidance and can be found in a separate document (http://www.britishpainsociety.org/pub_professional.htm#assessmentpop). Substantial differences in the population, methods and definitions used in published research makes it difficult to compare across studies and impossible to determine the definitive prevalence of pain in older people. There are inconsistencies within the literature as to whether or not pain increases or decreases in this age group, and whether this is influenced by gender. There is, however, some evidence that the prevalence of pain is higher within residential care settings. The three most common sites of pain in older people are the back; leg/knee or hip and 'other' joints. In common with the working-age population, the attitudes and beliefs of older people influence all aspects of their pain experience. Stoicism is particularly evident within this cohort of people. Evidence from the literature search suggests that paracetamol should be considered as first-line treatment for the management of both acute and persistent pain, particularly that which is of musculoskeletal origin, due to its demonstrated efficacy and good safety profile. There are few absolute contraindications and relative cautions to prescribing paracetamol. It is, however, important that the maximum daily dose (4 g/24 h) is not exceeded. Non-selective non-steroidal anti-inflammatory drugs (NSAIDs) should be used with caution in older people after other safer treatments have not provided sufficient pain relief. The lowest dose should be provided

  11. Cortisol Awakening Response and Walking Speed in Older People.

    PubMed

    Pulopulos, Matias M; Puig-Perez, Sara; Hidalgo, Vanesa; Villada, Carolina; Salvador, Alicia

    2016-01-01

    In older people, less diurnal variability in cortisol levels has been consistently related to worse physical performance, especially to slower walking speed (WS). The cortisol awakening response (CAR) is a discrete component of the hypothalamic-pituitary-adrenal axis that has been related to several health problems, such as cardiovascular disease and/or worse performance on executive function and memory. The relationship between the CAR and physical performance in older people is poorly understood. In this study, in 86 older people (mean age = 64.42, SD = 3.93), we investigated the relationship between the CAR and WS, a commonly used measure of physical performance in the older population that has also been related to health problems, such as cardiovascular disease and executive function performance in older people. Additionally, we studied whether the relationship between the CAR and WS was independent from cortisol levels on awakening and several possible confounders. Results showed that a CAR of reduced magnitude (measured with 3 samples each day, for two consecutive days, and calculated as the area under the curve with respect to the increase), but not cortisol levels on awakening, was related to slower WS. In addition, this relationship was independent from cortisol levels on awakening. It is possible that a CAR of reduced magnitude would contribute to less diurnal cortisol variability, affecting physical performance. Additionally, it is possible that a CAR of reduced magnitude affects WS through a possible negative effect on executive function, or that the association between the CAR and WS is due to the fact that both are related to similar health problems and to changes in cognitive performance in older people. PMID:27191847

  12. Cortisol Awakening Response and Walking Speed in Older People

    PubMed Central

    Pulopulos, Matias M.; Puig-Perez, Sara; Hidalgo, Vanesa; Villada, Carolina; Salvador, Alicia

    2016-01-01

    In older people, less diurnal variability in cortisol levels has been consistently related to worse physical performance, especially to slower walking speed (WS). The cortisol awakening response (CAR) is a discrete component of the hypothalamic-pituitary-adrenal axis that has been related to several health problems, such as cardiovascular disease and/or worse performance on executive function and memory. The relationship between the CAR and physical performance in older people is poorly understood. In this study, in 86 older people (mean age = 64.42, SD = 3.93), we investigated the relationship between the CAR and WS, a commonly used measure of physical performance in the older population that has also been related to health problems, such as cardiovascular disease and executive function performance in older people. Additionally, we studied whether the relationship between the CAR and WS was independent from cortisol levels on awakening and several possible confounders. Results showed that a CAR of reduced magnitude (measured with 3 samples each day, for two consecutive days, and calculated as the area under the curve with respect to the increase), but not cortisol levels on awakening, was related to slower WS. In addition, this relationship was independent from cortisol levels on awakening. It is possible that a CAR of reduced magnitude would contribute to less diurnal cortisol variability, affecting physical performance. Additionally, it is possible that a CAR of reduced magnitude affects WS through a possible negative effect on executive function, or that the association between the CAR and WS is due to the fact that both are related to similar health problems and to changes in cognitive performance in older people. PMID:27191847

  13. Frail bodies, courageous voices: older people influencing community care.

    PubMed

    Barnes, Marian; Bennett, Gaynor

    1998-03-01

    Involving frail older users of health and social care services in decision making presents particular challenges for those committed to hearing the voices of service users. Age Concern Scotland initiated a project in Fife, the User Panels project, intended to enable older people who were unable to leave their homes without assistance to meet together to develop a collective voice expressing the needs and experiences of older service users. This paper reports on an evaluation of that project. It considers methodological questions posed by the evaluation of projects which aim to empower users, as well as discussing key findings from the evaluation. Older people were recruited through contacts in service agencies and other local organizations. The largest group was aged between 86 and 90 years and all were experiencing difficulties relating to poor health, physical frailty or disability. The project was based on a belief in the value of meeting together as a means through which people could develop the confidence to express their views. Those who became members of the panels valued this experience and reported intrinsic benefits related to the social contact, opportunities for learning and development of self-esteem. Evidence concerning enhanced capacity to exercise control over key aspects of their lives was less convincing. The work of the panels was generally well received by local social work and health agencies and had influenced local action in some areas. Responses to some issues raised by the panels generated a less positive response and the article considers reasons for this. The model is considered to demonstrate benefits both for the older people who become involved and for officials seeking to improve the sensitivity of services to the needs of older people. PMID:11560582

  14. Addressing the nutritional needs of older people in residential care homes.

    PubMed

    Merrell, Joy; Philpin, Susan; Warring, Joanne; Hobby, Debra; Gregory, Vic

    2012-03-01

    In the UK and Europe, malnutrition in older people is a significant and continuing problem. Malnutrition predisposes to disease, impedes recovery from illness, increases mortality and is costly to society. Despite the high number of older people potentially at risk, malnutrition in care homes has been under explored. There is concern that national guidelines regarding the nutritional care of older people in residential care homes are not always implemented. This qualitative study explored the factors that influence the nutritional care provided to residents in two different types of local authority residential care homes (providing personal care) in Wales. One home had communal dining rooms; the other had eight bedded units with their own kitchen and dining facilities. The sample of 45 participants, comprised 19 staff (managers, care and catering staff), 16 residents and 10 residents' relatives. Data were collected using semi-structured interviews, focus groups, observation and documentary review between August 2009 and January 2010. This paper focuses on how staff assessed and addressed residents' nutritional needs. In both care homes, staff strove to be responsive to residents' dietary preferences, provided person-centred care and worked in partnership with residents and their families to provide nutritious food in a homely environment. Neither home conducted nutritional screening to identify those at risk of malnutrition, contrary to national guidelines, but relied on ad hoc observation and monitoring. The staff's knowledge of special dietary needs was limited. A need for further training for care home staff regarding the importance of nutrition in maintaining health in older people, use of nutritional screening and special dietary needs was identified. Shared nutrition training between health and social care staff needs expansion and policy implications in terms of an enhanced regulatory focus on maintaining nutritional needs in care homes are proposed. PMID

  15. Sustainability Literacy of Older People in Retirement Villages

    PubMed Central

    Xia, Bo; Zuo, Jian; Skitmore, Martin; Buys, Laurie; Hu, Xin

    2014-01-01

    With many developed countries experiencing the aging of the population, older people play a large role in contributing to environmental problems but also to environmental solutions. The purpose of this research is to understand the awareness and behavior of current older people living in retirement villages towards sustainability development. To achieve this, a sustainability literacy survey was conducted with 65 older residents of a private retirement village located 10 Km outside the Brisbane, Australia's central business district (CBD). Most of residents recognized the importance of environment protection and would like to lead a more environmentally friendly lifestyle. In addition, the majority were willing to pay higher prices for a living environment with sustainable features. The importance of positive social communications was emphasized with most residents having established good relationships with others in the village. The findings provide an important insight into consumer perspectives regarding the sustainable features that should and can be incorporated into the village planning and development. PMID:25587448

  16. Measures for Assessing Student Attitudes toward Older People

    ERIC Educational Resources Information Center

    Lin, Xiaoping; Bryant, Christina; Boldero, Jennifer

    2011-01-01

    Measuring medical and allied health students' attitudes towards older people has been identified as an important research area. The present study compared the use of implicit and explicit attitude measures. Sixty-five undergraduates completed one explicit measure, the Fraboni Scale of Ageism (FSA), (Fraboni, Saltstone, & Hughes, 1990) and one…

  17. Newer Drugs Helping Older People with Eye Disease

    MedlinePlus

    ... 158961.html Newer Drugs Helping Older People With Eye Disease Treatments keeping those with macular degeneration reading and ... of long-term follow-up in studies evaluating disease treatments." Study ... U.S. National Eye Institute. The findings were published recently in the ...

  18. Children's Views of Older People

    ERIC Educational Resources Information Center

    Robinson, Sally; Howatson-Jones, Lioba

    2014-01-01

    Worldwide demographic change means that the responsibility for an aging population will fall to younger generations. This narrative literature review comprises an international examination of what has been published about children's views of older people between 1980 and 2011. Sixty-nine academic articles were inductively analyzed, and the…

  19. The Engagement of Older People in Civil Society Organizations

    ERIC Educational Resources Information Center

    Principi, Andrea; Chiatti, Carlos; Lamura, Giovanni; Frerichs, Frerich

    2012-01-01

    This article reviews recent international literature on the opportunities and restrictions experienced by older people to act as volunteers in civil society organizations. Our aim was to develop a conceptual framework applicable to the European ageing society. This aim was pursued through a computerized database search focused on studies analyzing…

  20. The Life-Course Origins of Mastery among Older People

    ERIC Educational Resources Information Center

    Pearlin, Leonard I.; Nguyen, Kim B.; Schieman, Scott; Milkie, Melissa A.

    2007-01-01

    In this article, we aim to identify the sources of mastery--the understanding that individuals hold about their ability to control the circumstances of their lives. The sample for our inquiry was drawn from the Medicare beneficiary files of people 65 and older living in Washington, DC, and two adjoining Maryland counties. We find that past…

  1. Social Exclusion and Older People: Exploring the Connections.

    ERIC Educational Resources Information Center

    Phillipson, Chris; Scharf, Thomas; Kingston, Paul; Smith, Allison E.

    2001-01-01

    The effect of social exclusion on older people has not been examined. Three issues regarding their participation in community life can be discerned: (1) participation and integration beyond the labor market; (2) spatial segregation, including geographic, economic, and social isolation; and (3) exclusion through withdrawal of institutions from…

  2. Balance-Boosting Footwear Tips for Older People

    MedlinePlus

    ... Home » Learn About Feet » Tips for Healthy Feet Balance-Boosting Footwear Tips for Older People Balance in all aspects of life is a good ... mental equilibrium isn't the only kind of balance that's important in life. Good physical balance can ...

  3. Older people's conceptualization of elder abuse and neglect.

    PubMed

    Taylor, Brian J; Killick, Campbell; O'Brien, Marita; Begley, Emer; Carter-Anand, Janet

    2014-01-01

    This qualitative study used data from eight focus groups involving 58 people aged over 65 years in both urban and rural settings across Northern Ireland and the Republic of Ireland. Following training, four older people assisted in facilitation and analysis as peer researchers. Increasing lack of respect within society was experienced as abusive. The vulnerability of older people to abuse was perceived as relating to the need for help and support, where standing up for themselves might have repercussions for the person's health or safety. Emotional abusiveness was viewed as underpinning all forms of abuse, and as influencing its experienced severity. Respondents' views as to whether an action was abusive required an understanding of intent: some actions that professionals might view as abusive were regarded as acceptable if they were in the older person's best interests. Preventing abuse requires a wide-ranging approach including rebuilding respect for older people within society. Procedures to prevent elder abuse need to take into account the emotional impact of family relationships and intent, not just a description of behaviors that have occurred. PMID:24779538

  4. Gateway to College: Lessons from Implementing a Rigorous Academic Program for At-Risk Young People

    ERIC Educational Resources Information Center

    Willard, Jacklyn Altuna; Bayes, Brian; Martinez, John

    2015-01-01

    This study reports on the implementation of Gateway to College, a program whose mission is to serve students who have dropped out of high school, or who are at risk of dropping out of high school, by allowing them to earn a high school diploma and credits toward a postsecondary degree. Gateway to College is uniquely ambitious in providing…

  5. Older people and digital disengagement: a fourth digital divide?

    PubMed

    Olphert, Wendy; Damodaran, Leela

    2013-01-01

    Digital technologies are becoming more pervasive in all areas of society. Enabling everyone to have access and capability to use the Internet and associated digital technologies, summed up in the term 'digital inclusion', is seen to have wide-ranging benefits to the individual, to the economy and to society. For older people, being digitally included can help them to maintain their independence, social connectedness and sense of worth in the face of declining health or limited capabilities, as well as also offering new opportunities to improve their quality of life. At present however, access to the technology and to the benefits is not equally distributed either between or within nations, and older people tend to be on the 'wrong' side of what is termed the 'digital divide'. Governments globally are developing strategies to promote digital inclusion and indeed Internet uptake is increasing steadily, including amongst older people. However, such strategies have focussed on getting people online, and there appears to be an assumption that once someone is online they will remain 'digitally engaged'. In fact statistics show that some users give up using the Internet, and there is emerging evidence that older people are more vulnerable to the factors which can lead to this outcome. The authors see this phenomenon as a potential but largely unrecognised 'fourth digital divide' which has serious implications for social inclusion. The objectives of this article are (a) to raise awareness of the phenomenon of digital disengagement by considering some of the emerging evidence, (b) to explore some of the potential implications of not recognising and therefore not addressing the needs of the digitally disengaged older population, and (c) to reveal the prevailing gap in knowledge which future research should address. PMID:23969758

  6. 10 Hz flicker improves recognition memory in older people

    PubMed Central

    Williams, Jonathan; Ramaswamy, Deepa; Oulhaj, Abderrahim

    2006-01-01

    Background 10 Hz electroencephalographic (EEG) alpha rhythms correlate with memory performance. Alpha and memory decline in older people. We wished to test if alpha-like EEG activity contributes to memory formation. Flicker can elicit alpha-like EEG activity. We tested if alpha-frequency flicker enhances memory in older people. Pariticpants aged 67–92 identified short words that followed 1 s of flicker at 9.0 Hz, 9.5 Hz, 10.0 Hz, 10.2 Hz, 10.5 Hz, 11.0 Hz, 11.5 Hz or 500 Hz. A few minutes later, we tested participants' recognition of the words (without flicker). Results Flicker frequencies close to 10 Hz (9.5–11.0 Hz) facilitated the identification of the test words in older participants. The same flicker frequencies increased recognition of the words more than other frequencies (9.0 Hz, 11.5 Hz and 500 Hz), irrespective of age. Conclusion The frequency-specificity of flicker's effects in our participants paralleled the power spectrum of EEG alpha in the general population. This indicates that alpha-like EEG activity may subserve memory processes. Flicker may be able to help memory problems in older people. PMID:16515710

  7. Older People and Social Connectedness: How Place and Activities Keep People Engaged

    PubMed Central

    Yen, Irene H.; Shim, Janet K.; Martinez, Airin D.; Barker, Judith C.

    2012-01-01

    To understand how older adults perceive and navigate their neighborhoods, we examined the implications of activity in their neighborhoods for their health. We interviewed 38 adults (ages 62–85) who lived in San Francisco or Oakland, California. Seven key themes emerged: (1) people express a wide range of expectations for neighborliness, from “we do not bother each other” to “we have keys to each other's houses”, (2) social distance between “other” people impede a sense of connection, (3) ethnic differences in living arrangements affect activities and activity locations, (4) people try to stay busy, (5) people able to leave their homes do many activities outside their immediate residential neighborhoods, (6) access to a car is a necessity for most, and (7) it is unusual to plan for the future when mobility might become limited. Multiple locations influence older adults' health, including residential neighborhoods. Older adults value mobility, active lives, and social connections. PMID:22272374

  8. Well-being and prejudice toward obese people in women at risk to develop eating disorders.

    PubMed

    Magallares, Alejandro

    2012-11-01

    The literature has found that eating disorders (ED) patients usually have a depression and anxiety diagnosis. However, not many investigations have studied the relationship between ED and well-being. One of the main problems of patients with ED is their body image. These individuals usually see themselves too big but there are not many investigations that focus on how these patients see people with real weight problems. For this reason in this study it is analyzed how women in risk to develop ED see obese people. 456 female students were selected. It was found that women with high scores in the different subscales of the Eating Attitudes Test 26 (EAT-26; dieting, bulimia and oral control) had lower well-being (both subjective and psychological) and worse attitudes toward obese people (measured with Antifat Attitudes Test, AFA, Beliefs About Obese People Scale, BAOP, and Attitudes Toward Obese People Scale, ATOP) compared with women with low scores in the EAT-26. PMID:23156933

  9. Understanding factors influencing vulnerable older people keeping warm and well in winter: a qualitative study using social marketing techniques

    PubMed Central

    Lusambili, Adelaide; Homer, Catherine; Abbott, Joanne; Cooke, Joanne Mary; Stocks, Amanda Jayne; McDaid, Kathleen Anne

    2012-01-01

    Objectives To understand the influences and decisions of vulnerable older people in relation to keeping warm in winter. Design A qualitative study incorporating in-depth, semi-structured individual and group interviews, framework analysis and social marketing segmentation techniques. Setting Rotherham, South Yorkshire, UK. Participants 50 older people (>55) and 25 health and social care staff underwent individual interview. The older people also had household temperature measurements. 24 older people and 19 health and social care staff participated in one of the six group interviews. Results Multiple complex factors emerged to explain whether vulnerable older people were able to keep warm. These influences combined in various ways that meant older people were not able to or preferred not to access help or change home heating behaviour. Factors influencing behaviours and decisions relating to use of heating, spending money, accessing cheaper tariffs, accessing benefits or asking for help fell into three main categories. These were situational and contextual factors, attitudes and values, and barriers. Barriers included poor knowledge and awareness, technology, disjointed systems and the invisibility of fuel and fuel payment. Findings formed the basis of a social marketing segmentation model used to develop six pen portraits that illustrated how factors that conspire against older people being able to keep warm. Conclusions The findings illustrate how and why vulnerable older people may be at risk of a cold home. The pen portraits provide an accessible vehicle and reflective tool to raise the capacity of the NHS in responding to their needs in line with the Cold Weather Plan. PMID:22798252

  10. The relationship between oral health and nutrition in older people.

    PubMed

    Walls, A W G; Steele, J G

    2004-12-01

    The oral health of older people is changing with reducing numbers of people relying on complete dentures for function, and retaining some natural teeth. Despite this there are substantial numbers of older people whose ability to chew foods is compromised by their oral health status, either because they have few or no natural teeth. This alteration results in individuals selecting a diet that they can chew in comfort. Such diets are low in fruits and vegetables intake with associated reduction in both non-starch polysaccharide and micronutrient intakes. There is also a trend for reduced dietary intake overall. Salivary flow and function may have an impact in relation to the ability to chew and swallow. Whilst there are few differences in salivary function in fit healthy unmedicated subjects, disease resulting in reduced salivary flow and particularly polypharmacy, with xerostomia as a side effect, are likely to have a role in older people. This paper explores the relationships between oral health status and food's choice and discusses the potential consequences for the individual of such dietary change. PMID:15563930

  11. Stigma as a stressor and transition to schizophrenia after one year among young people at risk of psychosis.

    PubMed

    Rüsch, Nicolas; Heekeren, Karsten; Theodoridou, Anastasia; Müller, Mario; Corrigan, Patrick W; Mayer, Benjamin; Metzler, Sibylle; Dvorsky, Diane; Walitza, Susanne; Rössler, Wulf

    2015-08-01

    According to stress-vulnerability models, social stressors contribute to the onset of schizophrenia. Stigma and discrimination associated with mental illness may be a stressor for young people at risk of psychosis even prior to illness onset, but quantitative longitudinal data on this issue are lacking. We examined the cognitive appraisal of stigma-related stress as predictor of transition to schizophrenia among young people at risk of psychosis. In Zürich, Switzerland, 172 participants between 13 and 35years old and with either high or ultra-high risk of psychosis or risk of bipolar disorder were included. With 71 dropouts, transition was assessed during 12months among 101 participants of whom 13 converted to schizophrenia. At baseline, the cognitive appraisal of stigma as a stressor was measured by self-report, based on the primary appraisal of stigma as harmful and the secondary appraisal of resources to cope with stigma. Positive and negative symptoms were examined using the Positive and Negative Syndrome Scale. Compared with participants who did not convert to schizophrenia, converters had significantly more positive (p<.001) and negative (p<.001) symptoms and reported higher levels of stigma-related harm (p=.003) and stress (p=.009) at baseline. More perceived harm due to stigma at baseline predicted transition to schizophrenia (odds ratio 2.34, 95%-CI 1.19-4.60) after adjusting for age, gender, symptoms and functioning. Stigma stress may increase the risk of transition to schizophrenia. Research is needed on interventions that reduce public negative attitudes towards young people at risk and that support individuals at risk to cope with stigma-related stress. PMID:26036814

  12. Diagnosing and treating urinary tract infections in older people.

    PubMed

    Armstrong, Kirsty

    2015-05-01

    Even though diagnosing and treating urinary tract infections (UTIs) in older people can be difficult, it is essential to prevent reduction in the patients' wellbeing. Near-patient testing can be useful, but guidelines on this discuss the use of urine dipstick testing and laboratory culture in some detail. In addition, there are significant differences in the management of males and females, those with recurrent infections, and those with catheters. Community nurses are well placed to assess and manage this common condition, implementing correct treatment and resolution, owing to the close relationships they cultivate with service users. This article discusses the diagnosis and management of UTIs in older people, highlighting the differentials and red flags that need to be addressed urgently. PMID:25993370

  13. Can older people remember medication reminders presented using synthetic speech?

    PubMed Central

    Wolters, Maria K; Johnson, Christine; Campbell, Pauline E; DePlacido, Christine G; McKinstry, Brian

    2015-01-01

    Reminders are often part of interventions to help older people adhere to complicated medication regimes. Computer-generated (synthetic) speech is ideal for tailoring reminders to different medication regimes. Since synthetic speech may be less intelligible than human speech, in particular under difficult listening conditions, we assessed how well older people can recall synthetic speech reminders for medications. 44 participants aged 50–80 with no cognitive impairment recalled reminders for one or four medications after a short distraction. We varied background noise, speech quality, and message design. Reminders were presented using a human voice and two synthetic voices. Data were analyzed using generalized linear mixed models. Reminder recall was satisfactory if reminders were restricted to one familiar medication, regardless of the voice used. Repeating medication names supported recall of lists of medications. We conclude that spoken reminders should build on familiar information and be integrated with other adherence support measures. PMID:25080534

  14. Interventions targeting social isolation in older people: a systematic review

    PubMed Central

    2011-01-01

    Background Targeting social isolation in older people is a growing public health concern. The proportion of older people in society has increased in recent decades, and it is estimated that approximately 25% of the population will be aged 60 or above within the next 20 to 40 years. Social isolation is prevalent amongst older people and evidence indicates the detrimental effect that it can have on health and wellbeing. The aim of this review was to assess the effectiveness of interventions designed to alleviate social isolation and loneliness in older people. Methods Relevant electronic databases (MEDLINE, EMBASE, ASSIA, IBSS, PsycINFO, PubMed, DARE, Social Care Online, the Cochrane Library and CINAHL) were systematically searched using an extensive search strategy, for randomised controlled trials and quasi-experimental studies published in English before May 2009. Additional articles were identified through citation tracking. Studies were included if they related to older people, if the intervention aimed to alleviate social isolation and loneliness, if intervention participants were compared against inactive controls and, if treatment effects were reported. Two independent reviewers extracted data using a standardised form. Narrative synthesis and vote-counting methods were used to summarise and interpret study data. Results Thirty two studies were included in the review. There was evidence of substantial heterogeneity in the interventions delivered and the overall quality of included studies indicated a medium to high risk of bias. Across the three domains of social, mental and physical health, 79% of group-based interventions and 55% of one-to-one interventions reported at least one improved participant outcome. Over 80% of participatory interventions produced beneficial effects across the same domains, compared with 44% of those categorised as non-participatory. Of interventions categorised as having a theoretical basis, 87% reported beneficial effects across

  15. Exploring nurses' use of language with older people.

    PubMed

    Draper, Peter; Wray, Jane; Burley, Sandra

    2013-11-01

    The authors discuss ways in which nurses speak to older people. Research shows that the words nurses use can have a powerful effect on the wellbeing of older people. An experimental project developed at the University of Hull is described in which creative writing techniques were used to increase nursing students' and staff's sensitivity to the importance of language in care. The project enabled participants to co-create a body of work that was subsequently displayed in the faculty reception, and it showed how trusting relationships could be developed between participants. The authors are working to extend the project by finding ways to embed creative writing in the undergraduate nursing curriculum. PMID:24171621

  16. Can older people remember medication reminders presented using synthetic speech?

    PubMed

    Wolters, Maria K; Johnson, Christine; Campbell, Pauline E; DePlacido, Christine G; McKinstry, Brian

    2015-01-01

    Reminders are often part of interventions to help older people adhere to complicated medication regimes. Computer-generated (synthetic) speech is ideal for tailoring reminders to different medication regimes. Since synthetic speech may be less intelligible than human speech, in particular under difficult listening conditions, we assessed how well older people can recall synthetic speech reminders for medications. 44 participants aged 50-80 with no cognitive impairment recalled reminders for one or four medications after a short distraction. We varied background noise, speech quality, and message design. Reminders were presented using a human voice and two synthetic voices. Data were analyzed using generalized linear mixed models. Reminder recall was satisfactory if reminders were restricted to one familiar medication, regardless of the voice used. Repeating medication names supported recall of lists of medications. We conclude that spoken reminders should build on familiar information and be integrated with other adherence support measures. PMID:25080534

  17. Assessing the nutritional vulnerability of older people in developing countries.

    PubMed

    1997-12-01

    The nutrition of older people in developing countries, and the effect of their nutritional status on the quality of life, have not received sufficient attention. A 1997 symposium held at the London (England) School of Hygiene and Tropical Medicine addressed the assessment of nutritional vulnerability in older people in rural and urban settings. Reported were the results of a collaborative study conducted in the urban slums of Mumbai, India; a refugee camp for Rwandans in Karagwe, Tanzania; and rural communities in Malawi. Physical impairment was highest in India and increased with both age and deteriorating nutritional status in all three settings. Among the risk factors for nutritional vulnerability identified through the study to date are living alone, social isolation, reduced food intake, illiteracy, low socioeconomic status, and certain diseases. A field handbook to assess nutritional vulnerability has been prepared based on the research program and will be published in 1988. PMID:12293175

  18. Nutrition, older people and the end of life.

    PubMed

    Donnelly, Geraldine; Wentworth, Lauren; Vernon, Martin J

    2013-12-01

    Older patients are at increased risk of malnutrition, resulting in higher mortality and morbidity. It is important to address nutritional need early in order to prevent or mitigate these adverse outcomes. Decisions about nutrition and hydration for older people presenting with acute illness or evolving multiple long-term conditions present great difficulty to all involved. Clinicians are more likely to encounter such situations as the population of older people with frailty syndromes expands. The clinical evidence base to guide such decisions is sparse and largely unhelpful. Clinicians must recognise their role in these difficult decisions. In addition to familiarity with the clinical evidence base, they must be fully informed of the legal, professional and moral context of the decisions with which they are faced. Responsible clinicians have a professional duty to elicit, understand and weigh the views of their patient, and where necessary their representatives. This can only be undertaken through a process of facilitated patient choice utilising the available legal and professional decision-making frameworks. Any decision relating to clinically assisted nutrition and/or hydration in a frail older person who is considered to be nearing the end of their life must also include explicit consideration of the needs of that individual for formalised palliative care. PMID:24298188

  19. Hair cortisol and cognitive performance in healthy older people.

    PubMed

    Pulopulos, Matias M; Hidalgo, Vanesa; Almela, Mercedes; Puig-Perez, Sara; Villada, Carolina; Salvador, Alicia

    2014-06-01

    Worse cognitive performance in older people has been associated with hypothalamic-pituitary-adrenal axis dysregulation (in particular, higher cortisol levels). Analysis of hair cortisol concentrations (HCC) is a novel method to measure long-term cortisol exposure, and its relationship with cognition in healthy older people has not yet been studied. We investigated whether HCC (measured in hair scalp) and diurnal salivary cortisol levels (awakening, 30min after awakening, and evening, across two days) were related to cognitive performance (assessed with the Trail-making Test A and B, Digit Span Forward and Backward, word list-RAVLT and Stories subtest of the Rivermead) in 57 healthy older people (mean age=64.75 years, SD=4.17). Results showed that lower HCC were consistently related to worse working memory, learning, short-term verbal memory (RAVLT first trial and immediate recall) and long-term verbal memory. In contrast, higher mean levels and higher diurnal area under the curve of diurnal salivary cortisol were related to worse attention and short-term verbal memory (immediate story recall), respectively. Interestingly, a higher ratio of mean levels of diurnal salivary cortisol over HCC were related to worse performance on working memory and short-term verbal memory, suggesting that those individuals with lower long-term cortisol exposure might be more vulnerable to the negative effect of HPA-axis dysregulation on these cognitive processes. Our findings suggest that both low long-term cortisol exposure and a possible dysregulation of the diurnal rhythm of the HPA-axis may account, at least in part, for the inter-individual variability in cognitive performance in healthy older people. PMID:24767624

  20. How Do Family Caregivers of Older People Give Up Caregiving?

    PubMed Central

    Mortazavi, Hamed; Peyrovi, Hamid; Joolaee, Soodabeh

    2015-01-01

    Background Population aging has social, economic and political consequences. Most family caregivers prefer to care for their family member older person with chronic disease at home. Despite traditional culture within Iranian families, in some cases, hospitalization of the elderly in nursing home is inevitable, and this affects the old person and his/her family. The aim of this study was to explain how Iranian family cargivers give up caring their older person with chronic condition at home. Methods A grounded theory approach was used to conduct the study. The study setting included four nursing homes under the auspices of Iran Welfare Organization. Fourteen participants were recruited through purposive sampling. Data were collected from December 2010 to March 2011 by Semi-structured interviews lasting about 17 to 95 minutes (average 52 minutes). Constant comparative analysis was used to analyze the data. Results Three main categories appeared at the end of the analysis: “going out of the road of usual life”, “challenge of meeting older person, family and caregivers care needs”, and “the appearance of inconstancy in the family”. They explained exclusively how family caregivers of old people give up caregiving. Conclusion Health care providers are recommended to become familiar with challenges of family caregivers in taking care of older person with chronic disease at home, and then organize their supportive and consulting actions according to family situations in order to improve the life quality of older person and family caregivers. PMID:26171407

  1. Older people with dysphagia: transitioning to texture-modified food.

    PubMed

    Ullrich, Sandra; Crichton, Jonathan

    Older people with dysphagia are at high risk of malnutrition. To maintain safe oral and nutritional intake, solid food may be texture-modified. Little is known about the transition experiences of older people who move from normal to texture-modified foods. The aim of this study was to describe residents' experiences as they transitioned from normal food to texture-modified food. The study used a qualitative descriptive design and individual interviews were conducted with a study group of 28 participants (residents, family members, nursing and care staff, and speech and language therapists). The interviews were thematically analysed. The findings suggest that transition creates the risk of distress, reducing eating to a matter of necessity and hunger, and that the process is perceived as abrupt, and characterised by lack of communication and awareness of the need for change. A key finding is that the language used during transition can be adversely affected by the management of risk. This language promotes a culture of care that emphasises the limitations of residents, reduces their motivation to eat and hinders the delivery of person-centred care. The findings suggest that care facilities for older people need to revisit their dysphagia management protocols to ensure that they support a person-centred approach for recipients of texture-modified food. PMID:26153808

  2. HIV among people who use drugs: a global perspective of populations at risk.

    PubMed

    Stockman, Jamila K; Strathdee, Steffanie A

    2010-12-01

    This article examines the epidemiology of HIV among selected subgroups of drug users around the world who are "most at risk"--men who have sex with men, female sex workers, prisoners, and mobile populations. The underlying determinants of HIV infection among these populations include stigma, physical and sexual violence, mental illness, social marginalization, and economic vulnerability. HIV interventions must reach beyond specific risk groups and individuals to address the micro-level and macro-level determinants that shape their risk environments. Public health interventions that focus on the physical, social, and health policy environments that influence HIV risk-taking in various settings are significantly more likely to impact the incidence of HIV and other blood-borne and sexually transmitted infections across larger population groups. PMID:21045594

  3. Barriers to physical activity in people at risk of coronary heart disease.

    PubMed

    Brown, J

    Scotland has a high risk of coronary heart disease (CHD) and a literature search identified the risk factors and the importance that physical activity plays in reducing the risk. The search also revealed that patients at risk of CHD find it difficult to increase their exercise levels. In an attempt to understand this, barriers to exercise were explored from a psychological perspective. The study uses the Multidimensional Health Locus of Control Scale (MHLCS) (Wallston and Wallston, 1978) in conjunction with a specifically designed exercise questionnaire. The results show that differences in exercise levels exist between different age groups and between males and females. Differences in MHLCS scores and in barriers to exercise are also shown between the different age groups and sexes, as well as between those working and those not working. The main barriers to exercises were time, ill health, preference to do other things, money, having nobody to go with and lack of confidence. PMID:10426012

  4. Positive Emotional Traits and Ambitious Goals among People at Risk for Mania: The Need for Specificity

    PubMed Central

    Gruber, June; Johnson, Sheri L.

    2010-01-01

    Recent psychosocial theories implicate disturbances in reward pursuit among individuals putatively at risk for mania. The present study examined associations of a measure of risk for mania (the Hypomanic Personality Scale; HPS) with both four trait positive emotions (joy, pride, compassion, and love) and ambitious life goals in five domains (fame, wealth, political influence, family, and friends) among 302 participants from two university settings. Findings indicated that higher HPS scores were related to reward (joy) and achievement-focused (pride) positive emotions, with weaker relations to prosocial (compassion, love) positive emotions. HPS scores were more robustly related to extrinsic (fame, politics) as compared to other-oriented (friends, family) ambitious life goals, with the exception of wealth. These effects were independent of current symptoms of mania and depression. Discussion focuses on the implications of elevated reward and achievement-related positive emotions and goals in understanding risk factors for mania. PMID:20360995

  5. Reviewing the Literature on "At-Risk" and Resilient Children and Young People

    ERIC Educational Resources Information Center

    Hanewald, Ria

    2011-01-01

    This review paper provides pre-service and in-service teachers, principals and other educational professionals with the information needed to understand the concept of resilience to affect positive development in children and young people in their care. It reviews and critiques the most influential literature on resiliency over the last four…

  6. Tackling anxiety and depression in older people in primary care.

    PubMed

    Bland, Phillip

    2012-01-01

    Epidemiological studies suggest that anxiety and depression are less common in older than younger adults. One in ten people aged > or = 65 fulfils the diagnostic criteria for at least one common mental disorder. Older depressed patients have an increased risk of both cardiac and all-cause mortality. Both anxiety and depression in older patients are often unrecognised and untreated, and have a poor prognosis. There is a progressive decline in the prevalence of common mental disorders above the age of 55. Anxiety and depression often occur together, and share many risk factors. However, anxiety tends to follow threats or traumatic events, whereas depression follows loss events. Chronic diseases, cognitive impairment, pain and functional disability are risk factors for the onset of depression, but not anxiety. Depression is between two and three times more common among those with a chronic physical health problem. Even patients with major depression often remain unrecognised and untreated. Generalised anxiety disorder (GAD) is by far the most common anxiety disorder in older people but most GAD patients are not recognised in primary care and only a third of them receive any form of treatment. Older patients often deny feeling anxious or depressed and are more likely to present with insomnia, irritability, agitation and multiple somatic complaints. GPs may erroneously believe that depression is a normal reaction to the losses of old age, and may be reluctant to initiate treatment. A good case can be made for replacing the PHQ-9 with the 15-item version of the Geriatric Depression Scale which almost entirely avoids somatic questions. This is a screening not a diagnostic tool and does not evaluate symptom severity. PMID:22720455

  7. Prefrontal hyperactivity in older people during motor planning.

    PubMed

    Berchicci, Marika; Lucci, Giuliana; Pesce, Caterina; Spinelli, Donatella; Di Russo, Francesco

    2012-09-01

    The aim of this study was to assess the influence of age-related changes in cortical activity related to the motor preparation involved in simple- and discriminative-reaction tasks. To distinguish between age effects on motor planning and stimulus processing, both movement- and stimulus-locked event related potentials (ERPs) were investigated in 14 younger, 14 middle-aged, and 14 older adults (mean ages 24.4, 49, and 70 years, respectively). The novel results of the present study are the prefrontal over-recruitment observed in older adults in movement-related cortical potentials (MRCPs) and the differential pattern of aging effects observed at behavioral and at electrophysiological level between middle-aged and older adults. Overall, the following results were observed: (i) behavioral results confirmed the well-known slowing of responses in aging people, which were associated with optimal accuracy; (ii) the age-related differences in cortical activity underlying the generation of voluntary movements in response to external stimuli were more pronounced for the motor planning than the stimulus processing stage; (iii) the source and the time-course analysis of the over-recruitment in the older adults indicated tonic involvement of prefrontal areas regardless of task complexity; and (iv) middle-aged adults showed a 'young adult-like' behavioral speed, but an 'older adult-like' overactivation of prefrontal areas. In summary, to reach the same accuracy, older subjects prepared the action with greater anticipation and higher cost, as indexed by the earlier latency onset and larger prefrontal cortical activation. PMID:22732557

  8. Assessment and management of nutrition in older people and its importance to health

    PubMed Central

    Ahmed, Tanvir; Haboubi, Nadim

    2010-01-01

    Nutrition is an important element of health in the older population and affects the aging process. The prevalence of malnutrition is increasing in this population and is associated with a decline in: functional status, impaired muscle function, decreased bone mass, immune dysfunction, anemia, reduced cognitive function, poor wound healing, delayed recovery from surgery, higher hospital readmission rates, and mortality. Older people often have reduced appetite and energy expenditure, which, coupled with a decline in biological and physiological functions such as reduced lean body mass, changes in cytokine and hormonal level, and changes in fluid electrolyte regulation, delay gastric emptying and diminish senses of smell and taste. In addition pathologic changes of aging such as chronic diseases and psychological illness all play a role in the complex etiology of malnutrition in older people. Nutritional assessment is important to identify and treat patients at risk, the Malnutrition Universal Screening Tool being commonly used in clinical practice. Management requires a holistic approach, and underlying causes such as chronic illness, depression, medication and social isolation must be treated. Patients with physical or cognitive impairment require special care and attention. Oral supplements or enteral feeding should be considered in patients at high risk or in patients unable to meet daily requirements. PMID:20711440

  9. Assessment and management of nutrition in older people and its importance to health.

    PubMed

    Ahmed, Tanvir; Haboubi, Nadim

    2010-01-01

    Nutrition is an important element of health in the older population and affects the aging process. The prevalence of malnutrition is increasing in this population and is associated with a decline in: functional status, impaired muscle function, decreased bone mass, immune dysfunction, anemia, reduced cognitive function, poor wound healing, delayed recovery from surgery, higher hospital readmission rates, and mortality. Older people often have reduced appetite and energy expenditure, which, coupled with a decline in biological and physiological functions such as reduced lean body mass, changes in cytokine and hormonal level, and changes in fluid electrolyte regulation, delay gastric emptying and diminish senses of smell and taste. In addition pathologic changes of aging such as chronic diseases and psychological illness all play a role in the complex etiology of malnutrition in older people. Nutritional assessment is important to identify and treat patients at risk, the Malnutrition Universal Screening Tool being commonly used in clinical practice. Management requires a holistic approach, and underlying causes such as chronic illness, depression, medication and social isolation must be treated. Patients with physical or cognitive impairment require special care and attention. Oral supplements or enteral feeding should be considered in patients at high risk or in patients unable to meet daily requirements. PMID:20711440

  10. The Teacher's Perspective in Older Education: The Experience of Teaching in a University for Older People in Spain

    ERIC Educational Resources Information Center

    Villar, Feliciano; Celdran, Montserrat; Pinazo, Sacramento; Triado, Carme

    2010-01-01

    The aim of this study was to explore university lecturers' descriptions of their teaching experience with older students. Twelve teachers of the Nau Gran (a university program for older people [UPOP] in Valencia, Spain) were interviewed. We analyzed their responses to questions about their experience of teaching older adults, the rewarding aspects…

  11. Magnitude of HIV infection among older people in Mufindi and Babati districts of the Tanzania mainland

    PubMed Central

    Nyigo, Vitus; Kilale, Andrew; Kilima, Stella; Shayo, Elizabeth H; Senkoro, Kesheni P; Mshana, Jonathan; Mushi, Adiel K; Matemba, Lucas; Massaga, Julius

    2014-01-01

    Introduction According to the 2011–2012 HIV and Malaria Indicator Survey, the prevalence of HIV infection in Tanzania is 5.1%, with limited information on its magnitude among older people, as the community believes that the elderly are not at risk. Consequently, little attention is given to the fight against HIV and AIDS in this group. The present study investigated the magnitude of HIV and AIDS infection among older people in rural and urban areas of the Tanzania mainland. Subjects and methods The study was conducted in Mufindi and Babati districts of Iringa and Manyara regions, respectively, through multistage sampling procedures. Dried blood spot cards were used to collect blood samples for HIV testing among consenting participants. HIV testing was done and retested using different enzyme-linked immunosorbent assay kits. Results A total of 720 individuals, 340 (47.2%) males and 380 (52.8%) females, were randomly selected, of whom 714 (99.2%) consented to HIV testing while six (0.8%) refused to donate blood. The age ranged from 50 to 98 years, with a mean age of 64.2 years. Overall, a total of 56 (7.8%) participants were HIV-positive. Females had a higher prevalence (8.3%) than males (7.4%), with Mufindi district recording the higher rate (11.3%) compared to the 3.7% of Babati district. The prevalence was higher in the rural population (9.4%) compared to 6.4% of their urban counterparts. Conclusion Although HIV/AIDS is considered a disease of individuals aged 15–49 years, the overall prevalence among the older people aged 50 years and above for Mufindi and Babati districts was higher than the national prevalence in the general population. These findings point to the need to consider strengthening interventions targeting older populations against HIV/AIDS in these districts while establishing evidence countrywide to inform policy decisions. PMID:24926202

  12. Draw a Young and an Older Person: Schoolchildren's Images of Older People

    ERIC Educational Resources Information Center

    Villar, Feliciano; Faba, Josep

    2012-01-01

    The goal of this study was to explore stereotypes of older people as expressed in drawings by a sample of primary school children. Sixty children from fourth to sixth grades (30 boys and 30 girls aged 9 to 12 years) were asked to draw a young man, a young woman, an old man, and an old woman. The drawings were content analyzed. Children in our…

  13. Food safety and older people: the Kitchen Life study.

    PubMed

    Dickinson, Angela; Wills, Wendy; Meah, Angela; Short, Frances

    2014-05-01

    Foodborne illness (FBI) is a major public health problem in the UK. Recent increases in cases of listeriosis in older people have focused attention on consumer food-related practices. Previous studies highlight poor relationships between what people know, what they say they do and what they actually do in the kitchen. The aim of the Kitchen Life study was to examine what actually happens in the domestic kitchen to assess whether and how this has the potential to influence food safety in the home. Drawing on a qualitative ethnographic approach, methods included a kitchen tour, photography, observation, video observation, informal interviews and diary methods. Ten households with older people (aged 60+) were recruited across the UK. It was found that trust in the food supply, use of food-labelling (including use-by dates), sensory logics (such as the feel or smell of food) and food waste were factors with the potential to influence risk of foodborne illness. Practices shifted with changing circumstances, including increased frailty, bereavement, living alone, receiving help with care and acquiring new knowledge, meaning that the risk of and vulnerability to foodborne illness is not straightforward. PMID:24784557

  14. An overview of appetite decline in older people.

    PubMed

    Pilgrim, Anna L; Robinson, Sian M; Sayer, Avan Aihie; Roberts, Helen C

    2015-06-01

    Poor appetite is a common problem in older people living at home and in care homes, as well as hospital inpatients. It can contribute to weight loss and nutritional deficiencies, and associated poor healthcare outcomes, including increased mortality. Understanding the causes of reduced appetite and knowing how to measure it will enable nurses and other clinical staff working in a range of community and hospital settings to identify patients with impaired appetite. A range of strategies can be used to promote better appetite and increase food intake. PMID:26018489

  15. Antimuscarinics in Older People: Dry Mouth and Beyond.

    PubMed

    Bostock, Clare; McDonald, Christopher

    2016-03-01

    Many common prescription and over-the-counter medications have antimuscarinic effects. Antimuscarinics are a well recognized cause of dry mouth, with potential to cause other physical and cognitive adverse effects. A comprehensive medication review in a patient presenting with dry mouth can lead to overall health improvements. Scoring systems can be helpful in identifying antimuscarinic drugs and their adverse effects. CPD/Clinical Relevance: Antimuscarinic drug use is prevalent and a common cause of dry mouth. Older people are particularly susceptible to antimuscarinic adverse effects. PMID:27188134

  16. Nonbelieved memories in middle-aged and older people.

    PubMed

    Brédart, Serge; Bouffier, Marion

    2016-05-01

    Previous studies have reported that young participants typically date events that they remember, but no longer believe they experienced, to the period of childhood. The present study investigated whether participants aged between 40 and 79years dated events related to relinquished memories to the period of childhood, as do younger people, or whether they dated such events to a period later in life. The study also compared believed and nonbelieved memories with respect to memory perspective (1st vs 3rd person perspective). Results indicated that the majority of middle-aged and older people dated nonbelieved memories to the period of childhood (median age=8years). No correlation was found between the participants' current age and their age at the time the nonbelieved event occurred. In addition, results showed that believed memories were more likely to be retrieved from a 1st person perspective than were nonbelieved memories. PMID:27136268

  17. Current Policy and Legislation in England Regarding Older People--What This Means for Older People with Learning Disabilities: A Discussion Paper

    ERIC Educational Resources Information Center

    Turner, Sue; Cooper Ueki, Madeline

    2015-01-01

    Background: This paper seeks to explore the opportunities and challenges generated by current policy, guidance and legislation in England relating to older people, in terms of the practical implications for older people with learning disabilities. Methods: Using the broad themes housing, employment, social inclusion and isolation, care and…

  18. "I Don't Want to Live like This Anymore": Disrupted Habitus in Young People "At Risk" of Diagnosis of Personality Disorder

    ERIC Educational Resources Information Center

    Gilbert, Tony; Farrand, Paul; Lankshear, Gloria

    2013-01-01

    This article reports on interview data gathered from 27 young people involved with a street-level service for young people considered "at risk" of diagnosis of personality disorder. Interviews with a self-selecting sample of young people explored the events that led to their initial contact with the service. Using Silverman's…

  19. Theorizing accommodation in supportive home care for older people.

    PubMed

    Ceci, Christine; Purkis, Mary Ellen; Björnsdóttir, Kristin

    2013-01-01

    This paper examines the issue of what thinking is necessary in order to advance a notion of accommodation in the organization and provision of supportive home care for older people. Accommodation in this context is understood as responsiveness to the singularity of older adults, and we consider how this idea might be used to support opportunities for (independent) living for elders as they age and become frailer. To elaborate the question we draw on examples from our empirical work - ethnographic studies of home care practice undertaken in Canada and Iceland - and consider these examples in light of critical philosophical and social theory, particularly Agamben's (1993) work, The Coming Community. This is a relevant frame through which to consider the potential for the accommodation of the unique needs of older adults in home care because it helps us to problematize the systems through which care is accomplished and the current, dominant terms of relations between individuals and collectives. We argue that giving substance to a notion of accommodation contributes an important dimension to aligned ideas, such as patient-centeredness in care, by working to shift the intentionality of these practices. That is, accommodation, as an orientation to care practices, contests the organizational impulse to carry on in the usual way. PMID:23273554

  20. Ginger Orally Disintegrating Tablets to Improve Swallowing in Older People.

    PubMed

    Hirata, Ayumu; Funato, Hiroki; Nakai, Megumi; Iizuka, Michiro; Abe, Noriaki; Yagi, Yusuke; Shiraishi, Hisashi; Jobu, Kohei; Yokota, Junko; Hirose, Kahori; Hyodo, Masamitsu; Miyamura, Mitsuhiko

    2016-01-01

    We previously prepared and pharmaceutically evaluated ginger orally disintegrating (OD) tablets, optimized the base formulation, and carried out a clinical trial in healthy adults in their 20 s and 50s to measure their effect on salivary substance P (SP) level and improved swallowing function. In this study, we conducted clinical trials using the ginger OD tablets in older people to clinically evaluate the improvements in swallowing function resulting from the functional components of the tablet. The ginger OD tablets were prepared by mixing the excipients with the same amount of mannitol and sucrose to a concentration of 1% ginger. Eighteen healthy older adult volunteers aged 63 to 90 were included in the swallowing function test. Saliva was collected before and 15 min after administration of the placebo and ginger OD tablets. Swallowing endoscopy was performed by an otolaryngologist before administration and 15 min after administration of the ginger OD tablets. A scoring method was used to evaluate the endoscopic swallowing. Fifteen minutes after taking the ginger OD tablets, the salivary SP amount was significantly higher than prior to ingestion or after taking the placebo (p<0.05). Among 10 subjects, one scored 1-3 using the four evaluation criteria. Overall, no aspiration occurred and a significant improvement in the swallowing function score was observed (p<0.05) after taking the ginger OD tablets. Our findings showed that the ginger OD tablets increased the salivary SP amount and improved swallowing function in older people with appreciably reduced swallowing function. PMID:27374286

  1. Ego Integrity of Older People with Physical Disability and Therapeutic Recreation

    ERIC Educational Resources Information Center

    de Guzman, Allan B.; Shim, Hye-Eun; Sia, Charmin Kathleen M.; Siazon, Wilbart Harvey S.; Sibal, Mary Joyce Ann P.; Siglos, Joanna Brigitte Lorraine C.; Simeon, Francis Marlo C.

    2011-01-01

    Ego integrity, the last developmental task in Erikson's psychological theory, develops naturally among older people. However, the presence of loss-like physical disability-can considerably affect the quality of life, interactions, and well being of older adults. Hence, older people with physical disabilities need more assistance in accomplishing…

  2. The Housing and Support Needs of People with an Intellectual Disability into Older Age

    ERIC Educational Resources Information Center

    Shaw, K.; Cartwright, C.; Craig, J.

    2011-01-01

    Background: People with intellectual disabilities (IDs) are growing older as a population cohort. Many live at home with family members who are their carers but who are also becoming older and less able to provide care. The housing and support preferences of people with IDs and their carers into older age are poorly characterised in the…

  3. Refining the Measure and Dimensions of Social Values of Older People (SVOP)

    ERIC Educational Resources Information Center

    Yoon, Eunkyung; Kolomer, Stacey R.

    2007-01-01

    Older persons are living longer and healthier and, thus, are capable of being more productive and less dependent. Despite this trend, young people persistently hold the age-old negative stereotypes about older persons. The goals of this study were to develop a valid, reliable measure of social values of older people and to assess its utility as…

  4. Behavioral surveillance among people at risk for HIV infection in the U.S.: the National HIV Behavioral Surveillance System.

    PubMed

    Gallagher, Kathleen M; Sullivan, Patrick S; Lansky, Amy; Onorato, Ida M

    2007-01-01

    The Centers for Disease Control and Prevention, in collaboration with 25 state and local health departments, began the National HIV Behavioral Surveillance System (NHBS) in 2003. The system focuses on people at risk for HIV infection and surveys the three populations at highest risk for HIV in the United States: men who have sex with men, injecting drug users, and high-risk heterosexuals. The project collects information from these three populations during rotating 12-month cycles. Methods for recruiting participants vary for each at-risk population, but NHBS uses a standardized protocol and core questionnaire for each cycle. Participating health departments tailor their questionnaire to collect information about specific prevention programs offered in their geographic area and to address local data needs. Data collected from NHBS will be used to describe trends in key behavioral risk indicators and evaluate current HIV prevention programs. This information in turn can be used to identify gaps in prevention services and target new prevention activities with the goal of reducing new HIV infections in the United States. PMID:17354525

  5. The Effect of an Educational Intervention on Alcohol Consumption, At-Risk Drinking, and Health Care Utilization in Older Adults: The Project SHARE Study

    PubMed Central

    Ettner, Susan L; Xu, Haiyong; Duru, O Kenrik; Tseng, Chi-Hong; Tallen, Louise; Barnes, Andrew; Mirkin, Michelle; Ransohoff, Kurt; Moore, Alison A

    2014-01-01

    Objective: The purpose of this study was to examine the effectiveness of a patient–provider educational intervention in reducing at-risk drinking among older adults. Method: This was a cluster-randomized controlled trial of 31 primary care providers and their patients ages 60 years and older at a community-based practice with seven clinics. Recruitment occurred from July 2005 to August 2007. Eligibility was determined by telephone and a baseline mailed survey. A total of 1,186 at-risk drinkers were identified by the Comorbidity Alcohol Risk Evaluation Tool. Follow-up patient surveys were administered at 3, 6, and 12 months after baseline. Study physicians and their patients were randomly assigned to usual care (n = 640 patients) versus the Project SHARE (Senior Health and Alcohol Risk Education) intervention (n = 546 patients), which included personalized reports, educational materials, drinking diaries, physician advice during office visits, and telephone counseling delivered by a health educator. Main outcomes were alcohol consumption, at-risk drinking (overall and by type), alcohol discussions with physicians, health care utilization, and screening and intervention costs. Results: At 12 months, the intervention was significantly associated with an increase in alcohol-related discussions with physicians (23% vs. 13%; p ≤ .01) and reductions in at-risk drinking (56% vs. 67%; p ≤ .01), alcohol consumption (-2.19 drinks per week; p ≤ .01), physician visits (-1.14 visits; p = .03), emergency department visits (16% vs. 25%; p ≤ .01), and nonprofessional caregiving visits (12% vs. 17%; p ≤ .01). Average variable costs per patient were $31 for screening and $79 for intervention. Conclusions: The intervention reduced alcohol consumption and at-risk drinking among older adults. Effects were sustained over a year and may have been associated with lower health care utilization, offsetting screening and intervention costs. PMID:24766757

  6. Older People's Views of Advice about Falls Prevention: A Qualitative Study

    ERIC Educational Resources Information Center

    Yardley, L.; Donovan-Hall, M.; Francis, K.; Todd, C.

    2006-01-01

    The aim of this study was to gain an understanding of older people's perceptions of falls prevention advice, and how best to design communications that will encourage older people to take action to prevent falls. Focus groups and interviews were carried out with 66 people aged 61-94 years recruited from a variety of settings, using falls…

  7. ICT, Education and Older People in Australia: A Socio-Technical Analysis

    ERIC Educational Resources Information Center

    Tatnall, Arthur

    2014-01-01

    People over 65 (or older people) are a growing proportion of the population in many developed countries including Australia. In the last 10 to 12 years interest from this group in the use of Information and Communication Technologies (ICT) and the Internet has also grown considerably. ICT has much to offer older people as a means of keeping in…

  8. Cognitive associations of subcortical white matter lesions in older people.

    PubMed

    O'Brien, John T; Wiseman, Rebecca; Burton, Emma J; Barber, Bob; Wesnes, Keith; Saxby, Brian; Ford, Gary A

    2002-11-01

    Hyperintense lesions (HL), as visualized on T2-weighted or FLAIR MRI, are a common finding in older people, but their clinical significance and influence on cognitive function remain to be clarified. We investigated the relationship between HL in deep white and gray matter structures and cognition in older subjects. We recruited 154 nondemented (Mini-Mental State Examination > 24) subjects (79 males) over the age of 70 from primary care (103 subjects with mild hypertension and 51 normotensive subjects). All subjects underwent FLAIR and proton density and T2-weighted axial 1.5-tesla MRI scans (slice thickness: 5 mm). The scans were rated for the presence and distribution of HL in the subcortical gray matter (caudate, putamen, globus pallidus, thalamus) and associated white matter tracts (internal/external capsule). Subjects (n = 149) underwent a comprehensive cognitive assessment involving tests of attention, processing speed, episodic memory, working memory, and executive function. Partial correlations (correcting for age, systolic blood pressure, and New Adult Reading Test [NART] score) were performed to investigate the relationship between cognition and white matter change. HL were found in 49% of subjects. HL in both the gray (thalamus and caudate) and white matter were significantly associated with impaired cognitive function in tasks involving processing speed and/or executive function, but showed no associations with episodic or working memory. HL in both subcortical gray matter structures and associated fiber tracts correlate with impairments in attention, executive function and processing, and memory retrieval speed in nondemented older community-dwelling subjects. Such lesions may be an important cause of age-related attentional and executive dysfunction in the elderly, as well as temporal lobe and hippocampal changes that have previously been reported to be associated with impairments to the ability to actually store and retrieve information from memory

  9. Predicting ecstasy use among young people at risk: a prospective study of initially ecstasy-naive subjects.

    PubMed

    Vervaeke, Hylke K E; Benschop, Annemieke; van den Brink, Wim; Korf, Dirk J

    2008-01-01

    Our aim is to identify predictors of first-time ecstasy use in a prospective study among young people at risk. As part of the multidisciplinary Netherlands XTC Toxicity Study (NeXT), we monitored 188 subjects aged > or = 18 who were ecstasy-naive at baseline but seemed likely to start taking ecstasy in the near future. After an 11- to 26-month follow-up period, 160 respondents remained (85.1%; mean age 21.0 years, 58.1% females): 65 who took ecstasy at least once (ecstasy users) and 95 non-users. At baseline and four times during follow-up, respondents completed self-report questionnaires. Cox regression analysis was used to examine the effects of baseline respondent characteristics on incident ecstasy use. Development of peer group ecstasy use was analyzed by logistic regression. Intention to use ecstasy, low education, and current weekly cannabis use independently increased the hazard rate for first ecstasy use. Although ecstasy use among peers at baseline was not a predictor, the proportion of ecstasy users with ecstasy-using peers increased markedly during the study. Our results suggest that targeted prevention activities should focus in particular on young people who have strong intentions to take ecstasy, especially if they are also regular smokers of cannabis. PMID:18724654

  10. Autonomy for older people in residential care: a selective literature review.

    PubMed

    Welford, Claire; Murphy, Kathy; Rodgers, Vivien; Frauenlob, Theresia

    2012-03-01

    Autonomy is an important concept because it brings dignity to peoples' lives, regardless of physical circumstances. The United Nations (UN) Madrid International Plan of Action on Ageing emphasises the need to include older adults in autonomous decision-making processes. However, many older people living in residential care find that their autonomy is curtailed. This is largely because autonomy for older people is poorly understood, and hence, nurses working with older people need to become clear about what autonomy is and how it can be facilitated. In this, the first of three papers, the literature is reviewed specifically to establish the meaning of autonomy for older people in residential care as opposed to autonomy in a wider context. This important distinction may help nurses working with older people to begin to facilitate autonomy more effectively. PMID:22348264

  11. Management of diabetes mellitus in older people with comorbidities.

    PubMed

    Huang, Elbert S

    2016-01-01

    Diabetes mellitus is a chronic disease of aging that affects more than 20% of people over 65. In older patients with diabetes, comorbidities are highly prevalent and their presence may alter the relative importance, effectiveness, and safety of treatments for diabetes. Randomized controlled trials have shown that intensive glucose control produces microvascular and cardiovascular benefits but typically after extended treatment periods (five to nine years) and with exposure to short term risks such as mortality (in one trial) and hypoglycemia. Decision analysis, health economics, and observational studies have helped to illustrate the importance of acknowledging life expectancy, hypoglycemia, and treatment burden when setting goals in diabetes. Guidelines recommend that physicians individualize the intensity of glucose control and treatments on the basis of the prognosis (for example, three tiers based on comorbidities and functional impairments) and preferences of individual patients. Very few studies have attempted to formally implement and study these concepts in clinical practice. To better meet the treatment needs of older patients with diabetes and comorbidities, more research is needed to determine the risks and benefits of intensifying, maintaining, or de-intensifying treatments in this population. This research effort should extend to the development and study of decision support tools as well as targeted care management. PMID:27307175

  12. Deprescribing in Frail Older People: A Randomised Controlled Trial

    PubMed Central

    Potter, Kathleen; Flicker, Leon; Page, Amy; Etherton-Beer, Christopher

    2016-01-01

    Objectives Deprescribing has been proposed as a way to reduce polypharmacy in frail older people. We aimed to reduce the number of medicines consumed by people living in residential aged care facilities (RACF). Secondary objectives were to explore the effect of deprescribing on survival, falls, fractures, hospital admissions, cognitive, physical, and bowel function, quality of life, and sleep. Methods Ninety-five people aged over 65 years living in four RACF in rural mid-west Western Australia were randomised in an open study. The intervention group (n = 47) received a deprescribing intervention, the planned cessation of non-beneficial medicines. The control group (n = 48) received usual care. Participants were monitored for twelve months from randomisation. Primary outcome was change in the mean number of unique regular medicines. All outcomes were assessed at baseline, six, and twelve months. Results Study participants had a mean age of 84.3±6.9 years and 52% were female. Intervention group participants consumed 9.6±5.0 and control group participants consumed 9.5±3.6 unique regular medicines at baseline. Of the 348 medicines targeted for deprescribing (7.4±3.8 per person, 78% of regular medicines), 207 medicines (4.4±3.4 per person, 59% of targeted medicines) were successfully discontinued. The mean change in number of regular medicines at 12 months was -1.9±4.1 in intervention group participants and +0.1±3.5 in control group participants (estimated difference 2.0±0.9, 95%CI 0.08, 3.8, p = 0.04). Twelve intervention participants and 19 control participants died within 12 months of randomisation (26% versus 40% mortality, p = 0.16, HR 0.60, 95%CI 0.30 to 1.22) There were no significant differences between groups in other secondary outcomes. The main limitations of this study were the open design and small participant numbers. Conclusions Deprescribing reduced the number of regular medicines consumed by frail older people living in residential care with no

  13. Radiographic correlates of hallux valgus severity in older people

    PubMed Central

    2010-01-01

    Background The severity of hallux valgus is easily appreciated by its clinical appearance, however x-ray measurements are also frequently used to evaluate the condition, particularly if surgery is being considered. There have been few large studies that have assessed the validity of these x-ray observations across a wide spectrum of the deformity. In addition, no studies have specifically focused on older people where the progression of the disorder has largely ceased. Therefore, this study aimed to explore relationships between relevant x-ray observations with respect to hallux valgus severity in older people. Methods This study utilised 402 x-rays of 201 participants (74 men and 127 women) aged 65 to 94 years. All participants were graded using the Manchester Scale - a simple, validated system to grade the severity of hallux valgus - prior to radiographic assessment. A total of 19 hallux valgus-related x-ray observations were performed on each set of x-rays. These measurements were then correlated with the Manchester Scale scores. Results Strong, positive correlations were identified between the severity of hallux valgus and the hallux abductus angle, the proximal articular set angle, the sesamoid position and congruency of the first metatarsophalangeal joint. As hallux valgus severity increased, so did the frequency of radiographic osteoarthritis of the first metatarsophalangeal joint and a round first metatarsal head. A strong linear relationship between increased relative length of the first metatarsal and increased severity of hallux valgus was also observed. Conclusions Strong associations are evident between the clinical appearance of hallux valgus and a number of hallux valgus-related x-ray observations indicative of structural deformity and joint degeneration. As it is unlikely that metatarsal length increases as a result of hallux valgus deformity, increased length of the first metatarsal relative to the second metatarsal may be a contributing factor to

  14. Belief in AIDS-Related Conspiracy Theories and Mistrust in the Government: Relationship With HIV Testing Among At-Risk Older Adults

    PubMed Central

    Ford, Chandra L.

    2013-01-01

    Purpose: One in 4 persons living with HIV/AIDS is an older adult (age 50 or older); unfortunately, older adults are disproportionately diagnosed in late stages of HIV disease. Psychological barriers, including belief in AIDS-related conspiracy theories (e.g., HIV was created to eliminate certain groups) and mistrust in the government, may influence whether adults undergo HIV testing. We examined relationships between these factors and recent HIV testing among at-risk, older adults. Design and Methods: This was a cross-sectional study among older adults enrolled in a large venue–based study. None had a previous diagnosis of HIV/AIDS; all were seeking care at venues with high HIV prevalence. We used multiple logistic regression to estimate the associations between self-reported belief in AIDS-related conspiracy theories, mistrust in the government, and HIV testing performed within the past 12 months. Results: Among the 226 participants, 30% reported belief in AIDS conspiracy theories, 72% reported government mistrust, and 45% reported not undergoing HIV testing within the past 12 months. Belief in conspiracy theories was positively associated with recent HIV testing (adjusted odds ratio [OR] = 1.94, 95% confidence interval [CI] = 1.05–3.60), whereas mistrust in the government was negatively associated with testing (OR = 0.43, 95% CI = 0.26–0.73). Implications: Psychological barriers are prevalent among at-risk older adults seeking services at venues with high HIV prevalences and may influence HIV testing. Identifying particular sources of misinformation and mistrust would appear useful for appropriate targeting of HIV testing strategies. PMID:23362210

  15. Functional Assessments Used by Occupational Therapists with Older Adults at Risk of Activity and Participation Limitations: A Systematic Review

    PubMed Central

    Wales, Kylie; Clemson, Lindy; Lannin, Natasha; Cameron, Ian

    2016-01-01

    Introduction The use of functional assessments to evaluate patient change is complicated by a lack of consensus as to which assessment is most suitable for use with older adults. Objective: To identify and appraise the properties of assessments used to evaluate functional abilities in older adults. Methods A systematic review of randomised controlled trials of occupational therapy interventions was conducted up to 2012 to identify assessments used to measure function. Two authors screened and extracted data independently. A second search then identified papers investigating measurement properties of each assessment. Studies from the second search were included if: i) published in English, ii) the assessment was not modified from its original published form, iii) study aim was to evaluate the quality of the tool, iv) and was original research. Translated versions of assessments were excluded. Measurement quality was rated using the COSMIN checklist and Terwee criteria. Results Twenty-eight assessments were identified from the systematic search of occupational therapy interventions provided to older adults. Assessments were of varied measurement quality and many had been adapted (although still evaluated as though the original tool had been administered) potentially altering the conclusions drawn about measurement quality. Synthesis of best evidence established 15 functional assessments have not been tested in an older adult population. Conclusions The Functional Autonomy Measurement System (SMAF) appears to be a promising assessment for use with older adults. Only two tools (the SMAF and the Assessment of Motor and Process Skills (AMPS)) were deemed to be responsive to change when applied to older adults. Health professionals should use functional assessments that have been validated with their population and in their setting. There are reliable and valid assessments to capture the functional performance of older adults in community and hospital settings, although

  16. Accident profile of older people in Antalya City Center, Turkey.

    PubMed

    Donmez, Levent; Gokkoca, Zuhal

    2003-01-01

    Accidents are major health problems leading to deaths and injuries among older people. The present study was performed to investigate the characteristics of the accidents experienced within the last 1 year in people aged 60 years and older living in Antalya City Center. The study was planned as a cross-sectional research. A total of 840 individuals selected from the study population with cluster-sampling method were used in questionnaires. A number of 163 (19.4%) individuals had at least one accident in the last year. A total of 178 accidents were reported within the last 1-year; 124 (69.7%) falls, 22 (12.4%) traffic accidents and 12 (6.7%) dropping of objects to head. The accidents occurred mostly at home (40.4%), at avenue-street etc. (31.5%), and in garden (8.4%). The result of logistic regression analysis revealed that accident frequency was positively related with female gender (odds=1.79, P<0.05), disability of lower extremities (odds=1.63, P<0.05) and hearing impairment (odds=2.01, P<0.05) whereas it was negatively related with living in detached house (odds=0.41, P<0.05). It was found that accidents caused health (82.0%) and financial (38.2%) problems in elderly and also the disabilities in daily activities (66.3%). Average numbers of days with disability in daily activities were 21.1 in 1 year per accident and 5.7 in 1 year per individual. Occurrence of health problems and disability in daily activities were more frequent among women compared to men (P<0.05). Methods like environmental measures or educational programs to prevent accidents and accident-related injuries must be focused on defined risk groups and places where the accidents occur more frequently. Future researches about the effectiveness of prevention in elderly on accident frequency, mortality and morbidity are needed to deal with this current problem. PMID:12888223

  17. An Exploration of Loneliness: Communication and the Social Networks of Older People with Cerebral Palsy

    ERIC Educational Resources Information Center

    Ballin, Liora; Balandin, Susan

    2007-01-01

    Background: There is a large body of research focusing on the experiences of loneliness of older adults, yet little is known about the loneliness experiences of older adults with lifelong disability. In this paper, the authors present some findings from a larger qualitative study on the loneliness experiences of older people with cerebral palsy.…

  18. Psychosocial Issues in Engaging Older People with Physical Activity Interventions for the Prevention of Falls

    ERIC Educational Resources Information Center

    Nyman, Samuel R.

    2011-01-01

    This article presents an overview of the psychosocial factors that influence older people's participation in physical activity interventions to prevent falls. The importance of psychosocial factors is stressed inasmuch as interventions will be rendered useless if they do not successfully gain the active participation of older people. The theory of…

  19. Older People Becoming Successful ICT Learners over Time: Challenges and Strategies through an Ethnographical Lens

    ERIC Educational Resources Information Center

    Sayago, Sergio; Forbes, Paula; Blat, Josep

    2013-01-01

    A growing ageing population and an increasing reliance on information and communication technologies (ICT) to conduct activities associated with daily living means that addressing how older people learn to use ICT is timely and important. By drawing on a four-year ethnographical study with 420 older people in two different environments, this paper…

  20. Older People and Poverty in Rural Britain: Material Hardships, Cultural Denials and Social Inclusions

    ERIC Educational Resources Information Center

    Milbourne, Paul; Doheny, Shane

    2012-01-01

    This paper explores the relations between older people, poverty and place in rural Britain. It develops previous work on rural poverty that has pointed both to the significance of older people within the rural poor population and to their denials of poverty. The paper also connects with recent discussions on the complexity of relations between…

  1. Randomized Trial of Social Rehabilitation and Integrated Health Care for Older People with Severe Mental Illness

    ERIC Educational Resources Information Center

    Mueser, Kim T.; Pratt, Sarah I.; Bartels, Stephen J.; Swain, Karin; Forester, Brent; Cather, Corinne; Feldman, James

    2010-01-01

    Objective: The Helping Older People Experience Success (HOPES) program was developed to improve psychosocial functioning and reduce long-term medical burden in older people with severe mental illness (SMI) living in the community. HOPES includes 1 year of intensive skills training and health management, followed by a 1-year maintenance phase.…

  2. Theorising the Relationship between Older People and Their Immediate Social Living Environment

    ERIC Educational Resources Information Center

    Buffel, Tine; Verte, Dominique; De Donder, Liesbeth; De Witte, Nico; Dury, Sarah; Vanwing, Tom; Bolsenbroek, Anouk

    2012-01-01

    This article presents a theoretical framework for exploring the dynamics between older people and their immediate social living environment. After introducing a gerontological perspective that goes beyond "microfication," a literature review presents findings from studies that have explored the role of place and locality for older people. Next,…

  3. Inquiry-Based Learning for Older People at a University in Spain

    ERIC Educational Resources Information Center

    Martorell, Ingrid; Medrano, Marc; Sole, Cristian; Vila, Neus; Cabeza, Luisa F.

    2009-01-01

    With the increasing number of older people in the world and their interest in education, universities play an important role in providing effective learning methodologies. This paper presents a new instructional methodology implementing inquiry-based learning (IBL) in two courses focused on alternative energies in the Program for Older People at…

  4. Communication between Older People and Their Health Care Agents: Results of an Intervention

    ERIC Educational Resources Information Center

    Gutheil, Irene A.; Heyman, Janna C.

    2005-01-01

    This study examined an intervention to help high-functioning community-dwelling older people communicate their wishes for care at the end of life with someone they would trust to make health care decisions for them if necessary. Groups consisted of dyads of older people and their potential or designated health care agents randomly assigned to the…

  5. Not Quite Color Blind: Ethnic and Gender Differences in Attitudes toward Older People among College Students

    ERIC Educational Resources Information Center

    Laditka, Sarah B.; Laditka, James N.; Houck, Margaret M.; Olatosi, Bankole A.

    2011-01-01

    Attitudes toward older people can influence how they are treated and their cognitive and physical health. The populations of the United States and many other countries have become more ethnically diverse, and are aging. Yet little research examines how ethnic diversity affects attitudes toward older people. Our study addresses this research gap.…

  6. Images of Older People in UK Magazine Advertising: Toward a Typology

    ERIC Educational Resources Information Center

    Williams, Angie; Wadleigh, Paul Mark; Ylanne, Virpi

    2010-01-01

    The use of images of older people in the British advertising media has been under-researched to date. Further, previous research in any country has tended to examine such images from an "a priori" framework of general impressions and stereotypes of older people. This study addresses these issues with British consumers' (n = 106) impressions, trait…

  7. Older People and Learning--Some Key Statistics. NIACE Briefing Sheet.

    ERIC Educational Resources Information Center

    National Inst. of Adult Continuing Education, Leicester (England).

    This briefing sheet provides a summary of statistics (primarily from United Kingdom and Dutch surveys) that relate to the participation of older people in learning. It provides evidence of current participation, recent trends, types of learning in which older people are involved, future intentions, and correlation between learning in later life…

  8. How Older People Position Their Late-Life Childlessness: A Qualitative Study

    ERIC Educational Resources Information Center

    Allen, Ruth E. S.; Wiles, Janine L.

    2013-01-01

    This research explored how older people describe their paths to late-life childlessness. In-depth accounts from 38 childless older people, age 63-93, highlight the complex journeys and diverse meanings of childlessness for male and female participants, single and partnered, including some who had outlived children. Positioning theory is used to…

  9. Mental Health and Wellbeing and Lifelong Learning for Older People. NIACE Briefing Sheet 92

    ERIC Educational Resources Information Center

    National Institute of Adult Continuing Education, 2009

    2009-01-01

    This briefing sheet is about lifelong learning for people aged 50+ years and how participation in learning can help maintain and improve mental health and wellbeing in later life. There is no commonly agreed definition of "older" people, and clearly people age at different rates. However, by the mid 50s, for most people retirement is beginning to…

  10. Mild cognitive impairment and its management in older people

    PubMed Central

    Eshkoor, Sima Ataollahi; Hamid, Tengku Aizan; Mun, Chan Yoke; Ng, Chee Kyun

    2015-01-01

    Mild cognitive impairment (MCI) is a common condition in the elderly. It is characterized by deterioration of memory, attention, and cognitive function that is beyond what is expected based on age and educational level. MCI does not interfere significantly with individuals’ daily activities. It can act as a transitional level of evolving dementia with a range of conversion of 10%–15% per year. Thus, it is crucial to protect older people against MCI and developing dementia. The preventive interventions and appropriate treatments should improve cognitive performance, and retard or prevent progressive deficits. The avoidance of toxins, reduction of stress, prevention of somatic diseases, implementation of mental and physical exercises, as well as the use of dietary compounds like antioxidants and supplements can be protective against MCI. The modification of risk factors such as stopping smoking, as well as the treatment of deficiency in vitamins and hormones by correcting behaviors and lifestyle, can prevent cognitive decline in the elderly. The progressive increase in the growth rate of the elderly population can enhance the rate of MCI all over the world. There is no exact cure for MCI and dementia; therefore, further studies are needed in the future to determine causes of MCI and risk factors of progression from MCI to dementia. This will help to find better ways for prevention and treatment of cognitive impairment worldwide. PMID:25914527

  11. Mild cognitive impairment and its management in older people.

    PubMed

    Eshkoor, Sima Ataollahi; Hamid, Tengku Aizan; Mun, Chan Yoke; Ng, Chee Kyun

    2015-01-01

    Mild cognitive impairment (MCI) is a common condition in the elderly. It is characterized by deterioration of memory, attention, and cognitive function that is beyond what is expected based on age and educational level. MCI does not interfere significantly with individuals' daily activities. It can act as a transitional level of evolving dementia with a range of conversion of 10%-15% per year. Thus, it is crucial to protect older people against MCI and developing dementia. The preventive interventions and appropriate treatments should improve cognitive performance, and retard or prevent progressive deficits. The avoidance of toxins, reduction of stress, prevention of somatic diseases, implementation of mental and physical exercises, as well as the use of dietary compounds like antioxidants and supplements can be protective against MCI. The modification of risk factors such as stopping smoking, as well as the treatment of deficiency in vitamins and hormones by correcting behaviors and lifestyle, can prevent cognitive decline in the elderly. The progressive increase in the growth rate of the elderly population can enhance the rate of MCI all over the world. There is no exact cure for MCI and dementia; therefore, further studies are needed in the future to determine causes of MCI and risk factors of progression from MCI to dementia. This will help to find better ways for prevention and treatment of cognitive impairment worldwide. PMID:25914527

  12. Unique factors that place older Hispanic women at risk for HIV: intimate partner violence, machismo, and marianismo.

    PubMed

    Cianelli, Rosina; Villegas, Natalia; Lawson, Sarah; Ferrer, Lilian; Kaelber, Lorena; Peragallo, Nilda; Yaya, Alexandra

    2013-01-01

    Hispanic women who are 50 years of age and older have been shown to be at increased risk of acquiring HIV infection due to age and culturally related issues. The purpose of our study was to investigate factors that increase HIV risk among older Hispanic women (OHW) as a basis for development or adaptation of an age and culturally tailored intervention designed to prevent HIV-related risk behaviors. We used a qualitative descriptive approach. Five focus groups were conducted in Miami, Florida, with 50 participants. Focus group discussions centered around eight major themes: intimate partner violence (IPV), perimenopausal-postmenopausal-related biological changes, cultural factors that interfere with HIV prevention, emotional and psychological changes, HIV knowledge, HIV risk perception, HIV risk behaviors, and HIV testing. Findings from our study stressed the importance of nurses' roles in educating OHW regarding IPV and HIV prevention. PMID:23790277

  13. Pain Assessment with Cognitively Impaired Older People in the Acute Hospital Setting

    PubMed Central

    2011-01-01

    Research reveals that older people continue to experience much suffering from acute and chronic pain conditions. People with cognitive impairment receive less analgesia than their cognitively intact peers. Postoperative pain assessment with older people in the acute hospital setting remains a challenge. Context and culture have a significant impact of pain assessment practices. Due to a paucity of research exploring how pain assessment and management practices with cognitively impaired older people may be realised in the acute hospital setting, there is a need for further research to be conducted. PMID:26524985

  14. The use of statins in people at risk of developing diabetes mellitus: evidence and guidance for clinical practice.

    PubMed

    Sattar, Naveed A; Ginsberg, Henry; Ray, Kausik; Chapman, M John; Arca, Marcello; Averna, Maurizio; Betteridge, D John; Bhatnagar, Deepak; Bilianou, Elena; Carmena, Rafael; Ceška, Richard; Corsini, Alberto; Erbel, Raimund; Flynn, Paul D; Garcia-Moll, Xavier; Gumprecht, Janusz; Ishibashi, Shun; Jambart, Selim; Kastelein, John J P; Maher, Vincent; da Silva, Pedro Marques; Masana, Luis; Odawara, Masato; Pedersen, Terje R; Rotella, Carlo Maria; Salti, Ibrahim; Teramoto, Tamio; Tokgozoglu, Lale; Toth, Peter P; Valensi, Paul; Vergès, Bruno

    2014-06-01

    Reducing low-density lipoprotein cholesterol (LDL-C) levels using statins is associated with significant reductions in cardiovascular (CV) events in a wide range of patient populations. Although statins are generally considered to be safe, recent studies suggest they are associated with an increased risk of developing Type 2 diabetes (T2D). This led the US Food and Drug Administration (FDA) to change their labelling requirements for statins to include a warning about the possibility of increased blood sugar and HbA1c levels and the European Medicines Agency (EMA) to issue guidance on a small increased risk of T2D with the statin class. This review examines the evidence leading to these claims and provides practical guidance for primary care physicians on the use of statins in people with or at risk of developing T2D. Overall, evidence suggests that the benefits of statins for the reduction of CV risk far outweigh the risk of developing T2D, especially in individuals with higher CV risk. To reduce the risk of developing T2D, physicians should assess all patients for T2D risk prior to starting statin therapy, educate patients about their risks, and encourage risk-reduction through lifestyle changes. Whether some statins are more diabetogenic than others requires further study. Statin-treated patients at high risk of developing T2D should regularly be monitored for changes in blood glucose or HbA1c levels, and the risk of conversion from pre-diabetes to T2D should be reduced by intensifying lifestyle changes. Should a patient develop T2D during statin treatment, physicians should continue with statin therapy and manage T2D in accordance with relevant national guidelines. PMID:24840509

  15. Reducing emergency bed-days for older people? Network governance lessons from the 'Improving the Future for Older People' programme.

    PubMed

    Sheaff, Rod; Windle, Karen; Wistow, Gerald; Ashby, Sue; Beech, Roger; Dickinson, Angela; Henderson, Catherine; Knapp, Martin

    2014-04-01

    In 2007, the UK government set performance targets and public service agreements to control the escalation of emergency bed-days. Some years earlier, nine English local authorities had each created local networks with their health and third sector partners to tackle this increase. These networks formed the 'Improving the Future for Older People' initiative (IFOP), one strand of the national 'Innovation Forum' programme, set up in 2003. The nine sites set themselves one headline target to be achieved jointly over three years; a 20 per cent reduction in the number of emergency bed-days used by people aged 75 and over. Three ancillary targets were also monitored: emergency admissions, delayed discharges and project sustainability. Collectively the sites exceeded their headline target. Using a realistic evaluation approach, we explored which aspects of network governance appeared to have contributed to these emergency bed-day reductions. We found no simple link between network governance type and outcomes. The governance features associated with an effective IFOP network appeared to suggest that the selection and implementation of a small number of evidence-based services was central to networks' effectiveness. Each service needed to be coordinated by a network-based strategic group and hierarchically implemented at operational level by the responsible network member. Having a network-based implementation group with a 'joined-at-the-top' governance structure also appeared to promote network effectiveness. External factors, including NHS incentives, health reorganisations and financial targets similarly contributed to differences in performance. Targets and financial incentives could focus action but undermine horizontal networking. Local networks should specify which interventions network structures are intended to deliver. Effective projects are those likely to be evidence based, unique to the network and difficult to implement through vertical structures alone. PMID

  16. Central Auditory Dysfunction in Older People with Memory Impairment or Alzheimer's Dementia

    PubMed Central

    Gates, George A.; Anderson, Melissa L.; Feeney, M. Patrick; McCurry, Susan M.; Larson, Eric B.

    2009-01-01

    Central auditory function is commonly compromised in people with a diagnosis of Alzheimer's disease (AD) and may precede the onset of clinical dementia by several years. Given that screening for AD in its earliest stages might someday be useful for emerging therapies aimed at limiting progression, we inquired whether central auditory testing might be suitable for identifying people at risk for dementia. To address this question, we performed a battery of behavioral central auditory tests in a cohort of 313 older people enrolled in a dementia surveillance research program. The cohort consisted of three groups: controls without memory loss (N=232), targets with mild memory impairment but without dementia (N=64), and targets with a dementia diagnosis (N=17). The auditory tests were the Synthetic Sentence Identification with Ipsilateral Competing Message (SSI), the Dichotic Sentence Identification test (DSI), the Dichotic Digits Test (DDT), and the Pitch Pattern Sequence (PPS) test. Additional control was provided by electrophysiologic testing to assess the integrity of the primary auditory pathways. The mean score on each central auditory test worsened significantly across the three memory groups even after adjusting for age and peripheral hearing status, being poorest in the pAD group and moderately reduced in the memory-impaired group compared to the mean scores in the control group. Heterogeneity of results was noted in all three groups. The electrophysiologic tests did not differ across the three groups. Central auditory function was affected by mild memory impairment. The Dichotic Sentence Identification in the free report mode appears to be the central auditory test most sensitive to the presence of memory impairment. Although central auditory testing requires specialized equipment and training, the objectivity of these tests is appealing. We recommend that comprehensive auditory testing be considered and further evaluated for its potential value as a baseline

  17. Social Peptides: Measuring Urinary Oxytocin and Vasopressin in a Home Field Study of Older Adults at Risk for Dehydration

    PubMed Central

    Galinsky, Adena M.; Hoffmann, Joscelyn N.; You, Hannah M.; Ziegler, Toni E.; McClintock, Martha K.

    2014-01-01

    Objectives. We present the novel urine collection method used during in-home interviews of a large population representative of older adults in the United States (aged 62–91, the National Social Life, Health and Aging Project). We also present a novel assay method for accurately measuring urinary peptides oxytocin (OT) and vasopressin (AVP), hormones that regulate social behaviors, stress, and kidney function. Method. Respondents in a randomized substudy (N = 1,882) used airtight containers to provide urine specimens that were aliquoted, stored under frozen refrigerant packs and mailed overnight for frozen storage (−80 °C). Assays for OT, AVP, and creatinine, including freeze-thaw cycles, were refined and validated. Weighted values estimated levels in the older U.S. population. Results. Older adults had lower OT, but higher AVP, without the marked gender differences seen in young adults. Mild dehydration, indicated by creatinine, specific gravity, acidity, and AVP, produced concentrated urine that interfered with the OT assay, yielding falsely high values (18% of OT). Creatinine levels (≥1.4mg/ml) identified such specimens that were diluted to solve the problem. In contrast, the standard AVP assay was unaffected (97% interpretable) and urine acidity predicted specimens with low OT concentrations. OT and AVP assays tolerated 2 freeze-thaw cycles, making this protocol useful in a variety of field conditions. Discussion. These novel protocols yielded interpretable urinary OT and AVP values, with sufficient variation for analyzing their social and physiological associations. The problem of mild dehydration is also likely common in animal field studies, which may also benefit from these collection and assay protocols. PMID:25360024

  18. Establishing the cause of memory loss in older people.

    PubMed

    Chouliaras, Leonidas; Topiwala, Anya; Cristescu, Tamara; Ebmeier, Klaus P

    2015-01-01

    Common causes of memory loss in older people are mild cognitive impairment, the various types of dementia, and psychiatric illness, mainly depression. Around 10% of patients with mild cognitive impairment progress to dementia each year. Alzheimer's disease accounts for 60-80% of cases. Other common types of dementia are vascular, fronto-temporal, Lewy body, Parkinson's, and mixed type dementia. There is evidence to suggest that dementia pathology is established before the onset of symptoms, and thus mild cognitive impairment can be considered as a predementia stage. NICE guidance suggests examination of: attention, concentration, short- and long-term memory, praxis, language and executive function. Particular attention should be paid to any signs of neglect, state of dress, agitation or poor attention. Dysphasia and difficulty in naming objects is often present. Mood symptoms (including suicidal ideation) may be primary or comorbid. Abnormal thoughts and perceptions should be probed for, as psychotic symptoms are common. Primary care options for cognitive testing include the General Practitioner Assessment of Cognition or the Abbreviated Mental Test Score. Physical examination should include observation of gait, inspection for tremor; examination for rigidity, bradykinesia, frontal release signs, upper motor neurone lesions, pulse and BP. Structural brain imaging can improve diagnostic accuracy, exclude other pathologies and act as a prognostic marker of dementia progression but the overlap in structural changes between the dementias makes imaging alone insufficient for diagnostic purposes. NICE guidelines recommend referral to a memory clinic for patients with mild cognitive impairment, those at high risk of dementia, such as patients with learning disabilities, Parkinson's disease, or patients who have had several strokes. PMID:25726616

  19. Iterative Evaluation in a Mobile Counseling and Testing Program to Reach People of Color at Risk for HIV--New Strategies Improve Program Acceptability, Effectiveness, and Evaluation Capabilities

    ERIC Educational Resources Information Center

    Spielberg, Freya; Kurth, Ann; Reidy, William; McKnight, Teka; Dikobe, Wame; Wilson, Charles

    2011-01-01

    This article highlights findings from an evaluation that explored the impact of mobile versus clinic-based testing, rapid versus central-lab based testing, incentives for testing, and the use of a computer counseling program to guide counseling and automate evaluation in a mobile program reaching people of color at risk for HIV. The program's…

  20. Evaluation of a Medicine Information Training Program for Older People.

    ERIC Educational Resources Information Center

    Quine, Susan

    1998-01-01

    Australian older adults were trained to act as advocates and role models to inform peers on effective use of medicines. Trainees reported difficulties experienced by older learners when training is too concentrated. Many noted increased self-esteem and personal growth as a result of their involvement. (SK)

  1. Higher Education and Older People: Some Theoretical Considerations, Part II.

    ERIC Educational Resources Information Center

    Covey, Herbert C.

    1983-01-01

    Describes disengagement, activity, lifespan, subcultural, and continuity theories of social gerontology in light of participation in higher education by older students. Argues that continuity theory holds the most promise in accounting for older students. Emphasizes the need to stress the positive roles of old age. (JAC)

  2. Older people's views on what they need to successfully adjust to life with a hearing aid

    PubMed Central

    Kelly, Timothy B; Tolson, Debbie; Day, Tracy; McColgan, Gillian; Kroll, Thilo; Maclaren, William

    2013-01-01

    This article reports a study exploring what older people believe would enable them to adjust to and gain maximum benefit from wearing a hearing aid. A mixed methods approach was employed during 2006 involving interviews with key stakeholders, a survey across three Scottish health board areas and focus groups. Nine key stakeholders from six national and local organisations were interviewed about the needs of older people being fitted with hearing aids. In total, 240 older people belonging to three different types of hearing impaired older people were surveyed: long-term users of hearing aids, new hearing aid users, and those on a waiting list from urban and rural areas (response rate = 24%). A series of eight follow-up focus groups with 31 audiology patients was held. Health professionals appeared to neglect appropriate provision of information and overly rely on technological interventions. Of 154 older people already fitted with hearing aids, only 52% of hearing aid users reported receiving enough practical help post fitting and only 41% reported receiving enough support. Approximately 40% reported not feeling confident in the use of their aids or their controls. Older people wanted more information than they received both before and after hearing aid fitting. Information provision and attention to the psychosocial aspects of care are key to enabling older people to adjust and optimise hearing aid benefit. PMID:23373520

  3. Vision and falls in older people: risk factors and intervention strategies.

    PubMed

    Lord, Stephen R; Smith, Stuart T; Menant, Jasmine C

    2010-11-01

    Poor vision impairs balance and increases the risk of falls and fractures in older people. Multifocal glasses can add to this risk by impairing contrast sensitivity, depth perception, and ability to negotiate obstacles. Vision assessment and provision of new spectacles may not reduce, and may even increase, the risk of falls. Restriction of the use of multifocal glasses may reduce falls in active older people. Other effective fall prevention strategies include maximizing vision through cataract surgery and occupational therapy interventions in visually impaired older people. PMID:20934611

  4. Partnership research with older people - moving towards making the rhetoric a reality.

    PubMed

    Reed, Jan; Weiner, Robert; Cook, Glenda

    2004-03-01

    As nursing develops closer partnerships with older people in delivering care, it also needs to develop partnerships in order to create the knowledge base for practice in a way that challenges professional hegemony and empowers older people. However, the process of developing partnerships in research takes place against a background of academic research traditions and norms, which can present obstacles to collaboration. This paper is a reflection on the issues that have arisen in three projects where older people were involved in research at different levels, from sources of data to independent researchers. It points to some of the areas that need further exploration and development. PMID:15028033

  5. Safer Wards: reducing violence on older people's mental health wards.

    PubMed

    Brown, Juliette; Fawzi, Waleed; McCarthy, Cathy; Stevenson, Carmel; Kwesi, Solomon; Joyce, Maggie; Dusoye, Jenny; Mohamudbucus, Yasin; Shah, Amar

    2015-01-01

    Through the Safer Wards project we aimed to reduce the number of incidents of physical violence on older people's mental health wards. This was done using quality improvement methods and supported by the Trust's extensive programme of quality improvement, including training provided by the Institute for Healthcare Improvement. Violence can be an indicator of unmet needs in this patient population, with a negative effect on patient care and staff morale. Reducing harm to patients and staff is a strategic aim of our Trust. We established a multi-disciplinary group who led on the project on each ward and used a Pareto diagram to establish the focus of our work. We established a dashboard of measures based on our incident reporting system Datix, including number of incidents of violence, days between incidents, days of staff sickness, days between staff injury, use of restraint, and use of rapid tranquilisation (the last two being balancing measures in the reduction of violence). Each team identified factors driving physical violence on the wards, under headings of unmet patient needs, staff needs and staff awareness, which included lack of activity and a safe and therapeutic environment. Using driver diagrams, we identified change ideas that included hourly rounding (proactive checks on patient well-being), the addition of sensory rooms, flexible leave for patients, and a structured activity programme. We also introduced exercise to music, therapeutic groups led by patients, and focused on discharge planning and pet therapy, each of which starting sequentially over the course of a one year period from late 2013 and subject to a cycle of iterative learning using PDSA methods. The specific aim was a 20% decrease in violent incidents on three wards in City and Hackney, and Newham. Following our interventions, days between violent incidents increased from an average of three to an average of six. Days between staff injury due to physical violence rose from an average of

  6. Safer Wards: reducing violence on older people's mental health wards

    PubMed Central

    Brown, Juliette; Fawzi, Waleed; McCarthy, Cathy; Stevenson, Carmel; Kwesi, Solomon; Joyce, Maggie; Dusoye, Jenny; Mohamudbucus, Yasin; Shah, Amar

    2015-01-01

    Through the Safer Wards project we aimed to reduce the number of incidents of physical violence on older people's mental health wards. This was done using quality improvement methods and supported by the Trust's extensive programme of quality improvement, including training provided by the Institute for Healthcare Improvement. Violence can be an indicator of unmet needs in this patient population, with a negative effect on patient care and staff morale. Reducing harm to patients and staff is a strategic aim of our Trust. We established a multi-disciplinary group who led on the project on each ward and used a Pareto diagram to establish the focus of our work. We established a dashboard of measures based on our incident reporting system Datix, including number of incidents of violence, days between incidents, days of staff sickness, days between staff injury, use of restraint, and use of rapid tranquilisation (the last two being balancing measures in the reduction of violence). Each team identified factors driving physical violence on the wards, under headings of unmet patient needs, staff needs and staff awareness, which included lack of activity and a safe and therapeutic environment. Using driver diagrams, we identified change ideas that included hourly rounding (proactive checks on patient well-being), the addition of sensory rooms, flexible leave for patients, and a structured activity programme. We also introduced exercise to music, therapeutic groups led by patients, and focused on discharge planning and pet therapy, each of which starting sequentially over the course of a one year period from late 2013 and subject to a cycle of iterative learning using PDSA methods. The specific aim was a 20% decrease in violent incidents on three wards in City and Hackney, and Newham. Following our interventions, days between violent incidents increased from an average of three to an average of six. Days between staff injury due to physical violence rose from an average of

  7. “More than I Expected”: Perceived Benefits of Yoga Practice among Older Adults at Risk for Cardiovascular Disease

    PubMed Central

    Alexander, Gina K.; Innes, Kim E.; Selfe, Terry K.; Brown, Cynthia J.

    2012-01-01

    Objective This study was conducted with participants from trials examining the effects of an Iyengar yoga program on cardiovascular disease risk. The objective of the current study was to evaluate the perceived benefits of yoga in a population of older, predominantly overweight adults participating in a gentle 8-week yoga program. Design This study used a constructivist-interpretive approach to naturalistic inquiry. Setting A total of 42 participants completed the intervention and met the inclusion criteria for the current qualitative study. Intervention The 8-week Iyengar yoga program included two 90-minute yoga classes and five 30-minute home sessions per week. Participants completed weekly logs and an exit questionnaire at the end of the study. Main Outcome Measures Qualitative data from weekly logs and exit questionnaires were compiled and conventional content analysis performed with the use of ATLAS.ti to facilitate the process. Results Four broad themes emerged from content analysis: Practicing yoga improved overall physical function and capacity (for 83% of participants); practicing yoga reduced stress/anxiety and enhanced calmness (83% of participants); practicing yoga enriched the quality of sleep (21% of participants); and practicing yoga supported efforts toward dietary improvements (14% of participants). Conclusions These results suggest that yoga may have ancillary benefits in terms of improved physical function, enhanced mental/emotional state, enriched sleep quality, and improved lifestyle choices, and may be useful as a health promotion strategy in the prevention and management of chronic disease. PMID:23374201

  8. Confidence and Expectations about Caring for Older People with Dementia: A Cross-Sectional Survey of Student Nurses

    ERIC Educational Resources Information Center

    Baillie, Lesley; Merritt, Jane; Cox, Janet; Crichton, Nicola

    2015-01-01

    Older people who are living with dementia often need healthcare, including hospital admissions, due to additional health conditions. Caring for older people who are living with dementia is, therefore, a core nursing role. This study investigated student nurses' expectations of, and confidence about, caring for older people with dementia and the…

  9. Diabetes in Older People - A Disease You Can Manage

    MedlinePlus

    ... Aging Diabetes In Older People—A Disease You Can Manage What Is Diabetes? Types Of Diabetes Pre- ... your diabetes in case of an emergency. Medicare Can Help Medicare will pay to help you learn ...

  10. Working...with Foreign Languages, with Older People, or Outdoors.

    ERIC Educational Resources Information Center

    Bluford, Verada; Dillon, Conley Hall, Jr.

    1995-01-01

    Describes employment outlook, working conditions, and training requirements for three types of jobs: language related (teachers, interpreters, finance), working with older adults (social and health services), and working outdoors (agriculture, construction, engineering, fishing, forestry, mining, recreation). (SK)

  11. On the threshold: older people's concerns about needs after discharge from hospital.

    PubMed

    Gabrielsson-Järhult, Felicia; Nilsen, Per

    2016-03-01

    Discharge from hospital is often strenuous for older people and requires adjustments from living an independent life to being in need of care and support. This study aims to explore older people's concerns about their needs after discharge. Twenty-seven observations recorded at hospital discharge planning meetings were analysed with content analysis. An overarching theme emerged: being in a life transition, which reflected the older person's vulnerable and ambiguous situation in the discharge process. The theme was developed from three categories: obtaining a secure life situation, need of continuous care and support, and influencing and regaining independence. The findings highlight that older patients want to influence their care after discharge. They strive to regain independence and express their concerns about how to obtain a secure life situation through care organised to fit their individual needs. Knowledge about older people's concerns is important for healthcare providers and social workers involved in planning and individualised care and services. PMID:25919854

  12. Emergency service use by older people in Samsun, Turkey.

    PubMed

    Dundar, Cihad; Sunter, A Tevfik; Canbaz, Sevgi; Cetinoglu, Erhan

    2006-01-01

    During the first 50 years of the 21st century, the world population aged 65 and older is expected to triple. Proper care of the older patient is one of the major priorities of many health care systems. In this descriptive study, patients treated and transported by 112 Emergency Help and Rescue Service in Samsun Province during the year 2004 were surveyed through review of command center records. All patients who were 65 years of age and older were included in the study. Collected data included patient sex and age, number of patients accessing emergency medical service (EMS) per hours of the day and per season, clinical diagnosis, and patient outcomes. In all, 2210 patients aged 65 years and older were identified; this group accounted for 24.5% of all records reviewed (n=9015). The rate of EMS use was highest in those older than 65 years of age (26 of 1000/y). Similar associations of ambulance transportation with older age and off-hour presentation were noted, as was increased usage during colder months of the year. Cardiovascular, neurologic, and respiratory problems were the 3 most frequent reasons for use of EMS. In almost three fourths of cases, outcome was recorded as transport to the hospital. Data presented here highlight the need for continued monitoring of EMS usage patterns so that planners will be prepared to accommodate the needs of the increasingly aging population. PMID:16644606

  13. Cultural and gender differences in coping strategies between Caucasian American and Korean American older people.

    PubMed

    Lee, HeeSoon; Mason, Derek

    2014-12-01

    Coping strategies have significant effects on older people's health. This study examined whether gender and ethnic differences influence the coping strategies chosen by older adults when they encounter daily life stressors. Data were collected from 444 community-dwelling people over the age of 65, including 238 Caucasian Americans and 206 Korean Americans. Results showed significant differences between the two groups. Korean Americans had higher scores on problem and emotion-focused coping strategies as well as avoidant coping strategies than Caucasian Americans. Caucasian older women employed more active coping, planning, and positive reframing skills; relied more on religion; and sought emotional support more than Caucasian men. For Korean Americans, older women utilized religion and denial; whereas older men employed instrumental support and substance abuse. The results suggest that practitioners should develop ethnic, gender-specific programs to help older adults cope more effectively with their daily life stressors. PMID:25260229

  14. In Hospital We Trust: Experiences of older peoples' decision to seek hospital care.

    PubMed

    Hallgren, Jenny; Ernsth Bravell, Marie; Dahl Aslan, Anna K; Josephson, Iréne

    2015-01-01

    The purpose of this study was to explore how older people experience and perceive decisions to seek hospital care while receiving home health care. Twenty-two Swedish older persons were interviewed about their experiences of decision to seek hospital while receiving home health care. The interviews were analyzed using qualitative content analysis. The findings consist of one interpretative theme describing an overall confidence in hospital staff to deliver both medical and psychosocial health care, In Hospital We Trust, with three underlying categories: Superior Health Care, People's Worries, and Biomedical Needs. Findings indicate a need for establishing confidence and ensuring sufficient qualifications, both medical and psychological, in home health care staff to meet the needs of older people. Understanding older peoples' arguments for seeking hospital care may have implications for how home care staff address individuals' perceived needs. Fulfillment of perceived health needs may reduce avoidable hospitalizations and consequently improve quality of life. PMID:25971421

  15. Imagery and Imaginary of Islander Identity: Older People and Migration in Irish Small-Island Communities

    ERIC Educational Resources Information Center

    Burholt, Vanessa; Scharf, Thomas; Walsh, Kieran

    2013-01-01

    This article examines the imagery and imaginaries of islander identity and makes an original contribution to the fields of gerontology and nissology. Drawing on data collected through in-depth interviews with 19 older residents of two small-island communities located off the island of Ireland, we address the central roles played by older people in…

  16. The Effects of an Education Program on Home Renovation for Fall Prevention of Korean Older People

    ERIC Educational Resources Information Center

    Jang, Miseon; Lee, Yeunsook

    2015-01-01

    This study aims to verify the effects of an education program on home renovation for fall prevention among older people, more specifically fall efficacy and home renovation intentions. A quasiexperimental study with nonequivalent control and comparative groups was conducted to demonstrate the effects of the education. A total of 51 older people…

  17. Considerations of prescription opioid abuse and misuse among older adults in West Virginia--An Under-Recognized Population at Risk.

    PubMed

    Grey, Carl; Hall, P Bradley

    2016-01-01

    Opioid abuse, misuse and overdose is now a public health epidemic receiving political, medical, and media attention at all levels. Despite the fact that many people know someone suffering from addiction, there is very little research focusing on this issue in older adults. Chronic pain, a highly prevalent affliction for the aging population, has been accompanied by a significant increase in opioid use. This, along with some unique aspects of older adults (increased susceptibility to illness, higher likelihood of altered presentation of illness, and impaired recovery), means that great care needs to be taken when considering opioids for treatment. Prudent prescribing is possible, but universal precautions should be taken to reduce the risk of opioid abuse, misuse, and addiction. This review provides education, summarizes current literature, and gives guidance in universal precautions for prescribing opioids. PMID:27301154

  18. Powerlessness of older people in Hong Kong: a political economy analysis.

    PubMed

    Kam, Ping-kwong

    2003-01-01

    Gerontologists agree that old age can be associated with an increase in powerlessness both in the personal domain and in the social and political fields. This paper is an attempt to understand the concept of powerlessness in old age within a political economy theoretical framework. The paper argues that the powerlessness of older people is not biologically determined. Rather, it is socially constructed. It has its roots in the social, economic, and political structure of society. For this reason, the paper argues that (a) the capitalist economic system discriminates against and marginalizes older people in the labor market. The current unfavorable economic climate will make the economic situation of older people worse. (b) The residual welfare system does not counteract the unfavorable impact of the economic system. Rather, it deprives older people of the necessary financial resources and social service supports that would enable them to lead independent and dignified lives. (c) The authoritarian political system creates adverse conditions that make it very difficult for older people to participate in the decision-making process on issues that affect their lives, as well as on broader political issues that affect the whole of society. It is the interplay among these economic, social, and political forces in Hong Kong that creates the political economy of powerlessness in old age and prevents older people from using their powers to master and control their lives. PMID:14733445

  19. Dimensions of Housing Deprivation for Older People in Ireland

    ERIC Educational Resources Information Center

    Nolan, Brian; Winston, Nessa

    2011-01-01

    Housing is an important aspect of living standards and quality of life for older persons, but the housing-related problems they may face encompass rather different circumstances, relating to the condition of the dwelling, how well equipped it is, whether housing costs represent a serious burden, and whether the neighbourhood environment is…

  20. Family, Close Relatives, Friends: Life Satisfaction among Older People

    ERIC Educational Resources Information Center

    Sener, Arzu; Oztop, Hulya; Dogan, Nuri; Guven, Seval

    2008-01-01

    This study examined the influence of socioeconomic (age, education, marital status, income, and health) and demographic variables and the quantity and quality of relationships with adult children, grandchildren, siblings and friends on life satisfaction of the elderly. Participants were 200 persons older than 60 years of age. Hierarchical…

  1. Adventure as Therapy: Using Adventure as Part of Therapeutic Programmes with Young People in Trouble and at Risk.

    ERIC Educational Resources Information Center

    McNutt, Brendan

    This paper defines "adventure-based intervention,""young people," and "trouble and risk" in light of the therapeutic work done at Bryn Melyn Community (Bala, Wales), a therapeutic treatment center. Bryn Melyn provides intensive individualized therapy to young people, aged 15-18, who are in the care of social services departments. Each teenager has…

  2. The “Younger-Sibling-at-Risk Design”: a Pilot Study of Adolescents with ADHD and an Older Sibling with Substance Use Disorder

    PubMed Central

    Donovan, Stephen J.; Levin, Frances R.

    2011-01-01

    Introduction This article introduces a “younger at-risk sibling” design to study progression from other psychopathologies to their substance use disorder (SUD) complications. The design selects not-yet-SUD adolescents with high-risk-for-SUD psychopathology only if an older sibling has SUD. This “proof of concept” pilot study examines the design’s feasibility if the younger sibling has attention deficit hyperactivity disorder (ADHD). Method Subjects were recruited from families at substance abuse treatment centers that had a non-SUD younger child with ADHD, from families at behavior disorder clinics that had a younger child with ADHD and SUD older child, and through general advertisements. Subjects were seen weekly for at least 3 months and monthly thereafter for 3 months. All were treated with open-label lisdexamfetamine dimesylate 30–70 mg per day. Outcomes explored were recruitment, compliance, diversion, ADHD improvement, and substance use interest. Results 25 families were screened, 13 evaluated, and 8 began medication. ADHD Rating Scale-IV scores obtained by parent adolescent consensus improved as expected with a stimulant. Rating forms could quantify substance use interest in subjects with some drug culture exposure but encountered a floor effect in those without. The design’s complexity and implicit commentary on family dynamics complicated recruitment but may have facilitated retention. Conclusion Sibling pairs in which the older sibling has substance use and the younger sibling has ADHD exist. Such younger siblings can be recruited into a treatment study. The design may shed light on the pathogenesis and prevention of SUD complications from ADHD and theoretically other SUD comorbidities. PMID:21517711

  3. Advertising Representations of Older People in the United Kingdom and Taiwan: A Comparative Analysis.

    PubMed

    Chen, Chin-Hui

    2015-01-01

    Cross-cultural studies of advertising representations of older people are relatively scarce. This article aims to fill in this gap via a comparison between Taiwan and the United Kingdom, employing a combination of quantitative content analysis and the qualitative grounded theory method. The content-analysis phase reveals underrepresentation of older people in both countries' advertising contexts, as well as representational differences between Taiwan and the United Kingdom in terms of older characters' role salience, the products, physical settings, and social networks they are associated with. The grounded-theory phase yields nine prototypes of older people along with subcategories to conceptualize the qualities of older people as they appear in TV ads in these countries. The findings are discussed in relation to the stereotyping of older people and transformed into hypothetical statements to be modified in future research. In conclusion, the Confucian tradition of filial piety is still found to be important in explaining the observed cross-cultural differences, but the emergence of new norms about aging in Taiwanese advertising also suggests that this tradition may be in decline. PMID:26243326

  4. Methodology for developing quality indicators for the care of older people in the Emergency Department

    PubMed Central

    2013-01-01

    Background Compared with younger people, older people have a higher risk of adverse health outcomes when presenting to emergency departments. As the population ages, older people will make up an increasing proportion of the emergency department population. Therefore it is timely that consideration be given to the quality of care received by older persons in emergency departments, and to consideration of those older people with special needs. Particular attention will be focused on important groups of older people, such as patients with cognitive impairment, residents of long term care and patients with palliative care needs. This project will develop a suite of quality indicators focused on the care of older persons in the emergency department. Methods/design Following input from an expert panel, an initial set of structural, process, and outcome indicators will be developed based on thorough systematic search in the scientific literature. All initial indicators will be tested in eight emergency departments for their validity and feasibility. Results of the data from the field studies will be presented to the expert panel at a second meeting. A suite of Quality Indicators for the older emergency department population will be finalised following a formal voting process. Discussion The predicted burgeoning in the number of older persons presenting to emergency departments combined with the recognised quality deficiencies in emergency department care delivery to this population, highlight the need for a quality framework for the care of older persons in emergency departments. Additionally, high quality of care is associated with improved survival & health outcomes of elderly patients. The development of well-selected, validated and economical quality indicators will allow appropriate targeting of resources (financial, education or quality management) to improve quality in areas with maximum potential for improvement. PMID:24314126

  5. Primary care professionals' perceptions of depression in older people: a qualitative study.

    PubMed

    Murray, Joanna; Banerjee, Sube; Byng, Richard; Tylee, Andre; Bhugra, Dinesh; Macdonald, Alastair

    2006-09-01

    An understanding of patients' perspectives is crucial to improving engagement with health care services. For older people who may not wish to bother medical professionals with problems of living such as depression, such exploration becomes critical. General practitioners (GPs), nurses and counsellors working in 18 South London primary care teams were interviewed about their perceptions of depression in older people. All three professional groups shared a predominantly psychosocial model of the causes of depression. While presentation of somatic symptoms was seen as common in all age groups, identification of depression in older patients was complicated by co-existent physical illnesses. GPs reported that older patients rarely mentioned psychological difficulties, but practice nurses felt that older people were less inhibited in talking to them about "non-medical" problems. Many older people were perceived to regard symptoms of depression as a normal consequence of ageing and not to think it appropriate to mention non-physical problems in a medical consultation. Men were thought to be particularly reluctant to disclose emotional distress and were more vulnerable to severe depression and suicide. Some GPs had mixed feelings about offering medication to address what they believed to be the consequences of loneliness and social isolation. Participants thought that many older people regard depression as a "sign of weakness" and the perceived stigma of mental illness was widely recognised as a barrier to seeking help. Cultural variations in illness beliefs, especially the attribution of symptoms, were thought to profoundly influence the help-seeking behaviour of elders from minority ethnic groups. Families were identified as the main source of both support and distress; and as such their influence could be crucial to the identification and treatment of depression in older people. PMID:16698157

  6. The Role of Housing Space in Determining Freedom and Flourishing in Older People

    ERIC Educational Resources Information Center

    Gilroy, Rose

    2005-01-01

    This paper takes as its central thesis Martha Nussbaum's normative proposition that social arrangements should be evaluated primarily according to the extent of freedom people have to promote or achieve functionings they value. Using this as a lens the paper explores the housing circumstances of older people in the UK. The paper makes three…

  7. Relating to Older People Evaluation (ROPE): A Measure of Self-Reported Ageism

    ERIC Educational Resources Information Center

    Cherry, Katie E.; Palmore, Erdman

    2008-01-01

    The Relating to Older People Evaluation (ROPE) is a 20-item questionnaire that measures positive and negative ageist behaviors that people may engage in during everyday life. In this article, we report the first findings from several administrations of the ROPE along with initial psychometric information on the instrument. Respondents were college…

  8. Patient safety and hydration in the care of older people.

    PubMed

    Burns, Julie

    2016-05-01

    Ensuring patients are adequately hydrated is a fundamental part of nursing care, however, it is clear from the literature that dehydration remains a significant problem in the NHS with implications for patient safety. The development of dehydration is often multifactorial and older age is an independent risk factor for the condition. However, the media often blame nursing staff for simply not giving patients enough to drink. This article discusses the scale of the problem in acute care settings and aims to raise awareness of the importance of hydration management and accurate documentation in nursing practice. It suggests that intentional hourly rounding may provide an opportunity for nurses to ensure older patients are prompted or assisted to take a drink. PMID:27125939

  9. Functional Balance and Its Determinants in Older People with Diabetes

    PubMed Central

    Tsai, Yi-Ju; Yang, Yi-Ching; Lu, Feng-Hwa; Lee, Pei-Yun; Lee, I-Ting; Lin, Sang-I

    2016-01-01

    Objective To determine functional balance abilities of older adults with diabetes, and identify determinants of these abilities. Methods Eighty diabetic and 67 healthy non-diabetic community-dwelling older adults completed the Mini Mental Status Examination (MMSE) and questionnaires about their medical and fall histories. Participants were also assessed for vision, plantar sensitivity, muscle strength, and functional balance, including Functional Reach (FR), Five Times Sit-to-Stand (FTSTS), and 180° turn (TURN). In addition to between-group comparisons, hierarchical regression analysis was conducted to identify the independent determinants for each of the individual balance tasks for the diabetes and control group separately. Results The diabetes group had significantly greater body mass index, higher rate of cardiac disease, and poorer plantar sensitivity, mental status, grip and lower limb strength. The diabetes group performed significantly poorer in FTSTS and TURN (both p<0.001), but not FR (p = 0.108). The significant determinants for the balance tasks varied substantially between tasks and groups. For the diabetes group, they included visual and plantar sensitivity and MMSE for FR (R2 = 0.39), ankle dorsiflexion strength for FTSTS (R2 = 0.377), and plantar sensitivity, knee extension strength and MMSE for TURN (R2 = 0.391). For the control group, knee extension strength emerged as the common and only significant determinant and only explained approximately 10% of the variance for FR and TURN. Conclusions Impairments in functional balance abilities were evident for older adults with diabetes. Their underpinning functional limitations were different for different tasks and were also different from those of the control group. Screening of functional balance and mental status, lower limb strength and sensory function, and interventions to address these impairments may be important to maintain function, independence and safety for older clients with diabetes

  10. Social connection, relationships and older lesbian and gay people1

    PubMed Central

    Barrett, Catherine; Whyte, Carolyn; Comfort, Jude; Lyons, Anthony; Crameri, Pauline

    2015-01-01

    This paper presents data from a small study exploring the impacts of homophobia on the lives of older lesbian and gay Australians. Eleven in-depth interviews were conducted with older lesbians (6) and gay men (5) ranging in age from 65 to 79 years. The study found that participants’ sense of self was shaped by the dominant medical, legal and religious institutions of their youth that defined them as sick, immoral or criminal. Participants described enforced “cure” therapies, being imprisoned, having employment terminated and being disowned and disinherited by family. In this context, intimate relationships and social networks provided refuge where trust was rebuilt and sexuality affirmed. Many created safe spaces for themselves. This equilibrium was threatened with increasing age, disability and the reliance on health and social services. Participants feared a return to institutional control and a need to “straighten up” or hide their sexuality. In response, partners stepped into the role of caregiver, at times beyond their capacity and at a cost to their relationship. The study describes the importance of understanding social connections in the lives of older lesbians and gay men. It highlights the need for inclusive services to ensure that social networks are supported and that health and well-being are promoted. PMID:25544830

  11. Nuances in the Management of Older People With Multiple Myeloma.

    PubMed

    Pawlyn, Charlotte; Gay, Francesca; Larocca, Alessandra; Roy, Vivek; Ailawadhi, Sikander

    2016-06-01

    Multiple myeloma is a disease of the elderly, with about a third of patients at diagnosis older than 75 years of age. Yet, the population of elderly patients is heterogeneous: older patients are more likely to have comorbidities and frailties complicating both their initial diagnosis and subsequent management, but these are not consistent across the group. Furthermore, patients with comorbidities and frailty are generally underrepresented in clinical trials. Despite the survival of myeloma patients increasing following the introduction of novel agents, older patients continue to have worse outcomes with increased treatment-related toxicity. Treatment tolerability is not defined by age alone, rather a combination of age, physical function, cognitive function, and comorbidities. These factors all influence patients' tolerability of treatment and therefore treatment efficacy and should also be considered when reviewing the results of clinical trials. It is the nuances of determining how these factors interact that should influence initial treatment and ongoing management decisions and these will be discussed here. PMID:27038805

  12. Concern about HIV and AIDS among older people in the slums of Nairobi, Kenya.

    PubMed

    Chepngeno-Langat, Gloria; Falkingham, Jane C; Madise, Nyovani J; Evandrou, Maria

    2012-09-01

    The article explores the way that social networks and personal experiences affect perceived HIV-related concerns among people aged 50 years or older living in a low resource neighborhood with high HIV prevalence in Nairobi, Kenya. Multiple logistic regression is used to model the association between the reporting of an HIV-related concern and individual-level characteristics, personal experiences, and social interaction. The main concerns regarding HIV reported by older people in the study included caring for orphaned children (65%), caring for people with AIDS (48%), and losing material and social support from adult children (36%). Interestingly, 38% of respondents voiced concerns about HIV infection among older people. Respondents who had been individually affected by HIV and AIDS, who were part of a wide social network, or who participated in community activities were frequently more likely to report a concern. The findings highlight the significance of the role of social interaction and social networks in the diffusion of information and knowledge. These findings have implications for HIV and AIDS policy and programs, highlighting the potential for social networks and community-level interventions to educate and increase awareness about HIV and AIDS among older people. Community leaders can make good peer educators and communication agents for HIV/AIDS campaigns. Additionally, the recognized high level of personal vulnerability to HIV infection among older people suggests the need for targeted sexual behavior change programs among this often neglected group. PMID:22324649

  13. The burden of disease in older people and implications for health policy and practice.

    PubMed

    Prince, Martin J; Wu, Fan; Guo, Yanfei; Gutierrez Robledo, Luis M; O'Donnell, Martin; Sullivan, Richard; Yusuf, Salim

    2015-02-01

    23% of the total global burden of disease is attributable to disorders in people aged 60 years and older. Although the proportion of the burden arising from older people (≥60 years) is highest in high-income regions, disability-adjusted life years (DALYs) per head are 40% higher in low-income and middle-income regions, accounted for by the increased burden per head of population arising from cardiovascular diseases, and sensory, respiratory, and infectious disorders. The leading contributors to disease burden in older people are cardiovascular diseases (30·3% of the total burden in people aged 60 years and older), malignant neoplasms (15·1%), chronic respiratory diseases (9·5%), musculoskeletal diseases (7·5%), and neurological and mental disorders (6·6%). A substantial and increased proportion of morbidity and mortality due to chronic disease occurs in older people. Primary prevention in adults aged younger than 60 years will improve health in successive cohorts of older people, but much of the potential to reduce disease burden will come from more effective primary, secondary, and tertiary prevention targeting older people. Obstacles include misplaced global health priorities, ageism, the poor preparedness of health systems to deliver age-appropriate care for chronic diseases, and the complexity of integrating care for complex multimorbidities. Although population ageing is driving the worldwide epidemic of chronic diseases, substantial untapped potential exists to modify the relation between chronological age and health. This objective is especially important for the most age-dependent disorders (ie, dementia, stroke, chronic obstructive pulmonary disease, and vision impairment), for which the burden of disease arises more from disability than from mortality, and for which long-term care costs outweigh health expenditure. The societal cost of these disorders is enormous. PMID:25468153

  14. Social marketing strategies for reaching older people with disabilities: findings from a survey of centers for independent living participants.

    PubMed

    Moone, Rajean Paul; Lightfoot, Elizabeth

    2009-01-01

    Centers for independent living (CILs) provide critical supports, services, and advocacy for assisting people with disabilities in living independently. As there is a rapidly increasing population of older people with disabilities, many CILs are now considering how to actively engage older adults in their organizations. This study utilized a survey of older people with disabilities to help identify social marketing techniques that community organizations like CILs can use to effectively reach older people with disabilities. Utilizing the components of the social marketing mix in designing outreach efforts, including a critical examination of product, place, price, participants, and partnering, CILs and other community agencies can better reach older adults with disabilities. PMID:19459127

  15. Differences in false recollection according to the cognitive reserve of healthy older people.

    PubMed

    Pitarque, Alfonso; Meléndez, Juan; Sales, Alicia; Mayordomo, Teresa; Escudero, Joaquín; Algarabel, Salvador

    2016-09-01

    We present an associative recognition experiment comparing three samples of healthy people (young people, older people with high cognitive reserve [HCR], and older people with low cognitive reserve [LCR], with each sample consisting of 40 people), manipulating stimuli repetition during the study phase. The results show significant differences among the three samples in their overall performance. However, these differences are not due to a different use of familiarity, but rather due to a different way of using recollection: although there are no differences in the hit rates between the HRC and LRC samples, the LCR group makes significantly more recollective false alarms than the HCR group. Moreover, repetition provokes an increase in the recollective false alarms in the LCR group, but this does not occur in the group of young people or in the HCR group. These findings are explained in terms of recollection-based monitoring errors and seem to provide support for the cognitive reserve hypothesis. PMID:26982550

  16. Olfactory processing in schizophrenia, non-ill first-degree family members, and young people at-risk for psychosis

    PubMed Central

    Kamath, Vidyulata; Turetsky, Bruce I.; Calkins, Monica E.; Kohler, Christian G.; Conroy, Catherine G.; Borgmann-Winter, Karin; Gatto, Dana E.; Gur, Raquel E.; Moberg, Paul J.

    2014-01-01

    Objectives While deficits in odor identification and discrimination have been reported in schizophrenia, few studies have examined the relative specificity of these deficits in patients and at-risk youth. Method Sniffin’ Sticks odor identification and discrimination were assessed in schizophrenia outpatients and non-ill first-degree relatives (Study One), as well as youth at clinical (CR) or genetic (GR) risk for schizophrenia (Study Two). Scores were z-transformed, using the performance of a demographically-matched adult or adolescent comparison group. Results Patients and relatives were impaired on odor identification, but odor discrimination impairment was limited to the patient group. A similar pattern of impairment emerged in at-risk youth. GR youth were impaired on odor identification but not discrimination, while CR youth were impaired on both tasks. In patients, olfactory impairment was correlated with negative symptomatology. Conclusions To our knowledge, this is the first study to show that CR youth are impaired on both olfactory tasks, as observed in adult schizophrenia patients. GR youth were impaired only on odor identification like their adult counterparts. These data suggest that odor identification impairment, in isolation, may represent a genetic marker of vulnerability for schizophrenia, while odor discrimination deficits may be a biomarker associated with the development of psychosis. PMID:22070564

  17. [The role of information as a preventive measure to the drug use among young people at risk].

    PubMed

    Sanchez, Zila van der Meer; Oliveira, Lúcio Garcia de; Ribeiro, Luciana Abeid; Nappo, Solange Aparecida

    2010-05-01

    Illicit drug consumption among youngsters is a public health concern that requires attention. However, little research has highlighted the importance of "drug information availability" among protection factors. The aim of this article is to identify, from the point of view of youngsters at risk, what factors could prevent them to try illicit drugs, focusing on the importance of "drug information availability". An intentional sample was selected, composed by 62 youngsters divided into two groups: (NU) non illicit users N=32 and (U) users N=30. The sample was recruited through key-informants and "snowball" and each participant was submitted to an in-depth semi-structured interview. According to NU "drug information availability" was reported as the main protector factor. Family-based information was the main source of knowledge followed by observation of the drug negative consequences on lives of friends who have already consumed illicit drugs in a regular-basis. Among users, it was reported a lack of drug knowledge or availability of partial information. We can conclude that among youngsters at risk, drug information availability is the main protection factor against experimental and regular drug consumption. Family based information was reported as its main source. PMID:20464182

  18. Care planning at home: a way to increase the influence of older people?

    PubMed Central

    Berglund, Helene; Dunér, Anna; Blomberg, Staffan; Kjellgren, Karin

    2012-01-01

    Introduction: Care-planning meetings represent a common method of needs assessment and decision-making practices in elderly care. Older people’s influence is an important and required aspect of these practices. This study’s objective was to describe and analyse older people’s influence on care-planning meetings at home and in hospital. Methods: Ten care-planning meetings were audio-recorded in the older people’s homes and nine were recorded in hospital. The study is part of a project including a comprehensive continuum-of-care model. A qualitative content analysis was performed. Results: Care-planning meetings at home appeared to enable older people’s involvement in the discussions. Fewer people participated in the meetings at home and there was less parallel talking. Unrelated to the place of the care-planning meeting, the older people were able to influence concerns relating to the amount of care/service and the choice of provider. However, they were not able to influence the way the help should be provided or organised. Conclusion: Planning care at home indicated an increase in involvement on the part of the older people, but this does not appear to be enough to obtain any real influence. Our findings call for attention to be paid to older people’s opportunities to receive care and services according to their individual needs and their potential for influencing their day-to-day provision of care and service. PMID:23593048

  19. An overview of foot ulceration in older people with diabetes.

    PubMed

    Moakes, Helen

    2012-09-01

    A patient's whole body is affected by diabetes but in particular this chronic disease can cause foot complications. Damage to the nerve and blood supply to the feet as a result of diabetes causes lack of sensation and ischaemia. These problems can lead to diabetic foot ulceration, which, if left untreated, can result in amputation or even death. An essential part of nurses' role in caring for older patients with diabetes in community, acute and residential settings is learning to recognise the signs of a high-risk diabetic foot, and when and where to get help for its treatment. PMID:23008915

  20. Cortisol awakening response and cognitive performance in hypertensive and normotensive older people.

    PubMed

    Pulopulos, Matias M; Hidalgo, Vanesa; Puig-Perez, Sara; Salvador, Alicia

    2016-07-01

    Healthy older people with a cortisol awakening response (CAR) of decreased magnitude show worse frontal cortex-related cognitive performance. Systemic hypertension has been related to a CAR of decreased magnitude. Additionally, worse executive function and processing speed have been observed in older people with systemic hypertension. This is the first study to examine the relationship between the CAR (measured with six saliva samples at home on two consecutive weekdays) and cognitive performance, in both hypertensive (n=26) and normotensive (n=28) older people (from 56 to 78years old). Hypertensive participants showed lower morning cortisol secretion, and they also woke up earlier. No differences in CAR were observed. A CAR of decreased magnitude was related to worse executive function in both hypertensive and normotensive participants, but to slower processing speed only in normotensive participants. Being treated with antihypertensive for a longer period of time was related to a CAR of increased magnitude and better performance on executive function. Our findings suggest that earlier awakening time in hypertensive older people might underlie the lower overall morning cortisol secretion observed in previous studies. Additionally, this study confirms that a dysregulation of the CAR is related to worse executive function, and it extends this association to hypertensive older people. Finally, it is worth noting that hypertension may moderate the relationship between CAR and processing speed. PMID:27208824

  1. TRialing individualized interventions to prevent functional decline in at-risk older adults (TRIIFL): study protocol for a randomized controlled trial nested in a longitudinal observational study

    PubMed Central

    2013-01-01

    Background Functional decline (FD) is a largely preventable feature of aging, characterized as gradual erosion of functional autonomy. This reduces an older person’s capacity for safe, independent community living. The healthcare needs of an unprecedented aging population places pressure on health systems to develop innovative approaches to ensuring older people live healthy and independent lives for as long as possible. TRIIFL aims to demonstrate that: 1. Incipient FD in older people can be identified using a simple telephone-screening process within four weeks of discharge from an emergency department presentation for a minor health event; and 2. Early engagement into a person-centered individualized intervention arrests or reduces the rate of FD over the next 12 months. Methods/Design A randomized controlled trial (RCT) nested within a 13-month longitudinal cohort study. The RCT (conducted over 12 months) tests the effectiveness of a novel, early, home-based, personalized program (compared with no intervention) in arresting or slowing FD. TRIIFL focuses on older adults living independently in the community, who have not yet had a serious health event, yet are potentially on the cusp of FD. Participants in the longitudinal cohort study will be recruited as they present to one large tertiary hospital Emergency Department, providing they are not subsequently admitted to a ward. Sample size calculations indicate that 570 participants need to be recruited into the longitudinal study, with 100 participants randomized into the trial arms. Measures from all subjects will be taken face-to-face at baseline (recruitment), then subsequently by telephone at one, four, seven and thirteen months later. Measures include functional abilities, quality of life, recent falls, mobility dependence, community supports and health service usage. Specific to the nested RCT, the quality of life tool (SF12) applied at one month, will identify individuals with low mental component quality

  2. Overweight and Obesity in Older People with Intellectual Disability

    ERIC Educational Resources Information Center

    de Winter, C. F.; Bastiaanse, L. P.; Hilgenkamp, T. I. M.; Evenhuis, H. M.; Echteld, M. A.

    2012-01-01

    Overweight and obesity are major health problems associated with increased cardiovascular disease risk, which is not sufficiently studied in people with intellectual disability yet. The present study was part of the Healthy Ageing in Intellectual Disability (HA-ID) study. The aim of this study was to establish (1) the prevalence of overweight,…

  3. A health visitor for older people in an accident and emergency department.

    PubMed

    Bridges, J; Meyer, J; McMahon, K; Bentley, J; Winter, J

    2000-02-01

    Published studies indicate that older people have special needs on discharge from accident and emergency (A&E) departments that are not always fully met. The literature reflects that although a significant proportion of older people have a decrease in functional independence and an increased need for services following discharge from A&E, social and functional assessment by A&E staff can be inadequate, as can the arrangement of follow-up community services. As part of a wider study into the organization of care for older people in A&E, a health visitor for older people was funded to work part-time in the A&E department of a large NHS Trust. The health visitor identified potential clients through reviewing the A&E documentation of patients aged 75 years or over discharged directly from A&E. Telephone calls or home visits were used to follow up those individuals deemed to be vulnerable by the health visitor. Interventions included health education, referral to other agencies and patient or family counselling. None of the clients followed up by the health visitor (n = 212) had been referred by A&E to a specialist in gerontology, which suggests that these clients would otherwise not have received the potential benefit of specialist intervention. The pilot study described here highlights a number of practical issues in relation to the health visitor post for older people in A&E, including the importance of dedicated office space and access to a telephone. Data collected during the study, plus the positive evaluation of the role by a small group of A&E staff confirm the claims made in other studies (e.g. Runciman et al, 1996) that health visitors for older people may be of value in meeting the post-discharge needs of these people. PMID:11125456

  4. Coffee, Cake & Culture: Evaluation of an art for health programme for older people in the community.

    PubMed

    Roe, Brenda; McCormick, Sheila; Lucas, Terri; Gallagher, Wendy; Winn, Andrea; Elkin, Sophie

    2016-07-01

    Arts for health initiatives and networks are being developed in a number of countries and an international literature is emerging on the evidence of their benefits to people's health, wellbeing and quality of life. Engagement in cultural and creative arts by older people can increase their morale and self-confidence and provides opportunities for social connection. Museums and galleries are increasingly required to justify their expenditure, reach and impact and some are working in partnership with local councils, hospitals, schools and communities to improve access to their collections. There is a body of literature emerging that describes such initiatives but empirical evidence of their benefits is less developed. This article reports an evaluation of an art for health initiative - Coffee, Cake & Culture organised and delivered by Whitworth Art Gallery and Manchester Museum in 2012 for older people living in a care home and a supported living facility. The study has identified the benefits and impacts of the arts for health programme and its feasibility for older people, with or without diagnosed memory loss - dementia, living in a care home or supported living facility and their care staff. The findings demonstrate there were benefits to the older people and their care staff in terms of wellbeing, social engagement, learning, social inclusion and creativity. These benefits were immediate and continued in the short term on their return home. The majority of older people and care staff had not previously been to the art gallery or museum and the programme encouraged creative arts and cultural appreciation which promoted social inclusion, wellbeing and quality of life. The programme is feasible and important lessons were identified for future planning. Further research involving partnerships of researchers, arts for health curators, artists, care staff, older people and their families is warranted. PMID:24686287

  5. Prevalence of Vestibular Disorder in Older People Who Experience Dizziness

    PubMed Central

    Chau, Allan T.; Menant, Jasmine C.; Hübner, Patrick P.; Lord, Stephen R.; Migliaccio, Americo A.

    2015-01-01

    Dizziness and imbalance are clinically poorly defined terms, which affect ~30% of people over 65 years of age. In these people, it is often difficult to define the primary cause of dizziness, as it can stem from cardiovascular, vestibular, psychological, and neuromuscular causes. However, identification of the primary cause is vital in determining the most effective treatment strategy for a patient. Our aim is to accurately identify the prevalence of benign paroxysmal positional vertigo (BPPV), peripheral, and central vestibular hypofunction in people aged over 50 years who had experienced dizziness within the past year. Seventy-six participants aged 51–92 (mean ± SD = 69 ± 9.5 years) were tested using the head thrust dynamic visual acuity (htDVA) test, dizziness handicap inventory (DHI), as well as sinusoidal and unidirectional rotational chair testing, in order to obtain data for htDVA score, DHI score, sinusoidal (whole-body, 0.1–2 Hz with peak velocity at 30°/s) vestibulo-ocular reflex (VOR) gain and phase, transient (whole-body, acceleration at 150°/s2 to a constant velocity rotation of 50°/s) VOR gain and time constant (TC), optokinetic nystagmus (OKN) gain, and TC (whole-body, constant velocity rotation at 50°/s). We found that BPPV, peripheral and central vestibular hypofunction were present in 38 and 1% of participants, respectively, suggesting a likely vestibular cause of dizziness in these people. Of those with a likely vestibular cause, 63% had BPPV; a figure higher than previously reported in dizziness clinics of ~25%. Our results indicate that htDVA, sinusoidal (particularly 0.5–1 Hz), and transient VOR testing were the most effective at detecting people with BPPV or vestibular hypofunction, whereas DHI and OKN were effective at only detecting non-BPPV vestibular hypofunction. PMID:26733940

  6. Prevalence of Vestibular Disorder in Older People Who Experience Dizziness.

    PubMed

    Chau, Allan T; Menant, Jasmine C; Hübner, Patrick P; Lord, Stephen R; Migliaccio, Americo A

    2015-01-01

    Dizziness and imbalance are clinically poorly defined terms, which affect ~30% of people over 65 years of age. In these people, it is often difficult to define the primary cause of dizziness, as it can stem from cardiovascular, vestibular, psychological, and neuromuscular causes. However, identification of the primary cause is vital in determining the most effective treatment strategy for a patient. Our aim is to accurately identify the prevalence of benign paroxysmal positional vertigo (BPPV), peripheral, and central vestibular hypofunction in people aged over 50 years who had experienced dizziness within the past year. Seventy-six participants aged 51-92 (mean ± SD = 69 ± 9.5 years) were tested using the head thrust dynamic visual acuity (htDVA) test, dizziness handicap inventory (DHI), as well as sinusoidal and unidirectional rotational chair testing, in order to obtain data for htDVA score, DHI score, sinusoidal (whole-body, 0.1-2 Hz with peak velocity at 30°/s) vestibulo-ocular reflex (VOR) gain and phase, transient (whole-body, acceleration at 150°/s(2) to a constant velocity rotation of 50°/s) VOR gain and time constant (TC), optokinetic nystagmus (OKN) gain, and TC (whole-body, constant velocity rotation at 50°/s). We found that BPPV, peripheral and central vestibular hypofunction were present in 38 and 1% of participants, respectively, suggesting a likely vestibular cause of dizziness in these people. Of those with a likely vestibular cause, 63% had BPPV; a figure higher than previously reported in dizziness clinics of ~25%. Our results indicate that htDVA, sinusoidal (particularly 0.5-1 Hz), and transient VOR testing were the most effective at detecting people with BPPV or vestibular hypofunction, whereas DHI and OKN were effective at only detecting non-BPPV vestibular hypofunction. PMID:26733940

  7. Population based study of hospitalised fall related injuries in older people

    PubMed Central

    Peel, N; Kassulke, D; McClure, R

    2002-01-01

    Objective: This study aimed to identify the distribution of fall related injury in older people hospitalised for acute treatment of injury, in order to direct priorities for prevention. Setting: A follow up study was conducted in the Brisbane Metropolitan Region of Australia during 1998. Methods: Medical records of patients aged 65 years and over hospitalised with a fall related injury were reviewed. Demographic and injury data were analysed and injury rates calculated using census data as the denominator for the population at risk. Results: From age 65, hospitalised fall related injury rates increased exponentially for both males and females, with age adjusted incidence rates twice as high in women than men. Fractures accounted for 89% of admissions, with over half being to the hip. Males were significantly more likely than females to have fractured their skull, face, or ribs (p<0.01). While females were significantly more likely than males to have fractured their upper or lower limbs (p<0.01), the difference between proportions of males and females fracturing their hip was not significant. Males were more likely than females (p<0.01) to have fall related head injuries (13% of admissions). Compared with hip fractures, head injuries contributed significantly to the burden of injury in terms of severity, need for intensive care, and excess mortality. Conclusions: The frequency and impact of hip fractures warrants continued emphasis in falls program interventions for both males and females to prevent this injury. However, interventions that go beyond measures to slow and protect against bone loss are also needed to prevent fall related head injuries. PMID:12460962

  8. Subcutaneous fluid administration and the hydration of older people.

    PubMed

    Gabriel, Janice

    Hypodermoclysis, or the subcutaneous administration of fluids, is a method of rehydration that is not routinely used in the UK. Yet it is a simple and effective method of fluid administration for individuals with mild-to-moderate dehydration, especially for the frail and elderly (Sasson and Shvartzman, 2001). Subcutaneous infusion is an alternative route of parenteral administration. It provides a number of advantages over the intravenous route for those individuals unable to tolerate enteral fluids, as it is associated with fewer complications, as well as a wider range of infusion sites. This makes it particularly advantageous for frail and/or older patients requiring low-volume hydration in the community setting. This article discusses indications and contraindications for subcutaneous infusions, as well as patient assessment, placement, securement and potential complications. PMID:25158361

  9. Subcutaneous fluid administration and the hydration of older people.

    PubMed

    Gabriel, Janice

    2014-07-01

    Hypodermoclysis, or the subcutaneous administration of fluids, is a method of rehydration that is not routinely used in the UK. Yet it is a simple and effective method of fluid administration for individuals with mild-to-moderate dehydration, especially for the frail and elderly ( Sasson and Shvartzman, 2001 ). Subcutaneous infusion is an alternative route of parenteral administration. It provides a number of advantages over the intravenous route for those individuals unable to tolerate enteral fluids, as it is associated with fewer complications, as well as a wider range of infusion sites. This makes it particularly advantageous for frail and/or older patients requiring low-volume hydration in the community setting. This article discusses indications and contraindications for subcutaneous infusions, as well as patient assessment, placement, securement and potential complications. PMID:25062366

  10. Experiences of predictive testing in young people at risk of Huntington's disease, familial cardiomyopathy or hereditary breast and ovarian cancer

    PubMed Central

    MacLeod, Rhona; Beach, Anna; Henriques, Sasha; Knopp, Jasmin; Nelson, Katie; Kerzin-Storrar, Lauren

    2014-01-01

    While debate has focused on whether testing of minors for late onset genetic disorders should be carried out if there is no medical benefit, less is known about the impact on young people (<25 years) who have had predictive testing often many years before the likely onset of symptoms. We looked at the experiences of young people who had had predictive testing for a range of conditions with variable ages at onset and options for screening and treatment. A consecutive series of 61 young people who had a predictive test aged 15–25 years at the Clinical Genetic Service, Manchester, for HD, HBOC (BrCa 1 or 2) or FCM (Hypertrophic Cardiomyopathy or Dilated Cardiomyopathy), were invited to participate. Thirty-six (36/61; 59%) agreed to participate (10 HD, 16 HBOC and 10 FCM) and telephone interviews were audiotaped, transcribed and analysed using Interpretative Phenomenological Analysis. None of the participants expressed regret at having the test at a young age. Participants saw the value of pretest counselling not in facilitating a decision, but rather as a source of information and support. Differences emerged among the three groups in parent/family involvement in the decision to be tested. Parents in FCM families were a strong influence in favour of testing, in HBOC the decision was autonomous but usually congruent with the views of parents, whereas in HD the decision was autonomous and sometimes went against the opinions of parents/grandparents. Participants from all three groups proposed more tailoring of predictive test counselling to the needs of young people. PMID:23860040

  11. The social positioning of older people living with Alzheimer's disease who scream in long-term care homes.

    PubMed

    Bourbonnais, Anne; Ducharme, Francine

    2015-11-01

    This article describes the social positioning of older people living with Alzheimer's disease who scream in a long-term care home. Few studies have focused on the social positions taken by older people, their family and formal caregivers during interaction and their effects on screams. A secondary data analysis was conducted using Harré and Van Langenhove's positioning theory. The results show that older people are capable of positioning and repositioning themselves in relational patterns. Family and formal caregivers position older people who scream according to their beliefs about their lived experience. They also react emotionally to older people and try to influence their behaviors. Understanding the social positioning of older people with Alzheimer's disease brought out their capacities and their caregivers' concerns for their well-being. Interventions should focus on these strengths and on promoting healthy relations in the triads to enhance quality of care in long-term care homes. PMID:24339123

  12. Cost-effectiveness of Occupational Therapy in Older People: Systematic Review of Randomized Controlled Trials.

    PubMed

    Nagayama, Hirofumi; Tomori, Kounosuke; Ohno, Kanta; Takahashi, Kayoko; Yamauchi, Keita

    2016-06-01

    A systematic review of the cost-effectiveness of occupational therapy for older people was conducted. MEDLINE, CINAHL, Web of Science, PsycINFO, Cochrane Library, OT seeker and unpublished trials registers were searched. Reference lists of all potentially eligible studies were searched with no language restrictions. We included trial-based full economic evaluations that considered both costs and outcomes in occupational therapy for older people compared with standard care (i.e. other therapy) or no intervention. We reviewed each trial for methodological quality using the Cochrane risk of bias tool and assessed the quality of economic evaluations using a Drummond checklist. In the results of this review, we included five eligible studies (1-5) that were randomized controlled trials with high-quality economic evaluation. Two studies were full economic evaluations of interventions for fall prevention (1 and 2); two studies were full economic evaluations of preventive occupational therapy interventions (3 and 4; one was a comparison of an occupational therapy group with a social work group); one study was a full economic evaluation of occupational therapy for individuals with dementia (5). Two of the studies (one was preventive occupational therapy [3] and the other was occupational therapy for dementia [5]) found a significant effect and confirmed the cost-effectiveness of occupational therapy for older people compared with the control group. These studies found that occupational therapy for older people was clinically effective and cost-effective in comparison with standard care or other therapies. With reference to their clinical implication, these intervention studies (using a client-centred approach) suggested potentially cost-effective means to motivate clients to maintain their own health. However, this review has limitations because of the high heterogeneity of the reviewed studies on full economic evaluations of occupational therapy for older people. Future

  13. Improving continence services for older people from the service-providers’ perspective: a qualitative interview study

    PubMed Central

    Orrell, Alison; McKee, Kevin; Dahlberg, Lena; Gilhooly, Mary; Parker, Stuart

    2013-01-01

    Objective To examine in depth the views and experiences of continence service leads in England on key service and continence management characteristics in order to identify and to improve our understanding of barriers to a good-quality service and potential facilitators to develop and to improve services for older people with urinary incontinence (UI). Design Qualitative semistructured interviews using a purposive sample recruited across 16 continence services. Setting 3 acute and 13 primary care National Health Service Trusts in England. Participants 16 continence service leads in England actively treating and managing older people with UI. Results In terms of barriers to a good-quality service, participants highlighted a failure on the part of commissioners, managers and other health professionals in recognising the problem of UI and in acknowledging the importance of continence for older people and prevalent negative attitudes towards continence and older people. Patient assessment and continence promotion regardless of age, rather than pad provision, were identified as important steps for a good-quality service for older people with UI. More rapid and appropriate patient referral pathways, investment in service capacity, for example, more trained staff and strengthened interservice collaborations and a higher profile within medical and nurse training were specified as being important facilitators for delivering an equitable and high-quality continence service. There is a need, however, to consider the accounts given by our participants as perhaps serving the interests of their professional group within the context of interprofessional work. Conclusions Our data point to important barriers and facilitators of a good-quality service for older people with UI, from the perspective of continence service leads. Further research should address the views of other stakeholders, and explore options for the empirical evaluation of the effectiveness of identified service

  14. Inter-generational family support provided by older people in Indonesia

    PubMed Central

    SCHRÖDER-BUTTERFILL, ELISABETH

    2007-01-01

    Most social research on ageing in Asia has focused on the support provided by adult children to their parents, and thereby suggests that as a matter of course older people are in need of support. This paper offers a different perspective. Drawing on ethnographic and quantitative data from a village in East Java, it examines the extent of older people’s dependence on others and highlights the material and practical contributions that they make to their families. It is shown that only a minority of older people are reliant on children or grandchildren for their daily survival. In the majority of cases, the net flow of inter-generational support is either downwards – from old to young – or balanced. Far from merely assisting with childcare and domestic tasks, older people are often the economic pillars of multi-generational families. Pension and agricultural incomes serve to secure the livelihoods of whole family networks, and the accumulated wealth of older parents is crucial for launching children into economic independence and underwriting their risks. Parental generosity does not generally elicit commensurate reciprocal support when it is needed, leaving many people vulnerable towards the end of their lives. PMID:23750060

  15. Gaps in the family networks of older people in three Indonesian communities.

    PubMed

    Kreager, Philip; Schröder-Butterfill, Elisabeth

    2007-03-01

    Family networks are widely assumed to be a key source of support for older people in Indonesia and Southeast Asia more generally, although empirical study of their composition and functioning is in its infancy. This paper draws on ethnographic and survey data collected in longitudinal research of ageing in three rural Indonesian communities, in order to identify demographic and social factors limiting the size of elders' networks. Gaps in networks commonly emerge as a result of childlessness, migration and alienation, but their implications for older people's vulnerability are shaped by socio-economic status, reputation and cultural norms. PMID:17072765

  16. [Medicines and frailty in older people. Towards a new nosological entity: A pharmacological frailty?].

    PubMed

    Nessighaoui, Hichem; Géniaux, Hélène; Dantoine, Thierry; Laroche, Marie-Laure

    2016-06-01

    Frailty is a complex geriatric syndrome linked to the overall decrease of physiological reserves. It could lead to disability and to an increase in mortality. Frailty could have an impact on the effect and on the use of medications. Drugs could also affect the frailty process. Currently, no specific guidelines exist for appropriately prescribing medications to frail older people. The aim of this paper is to explore the body of current knowledge about the relationship between drugs and frailty in older people and to introduce a new nosological entity: pharmacological frailty. PMID:27235650

  17. Factors influencing adherence among older people with osteoarthritis.

    PubMed

    Loew, Laurianne; Brosseau, Lucie; Kenny, Glen P; Durand-Bush, Natalie; Poitras, Stéphane; De Angelis, Gino; Wells, George A

    2016-09-01

    This study aims to identify potential factors that could affect adherence and influence the implementation of an evidence-based structured walking program, among older adults diagnosed with knee osteoarthritis. A total of 69 participants with mild to moderate osteoarthritis of the knee fulfilled an online survey on potential factors that could affect their adherence to an evidence-based structured walking program. Adherence with regard to the influencing factors was explored using a logistic regression model. Results tend to show higher odds of adhering to the evidence-based walking program if the participants were supervised (more than 2.9 times as high), supported by family/friends (more than 3.7 times as high), and not influenced by emotional involvement (more than 11 times as high). The odds of adhering were 3.6 times lower for participants who indicated a change in their medication intake and 3.1 times lower for individuals who considered themselves as less physically active (95 % confidence interval (CI)). Our exploratory findings identified and defined potential adherence factors that could guide health professionals in their practice to better identify positive influences and obstacles to treatment adherence, which would lead to the adoption of a more patient-centered approach. A large-scale study is required to clearly delineate the key factors that would influence adherence. We addressed a new knowledge gap by identifying the main strategies to promote the long-term adherence of community-based walking program. PMID:26646111

  18. Why Do Older People Change Their Ratings of Childhood Health?

    PubMed Central

    Vuolo, Mike; Ferraro, Kenneth F.; Morton, Patricia M.; Yang, Ting-Ying

    2014-01-01

    A growing number of studies in life course epidemiology and biodemography make use of a retrospective question tapping self-rated childhood health to assess overall physical health status. Analyzing repeated measures of self-rated childhood health from the Health and Retirement Study (HRS), this study examines several possible explanations for why respondents might change their ratings of childhood health. Results reveal that nearly one-half of the sample revised their rating of childhood health during the 10-year observation period. Whites and relatively advantaged older adults—those with more socioeconomic resources and better memory—were less likely to revise their rating of childhood health, while those who experienced multiple childhood health problems were more likely to revise their childhood health rating, either positively or negatively. Changes in current self-rated health and several incident physical health problems were also related to the revision of one’s rating of childhood health, while the development of psychological disorders was associated with more negative revised ratings. We then illustrate the impact that these changes may have on an adult outcomes: namely, depressive symptoms. Whereas adult ratings of childhood health are likely to change over time, we recommend their use only if adjusting for factors associated with these changes, such as memory, psychological disorder, adult self-rated health, and socioeconomic resources. PMID:25359668

  19. A profile of identity in early-stage dementia and a comparison with healthy older people.

    PubMed

    Caddell, Lisa S; Clare, Linda

    2013-01-01

    The aim of the study was to determine whether people in the early stages of dementia experience their sense of identity differently to healthy older people and to examine whether different aspects of identity are related to each other in each group. This was a cross-sectional questionnaire-based study; 50 people with early-stage dementia and 50 age-matched people without dementia completed measures pertaining to different aspects of identity. Measures of mood and self-esteem were also included so that any differences could be taken into account in the analysis. There were very few differences in identity between the groups. After differences in levels of anxiety were accounted for, there were no differences in scores on most measures of identity. However, people in the early stages of dementia scored significantly lower on one subtotal for one measure of identity, whereas healthy older adults reported significantly more identity-related distress than people in the early stages of dementia. For both groups, there were no associations between different aspects of identity. People in the early stages of dementia do not differ much from healthy older adults in terms of their identity. Since healthy older people experience more distress relating to identity, they may be more likely to benefit from some sort of intervention than people in the early stages of dementia. It might be useful to consider identity as consisting of multiple components in future studies, rather than assuming that one aspect of identity represents the overall experience of identity. PMID:23171274

  20. Enhancing Connectedness Through Peer Training for Community-Dwelling Older People: A Person Centred Approach.

    PubMed

    Burmeister, Oliver K; Bernoth, Maree; Dietsch, Elaine; Cleary, Michelle

    2016-06-01

    Social interaction and connectedness is important to the mental health and wellbeing of older people. The aim of this research study was to facilitate and increase opportunities for social connectedness for older people living in regional areas through the use of technology training. Weekly technology training sessions were conducted at a Seniors Citizen's Club with a peer trainer (an experienced, retired computer teacher) and sessions were attended not only by the six study participants, but also by other club members, with up to 15 club members participating in sessions. Data analysis involved all documents generated by the project, including the individual interviews, researcher observations of training sessions, reports from the peer trainer and weekly diaries maintained by participants. Findings demonstrated that computer training at the Senior Citizens Club helped participants build group cohesion and to form tiered connections with partners, family, and friends with whom they no longer live. When the trainer is seen as a peer, and training is person-centred, older people are more receptive to learning, exploring, and experimenting with technology. Although only six people were involved in the in-depth evaluation part of the study, voluntary training with the trainer in the absence of any funding continues even to this present time. The outcome of this research reinforces the potential for technology facilitated tiered connectivity to enhance the quality of life for older people living in regional and rural Australia. PMID:27050818

  1. A Pilot Physical Activity Initiative to Improve Mental Health Status amongst Iranian Institutionalized Older People

    PubMed Central

    Matlabi, Hossein; Shaghaghi, Abdolreza; Amiri, Shahriar

    2014-01-01

    Background: Sufficient level of physical activity may promote overall and mental health of old people. This study was carried out to investigate the practi­cability of a physical activity promotion initiative amongst institutionalized older people in Tabriz, Iran. Methods: Purposive sampling method was used in this semi-experimental study to recruit 31 older people living in a selected residential care in Tabriz. Moderate-intensity aerobic and mus­cle-strengthening activity was planned for those who had not severe baseline cognitive impairment or were not too frail to undertake the survey. The General Health Questionnaire (GHQ-28) was used to measure mental health status be­fore and after intervention through a face-to-face interview. Descriptive statistics, Wilkcoxon rank-sum, Mann-Whitney U and Chi-Square tests were employed to analyses the data. Results: The applied intervention was significantly improved status of physical health, anxiety and insomnia, social dysfunction and severe depression. Conclusion: Incorporation of physical activity promotion programs into routines of older people residential care homes in Iran is feasible but may need training of physical activity specialists to work with older people based on their physical endurance and limitations. PMID:25097839

  2. In their own words: Reports of stigma and genetic discrimination by people at risk for Huntington disease in the International RESPOND-HD study

    PubMed Central

    Williams, Janet K; Erwin, Cheryl; Juhl, Andrew R; Mengeling, Michelle; Bombard, Yvonne; Hayden, Michael R; Quaid, Kimberly; Shoulson, Ira; Taylor, Sandra; Paulsen, Jane S

    2011-01-01

    Genetic discrimination may be experienced in the day-to-day lives of people at risk for Huntington Disease (HD), encompassing occurrences in the workplace, when seeking insurance, within social relationships, and during other daily encounters. At-risk individuals who have tested either positive or negative for the genetic expansion that causes HD, as well as at-risk persons with a 50% chance for developing the disorder but have not had DNA testing completed the International RESPOND-HD (I-RESPOND-HD) survey. One of the study’s purposes was to examine perceptions of genetic stigmatization and discrimination. A total of 412 out of 433 participants provided narrative comments, and 191 provided related codable narrative data. The core theme, Information Control, refers to organizational policies and interpersonal actions. This theme was found in narrative comments describing genetic discrimination perceptions across employment, insurance, social, and other situations. These reports were elaborated with five themes: What they encountered, What they felt, What others did, What they did, and What happened. Although many perceptions were coded as hurtful, this was not true in all instances. Findings document that reports of genetic discrimination are highly individual, and both policy as well as interpersonal factors contribute to the outcome of potentially discriminating events. PMID:20468062

  3. Improving skills and care standards in the support workforce for older people: a realist review

    PubMed Central

    Rycroft-Malone, Jo; Burton, Christopher; Hall, Beth; McCormack, Brendan; Nutley, Sandra; Seddon, Diane; Williams, Lynne

    2014-01-01

    Introduction In the context of a population that is growing older, and a number of high-profile scandals about care standards in hospital and community settings, having a skilled and knowledgeable workforce caring for older people is an ethical and policy imperative. Support workers make up the majority of the workforce in health and social care services for older people (aged 65 years and over), and yet little is known about the best way to facilitate their development. Given this gap, this review will draw on evidence to address the question: how can workforce development interventions improve the skills and the care standards of support workers within older people's health and social care services? Methods and analysis As we are interested in how and why workforce development interventions might work, in what circumstances and with whom, we will conduct a realist review, sourcing evidence from health, social care, policing and education. The review will be conducted in four steps over 18 months to (1) construct a theoretical framework, that is, the review’s programme theories; (2) retrieve, review and synthesise evidence relating to interventions designed to develop the support workforce guided by the programme theories; (3) ‘test out’ our synthesis findings and refine the programme theories, establish their practical relevance/potential for implementation and (4) formulate recommendations about improvements to current workforce development interventions to contribute to the improvement of care standards in older people's health and social care services, potentially transferrable to other services. Ethics and dissemination Ethical approval is not required to undertake this review. Knowledge exchange activities through stakeholder engagement and online postings are embedded throughout the lifetime of the project. The main output from this review will be a new theory driven framework for skill development for the support workforce in health and social

  4. A joined-up approach to improving older people's health and wellbeing.

    PubMed

    Bradford, Angela

    2016-05-01

    This article describes how a joined-up approach to housing, health and wellbeing is making a difference to the lives of older people and particularly the lives of frail individuals. It looks at the services available at ExtraCare Charitable Trust's retirement villages and discusses how investing in the right staff and tools produces the best results and helps to keep people out of hospital. PMID:27138517

  5. What do older people value when they visit their general practitioner? A qualitative study.

    PubMed

    Marcinowicz, Ludmila; Pawlikowska, Teresa; Oleszczyk, Marek

    2014-01-01

    Older patients see their general practitioners (GPs) relatively often and so recognition of their preferences can lead to improvement of quality of care in general practice. This study aimed to identify which aspects of GPs' behaviour are the most important for older people in their assessment of the quality of their visits and to explore the application of Jung's taxonomy differentiating task and affective behaviour in this context. A qualitative approach to generating data was chosen. We conducted semi-structured interviews with a sample of 30 patients aged 65 and older using GP services in two demographically diverse big cities in Poland. Participants were interviewed in 2010 according to a pre-determined topic guide. This research showed that older people assess both 'task performance' and 'affective performance' behaviours of general practitioners. There were nearly twice as many patient comments concerning affective performance behaviour relative to task performance behaviour. Older people expect that their physicians will be demonstrably friendly, kind, able to joke and have enough time for the consultation. PMID:25431547

  6. Health informatics and the delivery of care to older people.

    PubMed

    Koch, Sabine; Hägglund, Maria

    2009-07-20

    In the light of an aging society, effective delivery of healthcare will be more dependent on different technological solutions supporting the decentralization of healthcare, higher patient involvement and increased societal demands. The aim of this article is therefore, to describe the role of health informatics in the care of elderly people and to give an overview of the state of the art in this field. Based on a review of the existing scientific literature, 29 review articles from the last 15 years and 119 original articles from the last 5 years were selected and further analysed. Results show that review articles cover the fields of information technology in the home environment, integrated health information systems, public health systems, consumer health informatics and non-technology oriented topics such as nutrition, physical behaviour, medication and the aging process in general. Articles presenting original data can be divided into 5 major clusters: information systems and decision support, consumer health informatics, emerging technologies, home telehealth, and informatics methods. Results show that health informatics in elderly care is an expanding field of interest but we still do lack knowledge about the elderly person's needs of technology and how it should best be designed. Surprisingly, few studies cover gender differences related to technology use. Further cross-disciplinary research is needed that relates informatics and technology to different stages of the aging process and that evaluates the effects of technical solutions. PMID:19487092

  7. Health risk appraisal in older people 6: factors associated with self-reported poor vision and uptake of eye tests in older people

    PubMed Central

    2013-01-01

    Background Although free eye testing is available in the UK from a nation-wide network of optometrists, there is evidence of unrecognised, tractable vision loss amongst older people. A recent review identified this unmet need as a priority for further investigation, highlighting the need to understand public perceptions of eye services and barriers to service access and utilisation. This paper aims to identify risk factors for (1) having poor vision and (2) not having had an eyesight check among community-dwelling older people without an established ophthalmological diagnosis. Methods Secondary analysis of self-reported data from the ProAge trial. 1792 people without a known ophthalmological diagnosis were recruited from three group practices in London. Results Almost two in ten people in this population of older individuals without known ophthalmological diagnoses had self-reported vision loss, and more than a third of them had not had an eye test in the previous twelve months. In this sample, those with limited education, depressed mood, need for help with instrumental and basic activities of daily living (IADLs and BADLs), and subjective memory complaints were at increased risk of fair or poor self-reported vision. Individuals with basic education only were at increased risk for not having had an eye test in the previous 12 months (OR 1.52, 95% CI 1.17-1.98 p=0.002), as were those with no, or only one chronic condition (OR 1.850, 95% CI 1.382-2.477, p<0.001). Conclusions Self-reported poor vision in older people without ophthalmological diagnoses is associated with other functional losses, with no or only one chronic condition, and with depression. This pattern of disorders may be the basis for case finding in general practice. Low educational attainment is an independent determinant of not having had eye tests, as well as a factor associated with undiagnosed vision loss. There are other factors, not identified in this study, which determine uptake of eye

  8. Foot and ankle compression improves joint position sense but not bipedal stance in older people.

    PubMed

    Hijmans, Juha M; Zijlstra, Wiebren; Geertzen, Jan H B; Hof, At L; Postema, Klaas

    2009-02-01

    This study investigates the effects of foot and ankle compression on joint position sense (JPS) and balance in older people and young adults. 12 independently living healthy older persons (77-93 years) were recruited from a senior accommodation facility. 15 young adults (19-24 years) also participated. Compression was applied at the ankles and feet using medical compression hosiery. The mean velocity of the centre of pressure (CoP) displacements and the root mean square of the CoP velocity in both anteroposterior and mediolateral directions, were measured with a foot pressure plate. In older people, ankle compression was associated with an improvement of JPS towards normal values. However, a concurrent deterioration of their balance was found. In young adults compression had no effect on either JPS or balance. PMID:19019679

  9. Spaces for inquiry into the role of place for older people's care.

    PubMed

    Cutchin, Malcolm P

    2005-09-01

    In this paper, I expand the scope of the two preceding papers and suggest emerging opportunities and needs relevant to future inquiry about place and older people. I cover these in three sections. The first section suggests several topical areas for inquiry: stress and health, social epidemiology and healthy ageing. The second section focuses on theoretical developments that could be extended to further inform research on place and older people. I discuss the concepts of therapeutic landscapes and home as well as actor-network theory and pragmatism. The last section briefly addresses methodological needs. I contend that while place is a complex object of inquiry, it is vital to older adults' well-being and offers many interesting and interdisciplinary avenues for important scholarly endeavour in nursing and related fields. PMID:16083494

  10. Adverse factors and the mental health of older people: implications for social policy and professional practice.

    PubMed

    Clarke, J

    2005-06-01

    Defining 'older people' as a homogenous group is problematic; it can lead to stereotypical and stigmatizing perceptions of what old age is, attracting consequent negative attitudes to later life. Nevertheless, evidence suggests that some in the older age bracket are subject to particular stressors and physical changes that can adversely affect their mental health. This paper will consider challenges to mental health in older age groups and particularly the phenomenon of dementia. The role and influence of diagnosis, social policy and professional practice will also be addressed and suggestions will be made as to how people could improve their responses to either the predisposition to or the actual occurrence of mental distress in later life. In addition, it is argued that person-centredness is important as the caring/cultural medium through which provisions and policies are mediated: that obtaining appropriate balances between corporate and individual contributions and interventions must constitute the context wherein future developments lie. PMID:15876235

  11. Revisiting the Role of Neighbourhood Change in Social Exclusion and Inclusion of Older People

    PubMed Central

    Burns, Victoria F.; Lavoie, Jean-Pierre; Rose, Damaris

    2012-01-01

    Objective. To explore how older people who are “aging in place” are affected when the urban neighbourhoods in which they are aging are themselves undergoing socioeconomic and demographic change. Methods. A qualitative case study was conducted in two contrasting neighbourhoods in Montréal (Québec, Canada), the analysis drawing on concepts of social exclusion and attachment. Results. Participants express variable levels of attachment to neighbourhood. Gentrification triggered processes of social exclusion among older adults: loss of social spaces dedicated to older people led to social disconnectedness, invisibility, and loss of political influence on neighbourhood planning. Conversely, certain changes in a disadvantaged neighbourhood fostered their social inclusion. Conclusion. This study thus highlights the importance of examining the impacts of neighbourhood change when exploring the dynamics of aging in place and when considering interventions to maintain quality of life of those concerned. PMID:22013528

  12. Revisiting the role of neighbourhood change in social exclusion and inclusion of older people.

    PubMed

    Burns, Victoria F; Lavoie, Jean-Pierre; Rose, Damaris

    2012-01-01

    Objective. To explore how older people who are "aging in place" are affected when the urban neighbourhoods in which they are aging are themselves undergoing socioeconomic and demographic change. Methods. A qualitative case study was conducted in two contrasting neighbourhoods in Montréal (Québec, Canada), the analysis drawing on concepts of social exclusion and attachment. Results. Participants express variable levels of attachment to neighbourhood. Gentrification triggered processes of social exclusion among older adults: loss of social spaces dedicated to older people led to social disconnectedness, invisibility, and loss of political influence on neighbourhood planning. Conversely, certain changes in a disadvantaged neighbourhood fostered their social inclusion. Conclusion. This study thus highlights the importance of examining the impacts of neighbourhood change when exploring the dynamics of aging in place and when considering interventions to maintain quality of life of those concerned. PMID:22013528

  13. Attitudes of Students in Health Professions toward Caring for Older People: Needed Curricula Revisions in Nigeria

    ERIC Educational Resources Information Center

    Fajemilehin, Boluwaji Reuben

    2004-01-01

    This descriptive study examined the conceptions and misconceptions students in health professions have regarding older people. The research was conducted in Ile-Ife, Nigeria. The findings revealed that students in health professions, as a whole, demonstrated a high degree of stereotypic misconceptions and poor knowledge about aging and older…

  14. Medication use in residential care for older people with intellectual disabilities.

    PubMed

    2016-08-01

    Medication administration may appear to be a 'simple' nursing task, but this audit published in Learning Disability Practice found that, due to a combination of multiple medication use and medical complexity in older people with learning disabilities, it can be more complicated than staff realise. PMID:27573967

  15. Selective Attention in Web Forms: An Exploratory Case Study with Older People

    ERIC Educational Resources Information Center

    Sayago, Sergio; Guijarro, Jose-Maria; Blat, Josep

    2012-01-01

    This article reports on an exploratory study aimed to identify which ways of marking required and optional fields help older people fill in web forms correctly. Drawing on a pilot study and selective attention research in ageing, modified versions of widely used forms were created, in which standard asterisks were replaced with one of three…

  16. Employment Status and Perceived Health Status in Younger and Older People with Multiple Sclerosis

    ERIC Educational Resources Information Center

    Krokavcova, Martina; Nagyova, Iveta; Rosenberger, Jaroslav; Gavelova, Miriam; Middel, Berrie; Gdovinova, Zuzana; Groothoff, Johan W.; van Dijk, Jitse P.

    2012-01-01

    This study explores how employment is associated with perceived physical and mental health status in people with multiple sclerosis (MS) adjusted for sociodemographic and clinical variables stratified by age. The sample consisted of 184 MS patients divided into a younger (less than 45 years) and an older (greater than or equal to 45 years) age…

  17. Changes in Leisure Styles and Satisfaction of Older People: A Five Years Follow-Up

    ERIC Educational Resources Information Center

    Gagliardi, Cristina; Spazzafumo, Liana; Papa, Roberta; Marcellini, Fiorella

    2012-01-01

    The present study examines the leisure style and leisure satisfaction of a sample of older people at baseline and after a period of 5 years. Three groups were identified by factorial and cluster analyses and labelled under the headings of: Organised Style, Surrounding Style and Indoor Style. Each group represented a different typology of leisure,…

  18. The relationship between housing and heat wave resilience in older people.

    PubMed

    Loughnan, Margaret; Carroll, Matthew; Tapper, Nigel J

    2015-09-01

    Older people have justifiably been highlighted as a high-risk group with respect to heat wave mortality and morbidity. However, there are older people living within the community who have developed adaptive and resilient environments around their home that provide some protection during periods of extreme heat. This study investigated the housing stock and self-reported thermal comfort of a group of older people living in a regional town in Australia during the summer of 2012. The results indicated that daily maximum living room temperature was not significantly correlated with outdoor temperature, and daily minimum living room temperature was very weakly correlated with outdoor temperature. Residents reported feeling comfortable when indoor temperature approximated 26 °C. As living room temperature increased, indoor thermal comfort decreased. Significant differences between indoor temperatures were noted for homes that were related to house characteristics such as the age of the house, the number of air-conditioning units, the pitch of the roof, home insulation and the number of heat-mitigation modifications made to the home. Brick veneer homes showed smaller diurnal changes in temperature than other building materials. With population ageing and the increasing focus on older people living in the community, the quality of the housing stock available to them will influence their risk of heat exposure during extreme weather. PMID:25523613

  19. Keeping in Touch: Talking to Older People about Computers and Communication

    ERIC Educational Resources Information Center

    Dickinson, Anna; Hill, Robin L.

    2007-01-01

    Computer-based communication has tremendous potential to support older adults. But if people are to use such systems autonomously, it is necessary to move beyond current interfaces and systems and develop devices that fit into the environment of the user. Using a Grounded Theory approach, three focus groups were held and, subsequently, 9 older…

  20. The Meaning of Learning Piano Keyboard in the Lives of Older Chinese People

    ERIC Educational Resources Information Center

    Li, Sicong; Southcott, Jane

    2015-01-01

    Across the globe populations are ageing and living longer. Older people seek meaningful ways of occupying and enjoying their later years. Frequently, this takes the form of learning a new skill, in this case playing the piano keyboard. From the initial act of commitment to learning comes a raft of related aspects that influence the learner, their…

  1. Older People Learning through Contemporary Visual Art--Engagement and Barriers

    ERIC Educational Resources Information Center

    Goulding, Anna

    2013-01-01

    This article addresses how older people understand and engage with contemporary art in the gallery context--whether there is something unique to the art, the format of the visits, the pedagogical approaches used by gallery educators, the social contact, or a combination of all these factors. It also addresses the psychosocial barriers to…

  2. The relationship between housing and heat wave resilience in older people

    NASA Astrophysics Data System (ADS)

    Loughnan, Margaret; Carroll, Matthew; Tapper, Nigel J.

    2015-09-01

    Older people have justifiably been highlighted as a high-risk group with respect to heat wave mortality and morbidity. However, there are older people living within the community who have developed adaptive and resilient environments around their home that provide some protection during periods of extreme heat. This study investigated the housing stock and self-reported thermal comfort of a group of older people living in a regional town in Australia during the summer of 2012. The results indicated that daily maximum living room temperature was not significantly correlated with outdoor temperature, and daily minimum living room temperature was very weakly correlated with outdoor temperature. Residents reported feeling comfortable when indoor temperature approximated 26 °C. As living room temperature increased, indoor thermal comfort decreased. Significant differences between indoor temperatures were noted for homes that were related to house characteristics such as the age of the house, the number of air-conditioning units, the pitch of the roof, home insulation and the number of heat-mitigation modifications made to the home. Brick veneer homes showed smaller diurnal changes in temperature than other building materials. With population ageing and the increasing focus on older people living in the community, the quality of the housing stock available to them will influence their risk of heat exposure during extreme weather.

  3. Attitudes toward Older People among Nursing Students and Registered Nurses in Sweden.

    ERIC Educational Resources Information Center

    Soderhamn, Olle; Lindencrona, Catharina; Gustavsson, Siw Merit

    2001-01-01

    A survey of 151 undergraduate nursing students and 41 registered nurses in Sweden found that those who were under 25, male, or had limited prior experience caring for older people had less favorable attitudes toward the elderly. First-year students were more negative than third-year students. No differences among nurses in different practice…

  4. Older People Who Stutter: Barriers to Communication and Perceptions of Treatment Needs

    ERIC Educational Resources Information Center

    Bricker-Katz, Geraldine; Lincoln, Michelle; McCabe, Patricia

    2010-01-01

    Background: Little is known about the experience of stuttering for people over 55 years of age. Recent research has established that the same types of stuttering behaviours, cognitions, and emotional consequences experienced during young adulthood persist into older age. Aims: The aims were to investigate perceptions of limitations to activity and…

  5. An Innovative Continuing Nursing Education Program Targeting Key Geriatric Conditions for Hospitalized Older People in China

    ERIC Educational Resources Information Center

    Xiao, Lily Dongxia; Shen, Jun; Wu, Haifeng; Ding, Fu; He, Xizhen; Zhu, Yueping

    2013-01-01

    A lack of knowledge in registered nurses about geriatric conditions is one of the major factors that contribute to these conditions being overlooked in hospitalized older people. In China, an innovative geriatric continuing nursing education program aimed at developing registered nurses' understanding of the complex care needs of hospitalized…

  6. Ageing, Leisure, and Social Connectedness: How could Leisure Help Reduce Social Isolation of Older People?

    PubMed

    Toepoel, Vera

    2013-08-01

    This study investigates the relation between leisure activities and the social status of the elderly based on a heterogeneous sample of the Dutch population. Close relationships are also analyzed to identify which people could serve as successful stimulators of leisure participation. The social profile confirms that older people have fewer social contacts and often feel lonely. This study shows that leisure activities explain a significant part of older people's social connectedness. Voluntary work, cultural activities, holiday, sports, reading books, hobbies and shopping are found to be successful predictors for social connectedness of older people. Watching TV, listening to the radio, and spending time behind the computer (passive activities) were not associated with social connectedness. Friends correlate positively to participation in leisure activities. Partners play a role in participation in cultural activities and sports; parents play a role in participation in voluntary work and holidays; siblings play a role in voluntary work and sports; and children play a role in cultural activities, reading books, and shopping. Local communities can use these close relationships and develop special programs to increase social connectedness and hence improve quality of life for older adults. PMID:23874058

  7. Teaching about Older People in the Social Studies Curriculum--The Participation in Government Class

    ERIC Educational Resources Information Center

    Wasyliw, Zenon V.; Krout, John A.; McKernan, Peggy

    2003-01-01

    In response to the major demographic changes taking place in the United States and the world, teachers can successfully teach about older people within the framework of the social studies curriculum. A government course, as an example, offers varied approaches in methods to apply social studies concepts to the study and assessment of issues…

  8. Leisure Experiences and Depressive Symptoms among Chinese Older People: A National Survey in Taiwan

    ERIC Educational Resources Information Center

    Lu, Luo

    2011-01-01

    We aimed to explore older people's subjective leisure experiences and to further examine associations of such experiences with their depressive symptoms in Taiwan. Known correlates of depression, such as demographics, physical health, and social support, were taken into account. Face-to-face interviews were conducted to collect data using…

  9. Mental Health and Social Care Needs of Older People with Intellectual Disabilities

    ERIC Educational Resources Information Center

    Strydom, Andre; Hassiotis, Angela; Livingston, Gill

    2005-01-01

    Background: Older people with intellectual disabilities (ID) are a growing population but their age-related needs are rarely considered and community services are still geared towards the younger age group. We aimed to examine the mental health and social care needs of this new service user group. Methods: We identified all adults with ID without…

  10. Diagnostic Drawing Series: Research with Older People Diagnosed with Organic Mental Syndromes and Disorders.

    ERIC Educational Resources Information Center

    Couch, Janet Beaujon

    1994-01-01

    Used standardized three-picture art interview, Diagnostic Drawing Series (DDS), with older people. Collected artwork from 24 patients diagnosed with Organic Mental Syndromes and Disorders (OMS/D). Structural qualities found in art were identified using DDS. Observations of these qualities may aid in early diagnosis of OMS/D and help educate…

  11. Measuring the Knowledge and Attitudes of Health Care Staff toward Older People: Sensitivity of Measurement Instruments

    ERIC Educational Resources Information Center

    Cowan, David T.; Fitzpatrick, Joanne M.; Roberts, Julia D.; While, Alison E.

    2004-01-01

    This paper discusses the sensitivity of instruments used to measure knowledge and attitudes toward older people. Existing standardized measurement instruments are reviewed, including a detailed examination of Palmore's Facts on Ageing Quiz (FAQ). A recent study conducted by the research team into the knowledge and attitudes of support workers (n =…

  12. The 'right' place to care for older people: home or institution?

    PubMed

    Björnsdóttir, Kristin; Ceci, Christine; Purkis, Mary Ellen

    2015-03-01

    In 2008, the Minister of Health for Iceland issued a new regulation intended to govern assessment practices related to placement in nursing homes. One of the aims of the regulation was to ensure that those with the most severe need would have priority. This would be achieved, in part, by requiring older people to exhaust all available community-based service options before an assessment for placement would even take place. The new regulation was received with some hostility and criticism on the part of older people and their relatives, who described the changed expectations as 'abandonment' by the authorities. We present our analysis of these changes by examining how older people and families are reconfigured through the new policy and argue that this 'new' practice of de-institutionalization is underpinned by a shifting epistemic and normative context that is working to create a new identity and a different way of life in advanced age in Iceland. The analysis has implications for other nations as well, as much policy related to older people is broadly informed by this idea that 'home is best', that is, the idea that more care simply needs to happen outside of institutional settings. PMID:23786552

  13. The Long-Term Impact of Education on Diabetes for Older People: A Systematic Review

    PubMed Central

    Thongsai, Soontareeporn; Youjaiyen, Malinee

    2013-01-01

    Background: Although enthusiasm is growing for diabetic education programs for older people, data regarding their effectiveness and their long-term impact on self-management were neglected. Purpose: To systematically review diabetes mellitus education that has long-term effects on the self-management of older diabetic people. Data Sources: The authors searched multiple sources dated through September 2012, including the Cochrane Library, MEDLINE, PsycINFO, Nursing and Allied Health databases, and the bibliographies of 50 previous reviews. Methods and Data Extraction: Electronic databases were searched for controlled studies in English, published from 1987 to 2012, assessing the effects of long-term education for older people. Reviewers extracted study data using a structured abstraction form. Aggregated information about the effects of long-term education programs on older people with diabetes was used for making adjustments in the review. Results: The pooled estimate of the long-term effects of education was a 0.5 percentage point reduction (95% confidence interval), modest but significant improvement. The evidence also supports that long-term education is beneficial for improving diabetic patient self-care management in terms of glycemic control. PMID:24171871

  14. The involvement of Spanish older people in nondegree educational programs: reasons for and barriers to participation.

    PubMed

    Villar, Feliciano; Celdrán, Montserrat

    2014-01-01

    This article examines the reasons older Spanish people participate in nondegree educational programs and the barriers they may face when they want to do so. Data were drawn from the 2007 Survey on Adults' Involvement in Learning Activities (Encuesta sobre la Participación de la Población Adulta en Actividades de Aprendizaje: EADA) and correspond to a nationally representative sample of Spanish people aged between 60 and 74 years old (n=4,559). Overall, only 8.7% of the sample participated in a nondegree educational program. Predictors of participation were being a woman, being younger, having a higher educational level, and being employed. The most frequent reason given for participation was of an intrinsic nature (e.g., interest in the topic), although instrumental motives (e.g., utility of the content for daily life) were more common than suggested by previous research. As for barriers to participation, the vast majority of older people (95.6% of those who did not participate) did not even express a desire to participate. The most frequent barriers were internal (e.g., age/health restrictions). This kind of barrier was ascribed a greater importance by older and less educated groups as well as by those who participate less in cultural activities. Policies to promote older people's participation in nonformal educational activities are discussed in light of the data. PMID:25010657

  15. Sustainability of motor training effects in older people with dementia.

    PubMed

    Zieschang, Tania; Schwenk, Michael; Oster, Peter; Hauer, Klaus

    2013-01-01

    Evidence for sustainability of motor training effects in people with dementia is lacking. To examine whether the substantial improvements in motor performance achieved through a three-month specialized, standardized motor training were sustained, the participants of the randomized controlled trial were re-evaluated nine months after training had ceased. As part of a comprehensive study, participants with confirmed mild to moderate dementia underwent a progressive resistance and functional group training specifically developed for patients with dementia (intervention, n = 40) compared to a low-intensity motor placebo activity (control, n = 51). Primary and secondary outcome measures for maximal strength and function were measured before the start of the training (T1), directly after training ceased (T2), three months after training ceased (T3) and-the focus of this paper-nine months after training ceased (T4). Even after nine months without training, the gains in functional performance were sustained with significant group differences in the primary endpoint (five-chair-rise, relative change: IG: -8.54 ± 22.57 versus CG: +10.70 ± 45.89 s, p = 0.014, effect size ηp2 = 0.067). Other functional tests, such as walking speed and POMA (Tinetti), confirmed this result in the secondary analysis. Strength, as measured by the primary endpoint 1-Repetition Maximum (1RM) was still elevated (time effect for T1 versus T4: 148.68 ± 57.86 versus 172.79 ± 68.19 kg, p < 0.001, effect size ηp2 = 0.157), but between-group differences disappeared (relative change: maximal strength, IG: 22.75 ± 40.66 versus CG: 15.60 ± 39.26, p = 0.369). The study found that intensive dementia-specific motor training sustainably improved functional performance of patients with dementia nine months after cessation of training. PMID:23202438

  16. Using intervention mapping for the development of a targeted secure web-based outreach strategy named SafeFriend, for Chlamydia trachomatis testing in young people at risk

    PubMed Central

    2013-01-01

    Background Many young people at high risk for Chlamydia trachomatis (Ct) are not reached by current sexual health care systems, such as general practitioners and public sexual health care centres (sexually transmitted infection clinics).Ct is the most frequently diagnosed bacterial sexually transmitted infection (STI) among sexually active people and in particular young heterosexuals. Innovative screening strategies are needed to interrupt the transmission of Ct among young people and connect the hidden cases to care. Methods Intervention Mapping (IM), a systematic approach to develop theory- and evidence-based interventions, was used to develop a strategy to target Ct testing towards young people who are currently hidden to care in The Netherlands. Both clinical users (i.e. sexual health care nurses) and public users (i.e., young people at risk for Ct) were closely involved in the IM process. A needs assessment study was carried out using semi-structured interviews among users (N = 21), a literature search and by taking lessons learned from existing screening programmes. Theoretical methods and practical applications to reach high risk young people and influence testing were selected and translated into specific programme components. Results The IM approach resulted in the development of a secure and web-based outreach Ct screening strategy, named SafeFriend. It is developed to target groups of high-risk young people who are currently hidden to care. Key methods include web-based Respondent Driven Sampling, starting from young Ct positive sexual health care centre clients, to reach and motivate peers (i.e., sex partners and friends) to get tested for Ct. Testing and the motivation of peers were proposed as the desired behavioural outcomes and the Precaution Adoption Process Model was chosen as theoretical framework. End users, i.e., young people and sexual health care nurses were interviewed and included in the development process to increase the success of

  17. Older People with Visual Impairment: Clinical Management and Care Watkinson Susan Older People with Visual Impairment: Clinical Management and Care 176pp £25 M&K Publishing 9781905539451 1905539452 [Formula: see text].

    PubMed

    2014-09-01

    ISSUES SURROUNDING the diagnosis, care and treatment of older people with visual impairment are examined in this book. It begins with a useful overview of ageing and the needs of older people. The second chapter considers demographics and health policy and care post-Francis and the chief nursing officer for England's strategy for compassionate care, including the 6Cs. PMID:25258231

  18. 'Keeping going': chronic joint pain in older people who describe their health as good.

    PubMed

    Richardson, Jane C; Grime, Janet C; Ong, Bie Nio

    2014-09-01

    It is common for people with chronic conditions to report their health as good, although models of healthy ageing do not account for this. The concept of successful ageing focuses on overcoming problems, in contrast to the concept of resilience, which can acknowledge vulnerability. Osteoarthritis (OA) is the main cause of joint pain in older people, but research in this area has tended to focus on OA as an illness. Consequently, our research aimed to explore OA from the perspective of wellness. We undertook a longitudinal qualitative study to explore 'wellness and resilience' in a group of older people who reported chronic joint pain and considered themselves healthy. We interviewed 27 people and followed them up with monthly diary sheets, responding to reports of changes using their chosen contact method. This article focuses on how resilience relates to how people consider themselves to be well. Participants' experience of the adversity of their pain varied, and was influenced by context and meaning. Participants described 'keeping going' in body, mind and everyday life. Flexibility and pragmatism were key aspects of keeping going. The findings support a broader version of resilience that incorporates vulnerabilities. In the context of health care we suggest that treating the frail body should not come at the expense of undermining an older person's sense of a resilient self. PMID:25067864

  19. Don't Stop Me Now! A Report on the Lifelong Learning Needs of Older People in Ireland

    ERIC Educational Resources Information Center

    AONTAS The National Adult Learning Organisation, 2008

    2008-01-01

    The overall aim of the research which informs this report is to examine the extent to which the learning needs of older people are understood and addressed within the adult and community education sector, and to explore how adult educators can be supported to develop innovative approaches and processes which engage older people in learning and…

  20. The Characteristics of Older People Who Engage in Community Music Making, Their Reasons for Participation and the Barriers They Face

    ERIC Educational Resources Information Center

    Hallam, Susan; Creech, Andrea; Varvarigou, Maria; McQueen, Hilary

    2012-01-01

    There is now an accepted need for initiatives that support older people's health and well-being. There is increasing evidence that active engagement with music has the potential to contribute to this. This research aimed to explore the characteristics of older people who participated in active music making with a view to identifying the groups…

  1. A Web—Based Respondent Driven Sampling Pilot Targeting Young People at Risk for Chlamydia Trachomatis in Social and Sexual Networks with Testing: A Use Evaluation

    PubMed Central

    Theunissen, Kevin; Hoebe, Christian; Kok, Gerjo; Crutzen, Rik; Kara-Zaïtri, Chakib; de Vries, Nanne; van Bergen, Jan; Hamilton, Robert; van der Sande, Marianne; Dukers-Muijrers, Nicole

    2015-01-01

    Background: With the aim of targeting high-risk hidden heterosexual young people for Chlamydia trachomatis (CT) testing, an innovative web-based screening strategy using Respondent Driven Sampling (RDS) and home-based CT testing, was developed, piloted and evaluated. Methods: Two STI clinic nurses encouraged 37 CT positive heterosexual young people (aged 16–25 years), called index clients, to recruit peers from their social and sexual networks using the web-based screening strategy. Eligible peers (young, living in the study area) could request a home-based CT test and recruit other peers. Results: Twelve (40%) index clients recruited 35 peers. Two of these peers recruited other peers (n = 7). In total, 35 recruited peers were eligible for participation; ten of them (29%) requested a test and eight tested. Seven tested for the first time and one (13%) was positive. Most peers were female friends (80%). Nurses were positive about using the strategy. Conclusions: The screening strategy is feasible for targeting the hidden social network. However, uptake among men and recruitment of sex-partners is low and RDS stopped early. Future studies are needed to explore the sustainability, cost-effectiveness, and impact of strategies that target people at risk who are not effectively reached by regular health care. PMID:26308015

  2. Meanings of at-homeness at end-of-life among older people.

    PubMed

    Saarnio, Lotta; Boström, Anne-Marie; Gustavsson, Petter; Öhlén, Joakim

    2016-06-01

    Maintaining the well-being of older people who are approaching the end-of-life has been recognised as a significant aspect of well-being in general. However, there are few studies that have explicitly focused on at-homeness among older people. This study aims to illuminate meanings of at-homeness among older people with advancing illnesses. Twenty men and women, aged 85 or older, with advancing illnesses and who lived in their own homes, in nursing homes or in short-term nursing homes in three urban areas of Sweden were strategically sampled in the study. Data were generated in narrative interviews, and the analysis was based on a phenomenological hermeneutical method. After obtaining a naïve understanding and conducting structural analyses, two aspects of the phenomenon were revealed: at-homeness as being oneself and at-homeness as being connected. At-homeness as being oneself meant being able to manage ordinary everyday life as well as being beneficial to one's life. At-homeness as being connected meant being close to significant others, being in affirming friendships and being in safe dependency. Here, at-homeness is seen as a twofold phenomenon, where being oneself and being connected are interrelated aspects. Being oneself and being connected are further interpreted by means of the concepts of agency and communion, which have been theorised as two main forces of the human being. PMID:26058734

  3. Improvement in the physiological function and standing stability based on kinect multimedia for older people.

    PubMed

    Chen, Chih-Chen

    2016-04-01

    [Purpose] The increase in the Taiwanese older population is associated with age-related inconveniences. Finding adequate and simple physical activities to help the older people maintaining their physiological function and preventing them from falls has become an urgent social issue. [Subjects and Methods] This study aimed to design a virtual exercise training game suitable for Taiwanese older people. This system will allow for the maintenance of the physiological function and standing stability through physical exercise, while using a virtual reality game. The participants can easily exercise in a carefree, interactive environment. This study will use Kinect for Windows for physical movement detection and Unity software for virtual world development. [Results] Group A and B subjects were involved in the exercise training method of Kinect interactive multimedia for 12 weeks. The results showed that the functional reach test and the unipedal stance test improved significantly. [Conclusion] The physiological function and standing stability of the group A subjects were examined at six weeks post training. The results showed that these parameters remained constant. This proved that the proposed system provide substantial support toward the preservation of the Taiwanese older people' physiological function and standing stability. PMID:27190480

  4. Usability and acceptability of a website that provides tailored advice on falls prevention activities for older people.

    PubMed

    Nyman, Samuel R; Yardley, Lucy

    2009-03-01

    This article presents the usability and acceptability of a website that provides older people with tailored advice to help motivate them to undertake physical activities that prevent falls. Views on the website from interviews with 16 older people and 26 sheltered housing wardens were analysed thematically. The website was well received with only one usability difficulty with the action plan calendar. The older people selected balance training activities out of interest or enjoyment, and appeared to carefully add them into their current routine. The wardens were motivated to promote the website to their residents, particularly those who owned a computer, had balance problems, or were physically active. However, the participants noted that currently a minority of older people use the Internet. Also, some older people underestimated how much activity was enough to improve balance, and others perceived themselves as too old for the activities. PMID:19218310

  5. Association of sleep-wake habits in older people with changes in output of circadian pacemaker

    NASA Technical Reports Server (NTRS)

    Czeisler, C. A.; Dumont, M.; Duffy, J. F.; Steinberg, J. D.; Richardson, G. S.; Brown, E. N.; Sanchez, R.; Rios, C. D.; Ronda, J. M.

    1992-01-01

    Many elderly people complain of disturbed sleep patterns but there is not evidence that the need to sleep decreases with age; it seems rather that the timing and consolidation of sleep change. We tried to find out whether there is a concurrent change in the output of the circadian pacemaker with age. The phase and amplitude of the pacemaker's output were assessed by continuous measurement of the core body temperature during 40 h of sustained wakefulness under constant behavioural and environmental conditions. 27 young men (18-31 years) were compared with 21 older people (65-85 years; 11 men, 10 women); all were healthy and without sleep complaints. The mean amplitude of the endogenous circadian temperature oscillation (ECA) was 40% greater in young men than in the older group. Older men had a lower mean temperature ECA than older women. The minimum of the endogenous phase of the circadian temperature oscillation (ECP) occurred 1 h 52 min earlier in the older than in the young group. Customary bedtimes and waketimes were also earlier in the older group, as was their daily alertness peak. There was a close correlation between habitual waketime and temperature ECP in young men, which may lose precision with age, especially among women. These findings provide evidence for systematic age-related changes in the output of the human circadian pacemaker. We suggest that these changes may underlie the common complaints of sleep disturbance among elderly people. These changes could reflect the observed age-related deterioration of the hypothalamic nuclei that drive mammalian circadian rhythms.

  6. Gaps in the Family Networks of Older People in Three Indonesian Communities

    PubMed Central

    Schröder-Butterfill, E.

    2007-01-01

    Family networks are widely assumed to be a key source of support for older people in Indonesia and Southeast Asia more generally, although empirical study of their composition and functioning is in its infancy. This paper draws on ethnographic and survey data collected in longitudinal research of ageing in three rural Indonesian communities, in order to identify demographic and social factors limiting the size of elders’ networks. Gaps in networks commonly emerge as a result of childlessness, migration and alienation, but their implications for older people’s vulnerability are shaped by socio-economic status, reputation and cultural norms. PMID:17072765

  7. Catastrophic Health Care Expenditure among Older People with Chronic Diseases in 15 European Countries

    PubMed Central

    Arsenijevic, Jelena; Pavlova, Milena; Rechel, Bernd; Groot, Wim

    2016-01-01

    Introduction It is well-known that the prevalence of chronic diseases is high among older people, especially those who are poor. Moreover, chronic diseases can result in catastrophic health expenditure. The relationship between chronic diseases and their financial burden on households is thus double-sided, as financial difficulties can give rise to, and result from, chronic diseases. Our aim was to examine the levels of catastrophic health expenditure imposed by private out-of-pocket payments among older people diagnosed with diabetes mellitus, cardiovascular diseases and cancer in 15 European countries. Methods The SHARE dataset for individuals aged 50+ and their households, collected in 2010–2012 was used. The total number of participants included in this study was N = 51,661. The sample consisted of 43.8% male and 56.2% female participants. The average age was 67 years. We applied an instrumental variable approach for binary instrumented variables known as a treatment-effect model. Results We found that being diagnosed with diabetes mellitus and cardiovascular diseases was associated with catastrophic health expenditure among older people even in comparatively wealthy countries with developed risk-pooling mechanisms. When compared to the Netherlands (the country with the lowest share of out-of-pocket payments as a percentage of total health expenditure in our study), older people diagnosed with diabetes mellitus in Portugal, Poland, Denmark, Italy, Switzerland, Belgium, the Czech Republic and Hungary were more likely to experience catastrophic health expenditure. Similar results were observed for diagnosed cardiovascular diseases. In contrast, cancer was not associated with catastrophic health expenditure. Discussion Our study shows that older people with diagnosed chronic diseases face catastrophic health expenditure even in some of the wealthiest countries in Europe. The effect differs across chronic diseases and countries. This may be due to different socio

  8. Patterns of comorbidity in community-dwelling older people hospitalised for fall-related injury: A cluster analysis

    PubMed Central

    2011-01-01

    Background Community-dwelling older people aged 65+ years sustain falls frequently; these can result in physical injuries necessitating medical attention including emergency department care and hospitalisation. Certain health conditions and impairments have been shown to contribute independently to the risk of falling or experiencing a fall injury, suggesting that individuals with these conditions or impairments should be the focus of falls prevention. Since older people commonly have multiple conditions/impairments, knowledge about which conditions/impairments coexist in at-risk individuals would be valuable in the implementation of a targeted prevention approach. The objective of this study was therefore to examine the prevalence and patterns of comorbidity in this population group. Methods We analysed hospitalisation data from Victoria, Australia's second most populous state, to estimate the prevalence of comorbidity in patients hospitalised at least once between 2005-6 and 2007-8 for treatment of acute fall-related injuries. In patients with two or more comorbid conditions (multicomorbidity) we used an agglomerative hierarchical clustering method to cluster comorbidity variables and identify constellations of conditions. Results More than one in four patients had at least one comorbid condition and among patients with comorbidity one in three had multicomorbidity (range 2-7). The prevalence of comorbidity varied by gender, age group, ethnicity and injury type; it was also associated with a significant increase in the average cumulative length of stay per patient. The cluster analysis identified five distinct, biologically plausible clusters of comorbidity: cardiopulmonary/metabolic, neurological, sensory, stroke and cancer. The cardiopulmonary/metabolic cluster was the largest cluster among the clusters identified. Conclusions The consequences of comorbidity clustering in terms of falls and/or injury outcomes of hospitalised patients should be investigated by

  9. Effects of Nurse-Led Multifactorial Care to Prevent Disability in Community-Living Older People: Cluster Randomized Trial

    PubMed Central

    Buurman, Bianca M.; ter Riet, Gerben; Moll van Charante, Eric P.; de Rooij, Sophia E.

    2016-01-01

    Background To evaluate the effects of nurse-led multifactorial care to prevent disability in community-living older people. Methods In a cluster randomized trail, 11 practices (n = 1,209 participants) were randomized to the intervention group, and 13 practices (n = 1,074 participants) were randomized to the control group. Participants aged ≥ 70 years were at increased risk of functional decline based on a score ≥ 2 points on the Identification of Seniors at Risk- Primary Care, ISAR-PC. Participants in the intervention group received a systematic comprehensive geriatric assessment, and individually tailored multifactorial interventions coordinated by a trained community-care registered nurse (CCRN) with multiple follow-up home visits. The primary outcome was the participant’s disability as measured by the modified Katz activities of daily living (ADL) index score (range 0–15) at one year follow-up. Secondary outcomes were health-related quality of life, hospitalization, and mortality. Results At baseline, the median age was 82.7 years (IQR 77.0–87.1), the median modified Katz-ADL index score was 2 (IQR 1–5) points in the intervention group and 3 (IQR 1–5) points in the control group. The follow-up rate was 76.8% (n = 1753) after one year and was similar in both trial groups. The adjusted intervention effect on disability was -0.07 (95% confidence interval -0.22 to 0.07; p = 0.33). No intervention effects were found for the secondary outcomes. Conclusions We found no evidence that a one-year individualized multifactorial intervention program with nurse-led care coordination was better than the current primary care in community-living older people at increased risk of functional decline in The Netherlands. Trial Registration Netherlands Trial Register NTR2653 PMID:27459349

  10. Using Structured Observation and Content Analysis to Explore the Presence of Older People in Public Fora in Developing Countries

    PubMed Central

    2014-01-01

    There is a lack of research on the everyday lives of older people in developing countries. This exploratory study used structured observation and content analysis to examine the presence of older people in public fora and considered the methods' potential for understanding older people's social integration and inclusion. Structured observation occurred of public social spaces in six cities each located in a different developing country and in one city in the United Kingdom, together with content analysis of the presence of people in newspaper pictures and on television in the selected countries. Results indicated that across all fieldwork sites and data sources, there was a low presence of older people, with women considerably less present than men in developing countries. There was variation across fieldwork sites in older people's presence by place and time of day and in their accompanied status. The presence of older people in images drawn from newspapers was associated with the news/non-news nature of the source. The utility of the study's methodological approach is considered, as is the degree to which the presence of older people in public fora might relate to social integration and inclusion in different cultural contexts. PMID:25548675

  11. Internet use as a predictor of sense of community in older people.

    PubMed

    Sum, Shima; Mathews, R Mark; Pourghasem, Mohsen; Hughes, Ian

    2009-04-01

    The Internet opens new options for communication and may change the extent to which older people use other modes of communication. The importance of older adults' participation in cyberspace has increased as Internet use for commerce and communication has increased. The present study explores how older adults' Internet use affects their sense of community. An online survey was conducted at the University of Sydney to determine the associations between Internet use and seniors' sense of community and well-being. Participants were recruited online. There was a positive association between a sense of belonging to an online community, sense of community, and well-being. Seniors' use of the Internet for communication and information, and the frequency and history of their Internet use, were consistently related to a greater sense of community. PMID:19250013

  12. Painting place: Re-imagining landscapes for older people's subjective wellbeing.

    PubMed

    Rose, Emma; Lonsdale, Stephen

    2016-07-01

    This study provides insights into how a participatory painting activity impacts older people's subjective wellbeing. The study uses qualitative methods to analyze the findings, and employs qualitative data collection methods to examine how creativity conducted in an environment of relational connectivity is beneficial to wellbeing. The findings demonstrate that processes of re-imagining landscape contribute to participants' retaining significant places in the mind when physical engagement is limited. The study reveals how the activity of re-imagining landscape provokes emotions and memories that help participants connect the past with the present, and to connect their older and younger-age selves, positively to reaffirm their older age identity. The paper reflects on the intervention as a form of encounter with landscape whose benefits are potentially therapeutic for different groups, particularly those for whom engagement with memories may assist with processes of adaptation or transition. PMID:27179603

  13. Nocturnal Enuresis in Older People: Where Is the Evidence and What Are the Gaps?

    PubMed

    Howlett, Megan; Gibson, William; Hunter, Kathleen F; Chambers, Thane; Wagg, Adrian

    2016-01-01

    While there is extensive literature regarding nocturnal enuresis in children and young adults, relatively little research explores this problem in older people. This scoping review sought to identify knowledge gaps and provide research direction specifically for older, institutionalized adults with nocturnal enuresis. A comprehensive search of 8 electronic databases and the gray literature was undertaken. Studies focusing on the causes, symptoms, and treatment of nocturnal enuresis in older people were retrieved. A broad search strategy including all adults was employed in order to capture all relevant publications. Articles were then excluded by title and abstract such that only those relevant to the older adult and institutionalized populations remained. Relevant articles were identified by title and language. Further reading of the abstract allowed inclusion and a final full reading of the articles allowed all authors to map research activity and identify knowledge gaps. After duplicates and nonrelevant articles were eliminated, we identified 7 articles on nursing home residents and 2 involving older people living in psychiatric institutions. Published literature focused on causes and treatment with either desmopressin or aversive behavioral therapy. No study included a comprehensive continence assessment or controlled for comorbid conditions. Identified gray literature focused on general continence information for the public and nonspecialist clinicians. We conclude that there is a dearth of evidence relevant to this troublesome condition. Gaps in the evidence base include a lack of standardized terminology and limited research focusing on the epidemiology, pathophysiology, and treatment of nocturnal enuresis, all of which suggest a rich research agenda for future investigation. PMID:27196686

  14. Later endogenous circadian temperature nadir relative to an earlier wake time in older people

    NASA Technical Reports Server (NTRS)

    Duffy, J. F.; Dijk, D. J.; Klerman, E. B.; Czeisler, C. A.

    1998-01-01

    The contribution of the circadian timing system to the age-related advance of sleep-wake timing was investigated in two experiments. In a constant routine protocol, we found that the average wake time and endogenous circadian phase of 44 older subjects were earlier than that of 101 young men. However, the earlier circadian phase of the older subjects actually occurred later relative to their habitual wake time than it did in young men. These results indicate that an age-related advance of circadian phase cannot fully account for the high prevalence of early morning awakening in healthy older people. In a second study, 13 older subjects and 10 young men were scheduled to a 28-h day, such that they were scheduled to sleep at many circadian phases. Self-reported awakening from scheduled sleep episodes and cognitive throughput during the second half of the wake episode varied markedly as a function of circadian phase in both groups. The rising phase of both rhythms was advanced in the older subjects, suggesting an age-related change in the circadian regulation of sleep-wake propensity. We hypothesize that under entrained conditions, these age-related changes in the relationship between circadian phase and wake time are likely associated with self-selected light exposure at an earlier circadian phase. This earlier exposure to light could account for the earlier clock hour to which the endogenous circadian pacemaker is entrained in older people and thereby further increase their propensity to awaken at an even earlier time.

  15. Development of a virtual learning environment to enhance undergraduate nursing students' effectiveness and interest in working with older people.

    PubMed

    Edwards, Helen; Nash, Robyn; Sacre, Sandra; Courtney, Mary; Abbey, Jennifer

    2008-08-01

    Throughout the world populations are aging and there is a concomitant global need for increasing numbers of nurses who are skilled in working with older people. The aim of this study was to develop a web-based resource for use in nursing schools to help educate undergraduate nursing students about working effectively with older people. This paper details the process of developing the working with older people website, www.workingwitholderpeople.edu.au, which was launched at the end of 2006. The working with older people website was designed for use as a stand alone or self directed program and/or as a set of modules suitable for integration within individual undergraduate nursing programs. The resource is unique in its portrayal of older adults and the challenges they face in a way that is appealing to undergraduate students, and engages them in meaningful learning activities, based on authentic cases, while also providing comprehensive resources and links. PMID:18206272

  16. Patient choice for older people in english NHS primary care: theory and practice.

    PubMed

    Harding, Andrew J E; Sanders, Frances; Lara, Antonieta Medina; van Teijlingen, Edwin R; Wood, Cate; Galpin, Di; Baron, Sue; Crowe, Sam; Sharma, Sheetal

    2014-01-01

    In the English National Health Service (NHS), patients are now expected to choose the time and place of treatment and even choose the actual treatment. However, the theory on which patient choice is based and the implementation of patient choice are controversial. There is evidence to indicate that attitudes and abilities to make choices are relatively sophisticated and not as straightforward as policy developments suggest. In addition, and surprisingly, there is little research on whether making individual choices about care is regarded as a priority by the largest NHS patient group and the single largest group for most GPs-older people. This conceptual paper examines the theory of patient choice concerning accessing and engaging with healthcare provision and reviews existing evidence on older people and patient choice in primary care. PMID:24967329

  17. [The risk of general anaesthesia and sedation in the older people].

    PubMed

    Oomens, M A E M; Booij, L H D; Baart, J A

    2015-12-01

    Temporary memory problems and aggravation of pre-existing memory disorders may occur after treatment under general anaesthesia. A frequency of postoperative cognition disorders between 10 and 50% has been identified in the literature. Risk factors for the occurrence of postoperative memory disorders are advanced age, low level of education, intellectual comorbidity, the onset of dementia and other neurodegenerative disorders, existing sleep disorders and the experience of postoperative pain. The morphological changes seen in the brain after general anaesthesia are similar to the changes occurring in Alzheimer's disease. In addition to metabolic changes, general anaesthetics directly enhance the apoptosis of brain cells. Older people are already familiar with a decrease in the number of neurons, which provides them with a limited spare capacity. Moreover, older people are often known to have the risk factors for the occurrence of postoperative memory disorders as mentioned before. Caution and restraint in the indication for dental -treatment under general anaesthesia or sedation is therefore required. PMID:26665203

  18. Implementing the wandering evidence for older people with dementia: key issues for nurses and carers.

    PubMed

    Neville, Christine C; McMinn, Bryan; Cave, Patricia

    2006-12-01

    This paper explores and discusses key issues for nurses and carers in implementing the evidence from the recent assessment of wandering studies conducted by Algase. Wandering is one of the most burdensome of all the behavioural symptoms and is increasing as the prevalence rates of dementia rise with the aging of the population. Wandering describes a diverse pattern of behaviour from aimless walking and pacing through to elopement. Until recently, the empirical evidence in relation to wandering and its implications for caring for older people has seriously lagged behind other research. However, several studies have led to important advances in the management of wandering and despite there being in some instances methodological deficiencies and modest efficacy, nurses, carers and older people who wander will benefit from the findings. PMID:20925769

  19. Assessing the skills of home care workers in helping older people take their prescribed medications.

    PubMed

    Smyth, Elizabeth E J

    2015-08-01

    The Southern Health and Social Care Trust in Northern Ireland applied a modified version of the Objective Structured Clinical Examination (OSCE) to assess the skills of home care workers in assisting older people taking prescribed medications. In Northern Ireland, home care workers are care workers employed by health and social care trusts or private agencies. The application of the model has developed the skills of this staff group, improved the relationship between the commissioner and provider, significantly reduced the time spent by community nurses in individual training and assessment, and enhanced the patient experience for those taking medication. Overall, the application of this model has provided assurances to the Trust board, the executive director of nursing, and operational directors that home care workers are competent in assisting older people in this high-risk activity. PMID:26252238

  20. Robotic Companions for Older People: A Case Study in the Wild.

    PubMed

    Doering, Nicola; Richter, Katja; Gross, Horst-Michael; Schroeter, Christof; Mueller, Steffen; Volkhardt, Michael; Scheidig, Andrea; Debes, Klaus

    2015-01-01

    Older people tend to have difficulties using unknown technical devices and are less willing to accept technical shortcomings. Therefore, a robot that is supposed to support older people in managing daily life has to adapt to the users' needs and capabilities that are very heterogeneous within the target group. The aim of the presented case study was to provide in-depth insights on individual usage patterns and acceptance of a mobile service robot in real live environments (i.e. in the users' homes). Results from three cases (users aged 67, 78 and 85 living in their own apartments) are reported. Findings on usability and user experience illustrate that the robot has considerable potential to be accepted to support daily living at home. PMID:26799897

  1. Basis for a Swiss perspective on fall prevention in vulnerable older people.

    PubMed

    Gschwind, Yves J; Wolf, Irene; Bridenbaugh, Stephanie A; Kressig, Reto W

    2011-01-01

    During the 20th century Switzerland, like many other Western countries, experienced significant ageing of the population over the age of 65. As the lifespan of the Swiss population increases, so does the prevalence of falls. A multiplicity of fall prevention programmes are available, but extracting their most effective components remains a challenge. This article summarises the results of current studies on fall prevention, with a particular focus on methodological quality and successful reduction of fall incidence in vulnerable older people. Characteristics of effective fall prevention programmes in the fields of exercise, home modifications, appropriate footwear and walking aids are assessed. We then briefly discuss how these study results can be adapted to the Swiss context. This knowledge emphasises an interdisciplinary approach in the prevention of falls, the objective being to reinforce autonomy, promote health and enhance quality of life in vulnerable older people. PMID:22101891

  2. Improvement in the physiological function and standing stability based on kinect multimedia for older people

    PubMed Central

    Chen, Chih-Chen

    2016-01-01

    [Purpose] The increase in the Taiwanese older population is associated with age-related inconveniences. Finding adequate and simple physical activities to help the older people maintaining their physiological function and preventing them from falls has become an urgent social issue. [Subjects and Methods] This study aimed to design a virtual exercise training game suitable for Taiwanese older people. This system will allow for the maintenance of the physiological function and standing stability through physical exercise, while using a virtual reality game. The participants can easily exercise in a carefree, interactive environment. This study will use Kinect for Windows for physical movement detection and Unity software for virtual world development. [Results] Group A and B subjects were involved in the exercise training method of Kinect interactive multimedia for 12 weeks. The results showed that the functional reach test and the unipedal stance test improved significantly. [Conclusion] The physiological function and standing stability of the group A subjects were examined at six weeks post training. The results showed that these parameters remained constant. This proved that the proposed system provide substantial support toward the preservation of the Taiwanese older people’ physiological function and standing stability. PMID:27190480

  3. Liminal homes: Older people, loss of capacities, and the present future of living spaces.

    PubMed

    Leibing, Annette; Guberman, Nancy; Wiles, Janine

    2016-04-01

    There are many studies that have examined the meaning of home for older people. In this article, our aim is to add the concept of 'liminal homes' to the existing discussion: While the concept of liminal homes can be applied to a number of 'interim spaces', we focus in our study, on those older people who have to consider, or are concretely confronted with, the need to move into another living space, because of declining health. Based on interviews and photo-elicitation with 26 older lower-income seniors living in Montreal, Québec, this article demonstrates the complexity of liminality and analyzes the dynamics of this process, composed of a web of interrelated and often dichotomous elements. These include the idealized home in contrast to (sometimes imagined) institutions; declining health as opposed to the ideals of active aging and third age; and the widely promoted concept of aging in place versus the reality of being 'stuck in place' due to limited resources. The strategies employed by these older Quebeckers to remain in this state and resist a move to another living space, are the often arduous construction of a 'patchwork of care'. PMID:27131274

  4. Resilience from the point of view of older people: 'There's still life beyond a funny knee'.

    PubMed

    Wiles, Janine L; Wild, Kirsty; Kerse, Ngaire; Allen, Ruth E S

    2012-02-01

    Resilience is a concept of growing interest in relation to older people and within the context of population ageing. In this paper we explore older people's understandings and experiences of resilience, drawing on interviews and participant-led focus groups with 121 older people living in two case-study communities in Aotearoa, New Zealand. Close reading of extended conversations about what characterises resilience, such as positive attitude, counting blessings or keeping busy, reveal how all of these apparently internal or personal characteristics are deeply embedded in social and physical contexts. We argue that resilience should be seen as a contextualised process which can be both individual and environmental. Older people's experiences highlight the need to consider the effectiveness of environmental community resources and social-political structures such as state-funded service availability, as well as the personal characteristics that are usually focused on when considering resilience in old age. We also argue that it is important to consider different aspects of resilience, so that a person or group might face constraints in one area, such as physical or economic wellbeing, but be strong in other areas such as social relationships or mobility. Resilience can mean acknowledging and incorporating 'vulnerability' and balancing wellbeing across a range of areas. Thus even those living with significant illness or hardship can be understood to be ageing well and indeed to be resilient. Far from using resilience as a narrow measure against which to succeed or fail, resilience is a useful concept framing how ageing well can incorporate multidimensional pathways including both vulnerability and flourishing. We must pay adequate attention to the broader physical and social contexts and scales that underpin--or undermine--individual resilience. PMID:22204841

  5. Age Identification in the Framework of Successful Aging: A Study of Older Finnish People

    ERIC Educational Resources Information Center

    Uotinen, Virpi; Suutama, Timo; Ruoppila, Isto

    2003-01-01

    A person-oriented approach was used in a study of age identification among community-dwelling older people. The study was based on 8-year follow-up data; 843 persons aged 65-84 were involved in the first phase of the study, and 426 persons aged 73-92, in the second phase. Loosely, on the basis of the distinction between successful, usual, and…

  6. Plantar pressure analysis of accommodative insole in older people with metatarsalgia.

    PubMed

    Chang, Bao-Chi; Liu, Ding-Hao; Chang, Jeffrey Liao; Lee, Si-Huei; Wang, Jia-Yi

    2014-01-01

    Foot pain frequently reduces physical activity and increases the risk of falls in older people. In current orthotic management of forefoot pain, metatarsal padding is the main strategy to reduce metatarsal pressure. However, pressure reductions are usually diverse and limited. The multi-step accommodative insole is fabricated by sequential foam padding on Plastazote under dynamic accommodation in daily walking. The aims of this study were to investigate the effectiveness and mechanisms of accommodative insole on plantar pressure redistribution in older people with metatarsalgia. The study was conducted on 21 old outpatients with moderate to severe metatarsalgia, using the ethylene vinyl acetate control, 9-mm flat Plastazote, and accommodative insoles with and without metatarsal and arch support. Outcome measures included pressure-related variables measured by a Pedar-X system, and pain scores assessed with a 0-10 Visual Analog Scale. The accommodative insole significantly decreased peak pressure under the metatarsal heads by 47.2% (p<0.001) and the pain scores from 8.2 to 1.1 (p<0.001). Plantar pressure analyses indicated that the effects of dynamic metatarsal contouring and cushioning on reducing peak pressure were greater than those of metatarsal padding. The temporo-spatial relationships between the toe and metatarsal head can assist in explaining an elevated metatarsal pressure and higher risk of falls in older people with toe deformities. The multi-step insole is simple in orthotic fabrication and ensures an even distribution of plantar pressure loading in walking. It can effectively relieve metatarsalgia and help to preserve regular walking activity for older people with metatarsalgia. PMID:24119776

  7. A comparison of dance interventions in people with Parkinson disease and older adults.

    PubMed

    McNeely, M E; Duncan, R P; Earhart, G M

    2015-05-01

    It is important for our aging population to remain active, particularly those with chronic diseases, like Parkinson disease (PD), which limit mobility. Recent studies in older adults and people with PD suggest dance interventions provide various motor benefits. The literature for dance in PD is growing, but many knowledge gaps remain, relative to what is known in older adults. The purpose of this review is to: (1) detail results of dance intervention studies in older adults and in PD, (2) describe limitations of dance research in these populations, and (3) identify directions for future study. Generally, a wide variety of dance styles have been investigated in older adults, while a more limited subset has been evaluated in PD. Measures vary widely across studies and a lack of standardized outcomes measures hinders cross-studies comparisons. Compared to the dance literature in older adults, there is a notable absence of evidence in the PD literature in outcome domains related to cardiovascular health, muscle strength, body composition, flexibility, and proprioception. As a whole, the dance literature supports substantial and wide-ranging benefits in both populations, but additional effort should be dedicated to well-designed comparative studies using standardized outcome measures to identify optimal treatment programs. PMID:25771040

  8. Comparison of older people and patients with frontal lesions: evidence from world list learning.

    PubMed

    Stuss, D T; Craik, F I; Sayer, L; Franchi, D; Alexander, M P

    1996-09-01

    We examined the hypothesis that changes in memory performance of older normal participants are due to frontal lobe dysfunction by comparing three groups of normal individuals (young, middle-aged, and older) with three groups of patients who had documented lesions in specific frontal regions: unilateral right, unilateral left, and bilateral. All participants were given 4 successive learning trials on each of 3 lists of words: unrelated, related but presented in a pseudo-random order, and related and presented in a blocked format. We found significant correspondences in performance between the older normal participants and the (younger) frontal damaged groups. The qualitative nature of recall performance, particularly as measured by indices of organizational control processes, was similar between older normals and patients with frontal damage, particularly those with right frontal damage, but different from that normally exhibited by patients with focal limbic/memory dysfunction. These results add to the evidence that at least some of the decline in older people in tasks which measure executive or supervisory abilities is due to frontal system dysfunction. PMID:8893308

  9. A Comparison of Dance Interventions in People with Parkinson Disease and Older Adults

    PubMed Central

    McNeely, ME; Duncan, RP; Earhart, GE

    2015-01-01

    It is important for our aging population to remain active, particularly those with chronic diseases, like Parkinson disease (PD), which limit mobility. Recent studies in older adults and people with PD suggest dance interventions provide various motor benefits. The literature for dance in PD is growing, but many knowledge gaps remain, relative to what is known in older adults. The purpose of this review is to: 1) detail results of dance intervention studies in older adults and in PD, 2) describe limitations of dance research in these populations, and 3) identify directions for future study. Generally, a wide variety of dance styles have been investigated in older adults, while a more limited subset has been evaluated in PD. Measures vary widely across studies and a lack of standardized outcomes measures hinders cross-studies comparisons. Compared to the dance literature in older adults, there is a notable absence of evidence in the PD literature in outcome domains related to cardiovascular health, muscle strength, body composition, flexibility, and proprioception. As a whole, the dance literature supports substantial and wide-ranging benefits in both populations, but additional effort should be dedicated to well-designed comparative studies using standardized outcome measures to identify optimal treatment programs. PMID:25771040

  10. Healthy Aging from the Perspectives of 683 Older People with Multiple Sclerosis

    PubMed Central

    2016-01-01

    Purpose. The aim of this study was to determine what factors most greatly contributed to healthy aging with multiple sclerosis (MS) from the perspective of a large sample of older people with MS. Design and Methods. Participants (n = 683; >55 years of age with symptoms >20 years) provided answers to an open-ended question regarding healthy aging and were categorized into three groups, 55–64 (young), 65–74 (middle), and 75 and over (oldest old). Sociodemographic actors were compared using ANOVA. Two independent raters used the framework method of analyzing qualitative data. Results. Participants averaged 64 years of age (±6.2) with MS symptoms for 32.9 years (±9.4). 531 participants were female (78%). The majority of participants lived in their own home (n = 657) with a spouse or partner (n = 483). Participants described seven themes: social connections, attitude and outlook on life, lifestyle choices and habits, health care system, spirituality and religion, independence, and finances. These themes had two shared characteristics, multidimensionality and interdependence. Implications. Learning from the experiences of older adults with MS can help young and middle aged people with MS plan to age in their own homes and communities. Our data suggests that older people with MS prioritize factors that are modifiable through targeted self-management strategies. PMID:27504201

  11. Management of hyponatraemia in older people: old threats and new opportunities

    PubMed Central

    Talbot, Hannah S.C.

    2011-01-01

    Hyponatraemia is the commonest electrolyte abnormality seen in clinical practice, and is especially prevalent in frail, older people. However, the serious implications of hyponatraemia in this age group are seldom recognized by clinicians. Hyponatraemia is associated with osteoporosis, impaired balance, falls, hip fractures and cognitive dysfunction. Even mild, apparently asymptomatic hyponatraemia is associated with prolonged stays in hospital, institutionalization and increased risk of death. Emerging evidence of the potential benefits of improved treatment of hyponatraemia is slowly generating renewed clinical interest in this area. The development of specific vasopressin-2 receptor antagonists (vaptans) has the potential to revolutionize the management of hyponatraemia, in particular for the syndrome of inappropriate antidiuretic hormone. However, challenges remain for the attending physician. Diagnosing the cause or causes of hyponatraemia in older people is difficult, and incorrect diagnosis can lead to treatment that worsens the electrolyte imbalance. Established treatments are often poorly tolerated and patient outcomes remain poor, and the role of vaptans in the treatment of older people is unclear. This review summarizes the existing evidence base and highlights areas of controversy. It includes practical guidance for overcoming some common pitfalls in the management of the elderly patient with hyponatraemia. PMID:25083198

  12. Living with companion animals after stroke: experiences of older people in community and primary care nursing.

    PubMed

    Johansson, Maria; Ahlström, Gerd; Jönsson, Ann-Cathrin

    2014-12-01

    Older people often have companion animals, and the significance of animals in human lives should be considered by nurses-particularly in relation to older people's health, which can be affected by diseases. The incidence of stroke increases with age and disabilities as a result of stroke are common. This study aimed to explore older people's experiences of living with companion animals after stroke, and their life situation with the animals in relation to the physical, psychological and social aspects of recovery after stroke. The study was performed using individual interviews approximately 2 years after stroke with 17 participants (10 women and 7 men) aged 62-88 years. An overarching theme arising from the content analysis was contribution to a meaningful life. This theme was generated from four categories: motivation for physical and psychosocial recovery after stroke; someone to care for who cares for you; animals as family members; and providers of safety and protection. The main conclusion was that companion animals are experienced as physical and psychosocial contributors to recovery and a meaningful life after stroke. PMID:25475671

  13. Healthy Aging from the Perspectives of 683 Older People with Multiple Sclerosis.

    PubMed

    Wallack, Elizabeth M; Wiseman, Hailey D; Ploughman, Michelle

    2016-01-01

    Purpose. The aim of this study was to determine what factors most greatly contributed to healthy aging with multiple sclerosis (MS) from the perspective of a large sample of older people with MS. Design and Methods. Participants (n = 683; >55 years of age with symptoms >20 years) provided answers to an open-ended question regarding healthy aging and were categorized into three groups, 55-64 (young), 65-74 (middle), and 75 and over (oldest old). Sociodemographic actors were compared using ANOVA. Two independent raters used the framework method of analyzing qualitative data. Results. Participants averaged 64 years of age (±6.2) with MS symptoms for 32.9 years (±9.4). 531 participants were female (78%). The majority of participants lived in their own home (n = 657) with a spouse or partner (n = 483). Participants described seven themes: social connections, attitude and outlook on life, lifestyle choices and habits, health care system, spirituality and religion, independence, and finances. These themes had two shared characteristics, multidimensionality and interdependence. Implications. Learning from the experiences of older adults with MS can help young and middle aged people with MS plan to age in their own homes and communities. Our data suggests that older people with MS prioritize factors that are modifiable through targeted self-management strategies. PMID:27504201

  14. Self-reported diabetes in older people: comparison of prevalences and control measures

    PubMed Central

    Stopa, Sheila Rizzato; César, Chester Luiz Galvão; Segri, Neuber José; Goldbaum, Moisés; Guimarães, Vanessa Martins Valente; Alves, Maria Cecília Goi Porto; Barros, Marilisa Berti de Azevedo

    2014-01-01

    OBJECTIVE The objective of this study was to analyze the prevalence of diabetes in older people and the adopted control measures. METHODS Data regarding older diabetic individuals who participated in the Health Surveys conducted in the Municipality of Sao Paulo, SP, ISA-Capital, in 2003 and 2008, which were cross-sectional studies, were analyzed. Prevalences and confidence intervals were compared between 2003 and 2008, according to sociodemographic variables. The combination of the databases was performed when the confidence intervals overlapped. The Chi-square (level of significance of 5%) and the Pearson’s Chi-square (Rao-Scott) tests were performed. The variables without overlap between the confidence intervals were not tested. RESULTS The age of the older adults was 60-69 years. The majority were women, Caucasian, with an income of between > 0.5 and 2.5 times the minimum salary and low levels of schooling. The prevalence of diabetes was 17.6% (95%CI 14.9;20.6) in 2003 and 20.1% (95%CI 17.3;23.1) in 2008, which indicates a growth over this period (p at the limit of significance). The most prevalent measure adopted by the older adults to control diabetes was hypoglycemic agents, followed by diet. Physical activity was not frequent, despite the significant differences observed between 2003 and 2008 results. The use of public health services to control diabetes was significantly higher in older individuals with lower income and lower levels of education. CONCLUSIONS Diabetes is a complex and challenging disease for patients and the health systems. Measures that encourage health promotion practices are necessary because they presented a smaller proportion than the use of hypoglycemic agents. Public health policies should be implemented, and aimed mainly at older individuals with low income and schooling levels. These changes are essential to improve the health condition of older diabetic patients. PMID:25210814

  15. Interventions to improve the appropriate use of polypharmacy in older people: a Cochrane systematic review

    PubMed Central

    Cooper, Janine A; Cadogan, Cathal A; Patterson, Susan M; Bradley, Marie C; Ryan, Cristín; Hughes, Carmel M

    2015-01-01

    Objective To summarise the findings of an updated Cochrane review of interventions aimed at improving the appropriate use of polypharmacy in older people. Design Cochrane systematic review. Multiple electronic databases were searched including MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (from inception to November 2013). Hand searching of references was also performed. Randomised controlled trials (RCTs), controlled clinical trials, controlled before-and-after studies and interrupted time series analyses reporting on interventions targeting appropriate polypharmacy in older people in any healthcare setting were included if they used a validated measure of prescribing appropriateness. Evidence quality was assessed using the Cochrane risk of bias tool and GRADE (Grades of Recommendation, Assessment, Development and Evaluation). Setting All healthcare settings. Participants Older people (≥65 years) with ≥1 long-term condition who were receiving polypharmacy (≥4 regular medicines). Primary and secondary outcome measures Primary outcomes were the change in prevalence of appropriate polypharmacy and hospital admissions. Medication-related problems (eg, adverse drug reactions), medication adherence and quality of life were included as secondary outcomes. Results 12 studies were included: 8 RCTs, 2 cluster RCTs and 2 controlled before-and-after studies. 1 study involved computerised decision support and 11 comprised pharmaceutical care approaches across various settings. Appropriateness was measured using validated tools, including the Medication Appropriateness Index, Beers’ criteria and Screening Tool of Older Person's Prescriptions (STOPP)/ Screening Tool to Alert doctors to Right Treatment (START). The interventions demonstrated a reduction in inappropriate prescribing. Evidence of effect on hospital admissions and medication-related problems was conflicting. No differences in health-related quality of life were reported

  16. The impact of comprehensive geriatric assessment interventions on tolerance to chemotherapy in older people

    PubMed Central

    Kalsi, T; Babic-Illman, G; Ross, P J; Maisey, N R; Hughes, S; Fields, P; Martin, F C; Wang, Y; Harari, D

    2015-01-01

    Background: Although comorbidities are identified in routine oncology practice, intervention plans for the coexisting needs of older people receiving chemotherapy are rarely made. This study evaluates the impact of geriatrician-delivered comprehensive geriatric assessment (CGA) interventions on chemotherapy toxicity and tolerance for older people with cancer. Methods: Comparative study of two cohorts of older patients (aged 70+ years) undergoing chemotherapy in a London Hospital. The observational control group (N=70, October 2010–July 2012) received standard oncology care. The intervention group (N=65, September 2011–February 2013) underwent risk stratification using a patient-completed screening questionnaire and high-risk patients received CGA. Impact of CGA interventions on chemotherapy tolerance outcomes and grade 3+ toxicity rate were evaluated. Outcomes were adjusted for age, comorbidity, metastatic disease and initial dose reductions. Results: Intervention participants undergoing CGA received mean of 6.2±2.6 (range 0–15) CGA intervention plans each. They were more likely to complete cancer treatment as planned (odds ratio (OR) 4.14 (95% CI: 1.50–11.42), P=0.006) and fewer required treatment modifications (OR 0.34 (95% CI: 0.16–0.73), P=0.006). Overall grade 3+ toxicity rate was 43.8% in the intervention group and 52.9% in the control (P=0.292). Conclusions: Geriatrician-led CGA interventions were associated with improved chemotherapy tolerance. Standard oncology care should shift towards modifying coexisting conditions to optimise chemotherapy outcomes for older people. PMID:25871332

  17. Choice stepping reaction time test using exergame technology for fall risk assessment in older people.

    PubMed

    Ejupi, Andreas; Brodie, Matthew; Gschwind, Yves J; Schoene, Daniel; Lord, Stephen; Delbaere, Kim

    2014-01-01

    Accidental falls remain an important problem in older people. Stepping is a common task to avoid a fall and requires good interplay between sensory functions, central processing and motor execution. Increased choice stepping reaction time has been associated with recurrent falls in older people. The aim of this study was to examine if a sensor-based Exergame Choice Stepping Reaction Time test can successfully discriminate older fallers from non-fallers. The stepping test was conducted in a cohort of 104 community-dwelling older people (mean age: 80.7 ± 7.0 years). Participants were asked to step laterally as quickly as possible after a light stimulus appeared on a TV screen. Spatial and temporal measurements of the lower and upper body were derived from a low-cost and portable 3D-depth sensor (i.e. Microsoft Kinect) and 3D-accelerometer. Fallers had a slower stepping reaction time (970 ± 228 ms vs. 858 ± 123 ms, P = 0.001) and a slower reaction of their upper body (719 ± 289 ms vs. 631 ± 166 ms, P = 0.052) compared to non-fallers. It took fallers significantly longer than non-fallers to recover their balance after initiating the step (2147 ± 800 ms vs. 1841 ± 591 ms, P = 0.029). This study demonstrated that a sensor-based, low-cost and easy to administer stepping test, with the potential to be used in clinical practice or regular unsupervised home assessments, was able to identify significant differences between performances by fallers and non-fallers. PMID:25571596

  18. Promoting good dental health in older people: role of the community nurse.

    PubMed

    Daly, Blánaid; Smith, Kerry

    2015-09-01

    Good dental health enables a person to eat, speak, and socialise. It contributes to nutrition, general health, and quality of life. The dental health of people living in the UK has improved in the last 40 years, and older people are retaining their natural teeth throughout their life; nontheless, a significant proportion of people over 75 years still rely on partial and full dentures. Dental disease in all age groups is readily prevented by daily oral hygiene and adherence to a healthy diet, avoidance of smoking, and sensible alcohol intake. Some older people may simply need reminding and encouragement to carry out oral hygiene, while more dependent adults may need support and active help to do so. Nursing teams and health professionals play a key role in promoting oral health by supporting oral hygiene and adequate nutrition, preventing discomfort, and detecting dental diseases early. This article gives a brief overview of how nursing teams and health professionals can promote oral health and provides details of resources from which further detailed information may be obtained. PMID:26322990

  19. Anxiety, anxiety symptoms, and associations among older people with dementia in assisted-living facilities.

    PubMed

    Neville, Christine; Teri, Linda

    2011-06-01

    Anxiety is a major cause for distress among older people with dementia, and it impedes care. In order to develop interventions to treat anxiety and identify who might be most likely to benefit, mental health nurses need to understand what clinical and demographic factors are associated with anxiety in dementia. This cross-sectional study is a detailed assessment of anxiety in people living in assisted-living facilities using the Rating Anxiety in Dementia (RAID) scale and the Clinical Anxiety Scale (CAS). One hundred and forty-eight people, with a mean age of 86.2 years, were recruited from 19 assisted-living facilities in the USA. Prevalence rates for anxiety were 11% and 18%, as measured on the RAID and CAS, respectively. One or more symptoms of anxiety were exhibited for 49% (RAID) and 48% (CAS) of participants. Behavioural symptoms and the presence of depression strongly predicted anxiety, as did staff's reaction to behavioural symptoms and their sense of competence to care. These findings demonstrate that anxiety is prominent enough to warrant further investigation and treatment, and that anxiety in older people with dementia is closely associated with staff skill. This study has also identified areas for mental health nurses to target interventions. PMID:21492359

  20. Strategies to improve the quality of oral health care for frail and dependent older people.

    PubMed Central

    Steele, J G; Walls, A W

    1997-01-01

    The dental profile of the population of most industrialised countries is changing. For the first time in at least a century most elderly people in the United Kingdom will soon have some of their own natural teeth. This could be beneficial for the frail and dependent elderly, as natural teeth are associated with greater dietary freedom of choice and good nutrition. There may also be problems including high levels of dental disease associated with poor hygiene and diet. New data from a national oral health survey in Great Britain is presented. The few dentate elderly people in institutions at the moment have poor hygiene and high levels of dental decay. If these problems persist as dentate younger generations get older, the burden of care will be substantial. Many dental problems in elderly people are preventable or would benefit from early intervention. Strategies to approach these problems are presented. PMID:10173775

  1. Physical activity compensates for increased mortality risk among older people with poor muscle strength.

    PubMed

    Portegijs, E; Rantanen, T; Sipilä, S; Laukkanen, P; Heikkinen, E

    2007-10-01

    The aim of the study was to determine whether habitual physical activity can compensate for the increased mortality risk among older people with poor muscle strength. Mortality was followed up for 10 years after laboratory examination in 558 community dwelling 75- and 80-year-old men and women. Maximal isometric strength of five muscle groups was measured and tertile cut-off points were used to categorize participants. Participants, who reported moderate physical activity for at least 4 h a week, were categorized as physically active and the others as sedentary. High muscle strength and physical activity both protected from mortality, but their effect was not additive. Within each muscle strength tertile, physically active people had a lower mortality risk than sedentary people, the effect being most pronounced among those with lower strength in all muscle groups. A high level of physical activity may thus compensate for the increased mortality associated with low muscle strength. PMID:17166169

  2. Community social capital and tooth loss in Japanese older people: a longitudinal cohort study

    PubMed Central

    Koyama, Shihoko; Aida, Jun; Saito, Masashige; Kondo, Naoki; Sato, Yukihiro; Matsuyama, Yusuke; Tani, Yukako; Sasaki, Yuri; Kondo, Katsunori; Ojima, Toshiyuki; Yamamoto, Tatsuo; Tsuboya, Toru; Osaka, Ken

    2016-01-01

    Objective To date, no study has prospectively examined the association between social capital (SC) in the community and oral health. The aim of this longitudinal cohort study was to examine the association between both community-level and individual-level SC and tooth loss in older Japanese people. Design Prospective cohort study Setting We utilised data from the Japan Gerontological Evaluation Study (JAGES) performed in 2010 and 2013 and conducted in 525 districts. Participants The target population was restricted to non-institutionalised people aged 65 years or older. Participants included 51 280 people who responded to two surveys and who had teeth at baseline. Primary outcome measure The primary outcome measure was loss of remaining teeth, measured by the downward change of any category of remaining teeth, between baseline and follow-up. Results The mean age of the participants was 72.5 years (SD=5.4). During the study period, 8.2% (n=4180) lost one or more of their remaining teeth. Among three community-level SC variables obtained from factor analysis, an indicator of civic participation significantly reduced the risk of tooth loss (OR 0.93; 95% CI 0.88 to 0.99). The individual-level SC variables ‘hobby activity participation’ and ‘sports group participation’ were also associated with a reduced risk of tooth loss (OR 0.88; 95% CI 0.81 to 0.95 and OR 0.90; 95% CI 0.82 to 0.99, respectively). Conclusions Living in a community with rich SC and individuals with good SC is associated with lower incidence of tooth loss among older Japanese people. PMID:27048636

  3. Association of Day Length and Weather Conditions with Physical Activity Levels in Older Community Dwelling People

    PubMed Central

    Witham, Miles D.; Donnan, Peter T.; Vadiveloo, Thenmalar; Sniehotta, Falko F.; Crombie, Iain K.; Feng, Zhiqiang; McMurdo, Marion E. T.

    2014-01-01

    Background Weather is a potentially important determinant of physical activity. Little work has been done examining the relationship between weather and physical activity, and potential modifiers of any relationship in older people. We therefore examined the relationship between weather and physical activity in a cohort of older community-dwelling people. Methods We analysed prospectively collected cross-sectional activity data from community-dwelling people aged 65 and over in the Physical Activity Cohort Scotland. We correlated seven day triaxial accelerometry data with daily weather data (temperature, day length, sunshine, snow, rain), and a series of potential effect modifiers were tested in mixed models: environmental variables (urban vs rural dwelling, percentage of green space), psychological variables (anxiety, depression, perceived behavioural control), social variables (number of close contacts) and health status measured using the SF-36 questionnaire. Results 547 participants, mean age 78.5 years, were included in this analysis. Higher minimum daily temperature and longer day length were associated with higher activity levels; these associations remained robust to adjustment for other significant associates of activity: age, perceived behavioural control, number of social contacts and physical function. Of the potential effect modifier variables, only urban vs rural dwelling and the SF-36 measure of social functioning enhanced the association between day length and activity; no variable modified the association between minimum temperature and activity. Conclusions In older community dwelling people, minimum temperature and day length were associated with objectively measured activity. There was little evidence for moderation of these associations through potentially modifiable health, environmental, social or psychological variables. PMID:24497925

  4. Objectively Measured Walking Duration and Sedentary Behaviour and Four-Year Mortality in Older People

    PubMed Central

    Denkinger, Michael Dieter; Rapp, Kilian; Koenig, Wolfgang; Rothenbacher, Dietrich

    2016-01-01

    Background Physical activity is an important component of health. Recommendations based on sensor measurements are sparse in older people. The aim of this study was to analyse the effect of objectively measured walking and sedentary duration on four-year mortality in community-dwelling older people. Methods Between March 2009 and April 2010, physical activity of 1271 participants (≥65 years, 56.4% men) from Southern Germany was measured over one week using a thigh-worn uni-axial accelerometer (activPAL; PAL Technologies, Glasgow, Scotland). Mortality was assessed during a four-year follow-up. Cox-proportional-hazards models were used to estimate the associations between walking (including low to high intensity) and sedentary duration with mortality. Models were adjusted for age and sex, additional epidemiological variables, and selected biomarkers. Results An inverse relationship between walking duration and mortality with a minimum risk for the 3rd quartile (102.2 to128.4 minutes walking daily) was found even after multivariate adjustment with HRs for quartiles 2 to 4 compared to quartile 1 of 0.45 (95%-CI: 0.26; 0.76), 0.18 (95%-CI: 0.08; 0.41), 0.39 (95%-CI: 0.19; 0.78), respectively. For sedentary duration an age- and sex-adjusted increased mortality risk was observed for the 4th quartile (daily sedentary duration ≥1137.2 min.) (HR 2.05, 95%-CI: 1.13; 3.73), which diminished, however, after full adjustment (HR 1.63, 95%-CI: 0.88; 3.02). Furthermore, our results suggest effect modification between walking and sedentary duration, such that in people with low walking duration a high sedentary duration was noted as an independent factor for increased mortality. Conclusions In summary, walking duration was clearly associated with four-year overall mortality in community-dwelling older people. PMID:27082963

  5. Cost and burden of informal caregiving of dependent older people in a rural Indian community

    PubMed Central

    2014-01-01

    Background Lack of state supported care services begets the informal caregiving by family members as the mainstay of care provided to the dependent older people in many Low and Middle Income Countries (LMICs), including India. Little is known about the time spent on caregiving, its cost and the burden experienced by these informal caregivers. We aimed to estimate the costs of informal caregiving and to evaluate the nature as well as correlates of caregivers’ burden in a rural Indian community. Methods We assessed 1000 people aged above 65 years, among whom 85 were dependent. We assessed their socioeconomic profiles, disability, health status and health expenditures. Their caregivers’ socio-demographic profiles, mental health, and the time spent on caregiving were assessed using standard instruments. Caregiver’s burden was evaluated using Zarit Burden Scale. We valued the annual informal caregiving costs using proxy good method. We employed appropriate non-parametric multivariate statistics to evaluate the correlates of caregivers’ burden. Results Average time spent on informal caregiving was 38.6 (95% CI 35.3-41.9) hours/week. Estimated annual cost of informal caregiving using proxy good method was 119,210 US$ in this rural community. Mean total score of Zarit burden scale, measuring caregivers’ burden, was 17.9 (95% CI 15.6-20.2). Prevalence of depression among the caregivers was 10.6% (95% CI 4.1-17.1%). Cerebrovascular disease, Parkinson’s disease, higher disability, insomnia and incontinence of the dependent older people as well as the time spent on helping Activities of Daily Living and on supervision increased caregiver's burden significantly. Conclusions Cost and burden of informal caregiving are high in this rural Indian community. Many correlates of burden, experienced by caregivers, are modifiable. We discuss potential strategies to reduce this burden in LMICs. Need for support to informal caregivers and for management of dependent older

  6. Physical activity interventions to prevent falls among older people: update of the evidence.

    PubMed

    Sherrington, C; Lord, S R; Finch, C F

    2004-04-01

    Injuries resulting from falls are a significant public health issue, particularly for older people. This review provides an update of the evidence on the effects of various physical activity (PA) or exercise intervention strategies for the prevention of unintentional falls among older people. Six systematic reviews, and three randomised controlled trials not incorporated in previous reviews, were located with a literature search. There is clear evidence that a targeted supervised home exercise program of strength and balance exercise and walking practice, prescribed by a trained health professional, can prevent falls among older community dwellers. There is also an indication that untargeted group exercise (ie, not individually prescribed) can prevent falls among community dwellers, particularly if it involves Tai Chi or other exercises which challenge balance. There is some indication that individual prescription of PA is more important in frailer groups. Further investigation is required to establish the effects of PA in residential aged care, and the relative effects of different types of PA in different populations. In addition, multidisciplinary, multifactorial. health/environmental risk factor screening/intervention programs have been found to be effective in preventing falls. For many individuals with physical risk factors for falls (eg, impaired strength, balance or functional ability), PA alone is likely to reduce the risk of falls. For those with additional risk factors (eg, visual impairments, psychoactive medication use), other interventions may also be required. PMID:15214601

  7. Life situation and identity among single older home-living people: A phenomenological–hermeneutic study

    PubMed Central

    Söderhamn, Ulrika; Söderhamn, Olle

    2012-01-01

    Being able to continue living in their own home as long as possible is the general preference for many older people, and this is also in line with the public policy in the Nordic countries. The aim of this study was to elucidate the meaning of self-care and health for perception of life situation and identity among single-living older individuals in rural areas in southern Norway. Eleven older persons with a mean age of 78 years were interviewed and encouraged to narrate their self-care and health experiences. The interviews were audio taped, transcribed verbatim and analysed using a phenomenological–hermeneutic method inspired by the philosophy of Ricoeur. The findings are presented as a naïve reading, an inductive structural analysis characterized by two main themes; i.e., “being able to do” and “being able to be”, and a comprehensive interpretation. The life situation of the interviewed single-living older individuals in rural areas in southern Norway was interpreted as inevitable, appropriate and meaningful. Their identity was constituted by their freedom and self-chosen actions in their personal contexts. The overall impression was that independence and the ability to control and govern their own life in accordance with needs and preferences were ultimate goals for the study participants. PMID:22848230

  8. Life situation and identity among single older home-living people: a phenomenological-hermeneutic study.

    PubMed

    Dale, Bjørg; Söderhamn, Ulrika; Söderhamn, Olle

    2012-01-01

    Being able to continue living in their own home as long as possible is the general preference for many older people, and this is also in line with the public policy in the Nordic countries. The aim of this study was to elucidate the meaning of self-care and health for perception of life situation and identity among single-living older individuals in rural areas in southern Norway. Eleven older persons with a mean age of 78 years were interviewed and encouraged to narrate their self-care and health experiences. The interviews were audio taped, transcribed verbatim and analysed using a phenomenological-hermeneutic method inspired by the philosophy of Ricoeur. The findings are presented as a naïve reading, an inductive structural analysis characterized by two main themes; i.e., "being able to do" and "being able to be", and a comprehensive interpretation. The life situation of the interviewed single-living older individuals in rural areas in southern Norway was interpreted as inevitable, appropriate and meaningful. Their identity was constituted by their freedom and self-chosen actions in their personal contexts. The overall impression was that independence and the ability to control and govern their own life in accordance with needs and preferences were ultimate goals for the study participants. PMID:22848230

  9. Development of a Frailty Index for Older People with Intellectual Disabilities: Results from the HA-ID Study

    ERIC Educational Resources Information Center

    Schoufour, Josje D.; Mitnitski, Arnold; Rockwood, Kenneth; Evenhuis, Heleen M.; Echteld, Michael A.

    2013-01-01

    Background: Although there is no strict definition of frailty, it is generally accepted as a state of high vulnerability for adverse health outcomes at older age. Associations between frailty and mortality, dependence, and hospitalization have been shown. We measured the frailty level of older people with intellectual disabilities (ID).…

  10. Can clinicians benefit from patient satisfaction surveys? Evaluating the NSF for Older People, 2005–2006

    PubMed Central

    lliffe, Steve; Wilcock, Jane; Manthorpe, Jill; Moriarty, Jo; Cornes, Michelle; Clough, Roger; Bright, Les

    2008-01-01

    Summary Background A transformation of healthcare is underway, from a sellers' market to a consumers' market, where the satisfaction of the patient's needs is part of the definition of quality. Patient satisfaction surveys are widely used to judge service quality, but clinicians are sceptical about them because they are too often poorly designed measures that do not lead to improvements in the quality of care. Aim To explore the use of patient satisfaction survey data in identifying problems with the provision of inpatient care for older people. Methods A case study using secondary analysis of postal survey data about older people's experiences of health and social care services, obtained during the evaluation of the National Service Framework for Older People in 2005–2006. The survey asked about experiences of inpatient care and of discharge from hospital, and sought perceptions of the avoidability of the admission. Settings and participants A total of 4170 people aged 50 years and over returned a postal questionnaire in six local authority areas of England. Responses from 584 who had experienced a recent overnight stay in hospital are reported and discussed. Findings The response rate was 35%, ranging from 26% to 44% in the six areas surveyed. The great majority of those who had recent direct experience of inpatient care reported that they had been engaged in decision-making, that staff promoted their independence and maintained their dignity. There were widespread examples, however, of the opposite experiences. Discharge from hospital was problematic for about one-third of survey respondents with this experience, and there were different accounts of poorly managed discharges from all areas. Conclusions Case studies using local survey data can be used as formative assessments of services. The response rate to the survey and the likelihood of responder bias mean that patient satisfaction survey data of this sort cannot be used to judge or compare services in a

  11. Multidimensional structure of the Groningen Frailty Indicator in community-dwelling older people

    PubMed Central

    2013-01-01

    Background Due to the rapidly increasing number of older people worldwide, the prevalence of frailty among older adults is expected to escalate in coming decades. It is crucial to recognize early onset symptoms to initiate specific preventive care. Therefore, early detection of frailty with appropriate screening instruments is needed. The aim of this study was to evaluate the underlying dimensionality of the Groningen Frailty Indicator (GFI), a widely used self-report screening instrument for identifying frail older adults. In addition, criterion validity of GFI subscales was examined and composition of GFI scores was evaluated. Methods A cross-sectional study design was used to evaluate the structural validity, internal consistency and criterion validity of the GFI questionnaire in older adults aged 65 years and older. All subjects completed the GFI questionnaire (n = 1508). To assess criterion validity, a smaller sample of 119 older adults completed additional questionnaires: De Jong Gierveld Loneliness Scale, Hospital Anxiety Depression Scale, RAND-36 physical functioning, and perceived general health item of the EuroQol-5D. Exploratory factor analysis and Mokken scale analysis were used to evaluate the structural validity of the GFI. A Venn diagram was constructed to show the composition of GFI subscale scores for frail subjects. Results The factor structure of the GFI supported a three-dimensional structure of the scale. The subscales Daily Activities and Psychosocial Functioning showed good internal consistency, scalability, and criterion validity (Daily Activities: Cronbach’s α = 0.81, Hs = .84, r = −.62; Psychosocial Functioning: Cronbach’s α = 0.80, Hs = .35, r = −.48). The subscale Health Problems showed less strong internal consistency but acceptable scalability and criterion validity (Cronbach’s α = .57, Hs = .35, r = −.48). The present data suggest that 90% of the frail older adults experience

  12. Challenges of managing medications for older people at transition points of care.

    PubMed

    Manias, Elizabeth; Hughes, Carmel

    2015-01-01

    In clinical practice, pharmacists play a very important role in identifying and correcting medication discrepancies as older patients move across transition points of care. With increasing complexity of health care needs of older people, these discrepancies are likely to increase. The major concern with identifying and correcting medication discrepancies is that medication reconciliation is considered a retrospective problem--that is, dealing with medication discrepancies after they have occurred. It is argued here that a more proactive stance should be taken where doctors, nurses and pharmacists collectively work together to prevent medication discrepancies from happening in the first place. Improved involvement of patients and family members will help to facilitate better management of medications across transition points of care. Efficient use of information technology aids, such as electronic medication reconciliation tools, should also assist with organizational systems problems associated with the working culture, heavy workloads, and staff and skill mix of health professionals. PMID:25455760

  13. Sleep Quality and Recommended Levels of Physical Activity in Older People.

    PubMed

    Hartescu, Iuliana; Morgan, Kevin; Stevinson, Clare D

    2016-04-01

    A minimum level of activity likely to improve sleep outcomes among older people has not previously been explored. In a representative UK sample aged 65+ (n = 926), cross-sectional regressions controlling for appropriate confounders showed that walking at or above the internationally recommended threshold of ≥ 150 min per week was significantly associated with a lower likelihood of reporting insomnia symptoms (OR = 0.67, 95% CI = 0.45-0.91, p < .05). At a 4-year follow-up (n = 577), higher walking levels at baseline significantly predicted a lower likelihood of reporting sleep onset (OR = 0.64, 95% CI = 0.42-0.97, p < .05) or sleep maintenance (OR = 0.63, 95% CI = 0.41-0.95, p < .05) problems. These results are consistent with the conclusion that current physical activity guidelines can support sleep quality in older adults. PMID:26291553

  14. Porvoo sarcopenia and nutrition trial: effects of protein supplementation on functional performance in home-dwelling sarcopenic older people - study protocol for a randomized controlled trial

    PubMed Central

    2013-01-01

    Background Age-related muscle loss (that is, sarcopenia) is a common health problem among older people. Physical exercise and dietary protein have been emphasized in prevention and treatment of sarcopenia. Rigorous trials investigating the effects of protein supplementation on physical performance in sarcopenic populations are still scarce. The aim of this study is to investigate the effects of protein supplementation along with simple home-based exercises on physical performance among home-dwelling sarcopenic older people. Methods/Design During 2012 the entire 75 and older population (N = 3,275) living in Porvoo, Finland was contacted via a postal questionnaire. Persons at risk of sarcopenia are screened with hand grip strength and gait speed. Poorly performing persons are further examined by segmental bioimpendance spectroscopy to determine their skeletal muscle index. Sarcopenic patients (target N = 250) will be enrolled in a 12-month randomized controlled trial with three arms: 1) no supplementation, 2) protein supplementation (20 grams twice a day), and 3) isocaloric placebo. All the participants will receive instructions on simple home-based exercises, dietary protein, and vitamin D supplementation (20 μg/d). The recruitment of patients will be completed during 2013. The primary endpoint of the trial is the change in short physical performance battery score and percentage of patients maintaining or improving their physical performance. Secondary endpoints will be, among other things, changes in muscle functions, nutritional status, body composition, cognition, quality of life, use of health care services, falls, and mortality. The assessment times will be 0, 6, 12 and 24 months. Discussion To our knowledge, this is the first large scale randomized controlled trial among community dwelling older people with sarcopenia that focuses on the effects of protein supplementation on physical performance. Trial registration ACTRN12612001253897, date of

  15. A Turkish version of Kogan's attitude toward older people (KAOP) scale: reliability and validity assessment.

    PubMed

    Erdemir, Firdevs; Kav, Sultan; Citak, Ebru Akgun; Hanoglu, Ziyafet; Karahan, Azize

    2011-01-01

    The considerable growth in the elderly population in Turkey has brought with it problems as well as concerns regarding gerontological education for health care professionals. The quality of care provided for older people is directly related to the attitudes of health care professionals. Validated instruments are needed in order to study attitudes toward old people. Aim of this study was to assess the reliability and validity of a Turkish version of KAOP among faculty of health sciences (health management, nutrition and dietetics, nursing, physical therapy, social workers and sports) students (n=594) at a university. The scale was translated using the back-translation technique. A two-phase data collection design was used. Four weeks following the first completion, another KAOP form was given. Content validity, construct validity, internal consistency, and stability reliability were assessed. Scores were between 86 and 175. The study sample reported slightly positive attitudes (132.9 ± 14.74). All of the 34 items were found to have significant item-to-total correlations. The content validity index was 0.94. The Cronbach's alpha was 0.84 for the total scale. The Turkish version of the KAOP can be considered reliable and valid scale for assessing the attitudes toward older people. PMID:21075461

  16. Home accidents in older people: role of primary health care team.

    PubMed Central

    Graham, H. J.; Firth, J.

    1992-01-01

    OBJECTIVES--To determine the incidence and nature of unreported and reported home accidents in older people and to investigate associated environmental factors. DESIGN--Postal questionnaire requesting information on home accidents in the preceding month. SETTING--Inner London general practice. SUBJECTS--All registered patients aged over 65 years (n = 1662), of whom 120 were inappropriately registered and 1293 responded. MAIN OUTCOME MEASURE--Circumstances and consequences of accidents in the home. RESULTS--108 accidents were recorded in 100 patients, giving a home accident rate of 84/1000 patients, equivalent to an annual rate of 1002/1000. 73 accidents were falls, and 83 were unreported. Of the 25 reported accidents, 19 were reported to general practice and six to accident and emergency departments (5.6% of all events). Rates of home accidents increased with age and were higher in women than men (79/819 upsilon 29/474; chi 2 = 4.5, df = 1, p less than 0.05). CONCLUSIONS--The incidence of home accidents in people aged over 65 years was high but few events were reported to medical services. General practice provided the main contact for patients who reported home accidents, and primary care workers have important opportunities for advising elderly patients on home accident prevention. Improved publicity on home safety targeted at older people and their carers would support the primary health care team in this role. PMID:1638198

  17. [A Community-Based Experience Model of Mental-Social Health Promotion for Older People in Taichung City].

    PubMed

    Tsay, Shwu-Feng; Hsu, Yuan-Nian; Chen, Shu-Fen; Shen, Shu-Hua; Lin, Hsiang-Yi

    2015-08-01

    Active ageing is one of the most important issues taken up by the WHO in regard to ageing societies. "Prolonging Healthy Life Expectance" and "Decreasing the Depression Rate Among Older People" are critical indicators for "2020 Healthy People in Taiwan". This paper conducts a trial run of the program planning and evaluation of mental-social health promotion using focus group research that surveys 29 administrative districts and a depression survey that randomly samples older individuals in Taichung City. We also introduce how we apply local characteristics to develop the 3-level and innovative-action plans to meet the needs of self-identity and social participation for older people. For example, the "Learning Mobile Classroom" program promotes health promotion using activities that are tailored to the lifestyle and culture characteristics of target individuals. Another example is the "Seniors Show", which uses community groups and annual active-ageing shows to promote a positive concept of aging and to promote social participation for older people. Finally, the "Navigator APP of Active Ageing", created using a geographic information system, addresses the resource information needs of older people. This experience in Taichung City uniquely empowers older people, allowing them to take the initiative to make a difference not only for mental-social wellness but also for the hope of life and for graceful ageing. PMID:26242432

  18. The role of context and the interpersonal experience of loneliness among older people in a residential care facility

    PubMed Central

    Roos, Vera; Malan, Lelanie

    2012-01-01

    Older people are more prone to experience loneliness when living in residential care facilities. The purpose of this study was to explore older people's experiences of loneliness in the context of institutionalized care. A voluntary and convenience-based sample of 10 white South African older people (age range 62 to 82 years; three men and seven women) was drawn. Data on the subjective experience of loneliness were then gathered through the Mmogo-method®, whereby drawings were employed to explore matters and issues of importance in the lives of older people that could be used to deal with loneliness. Data were analyzed thematically and visually as well as through the use of keywords in context. The results showed that older people experienced loneliness in terms of having unavailable interactions due to loss, and an absence of meaningful interpersonal interactions. Meaningful interpersonal interactions were described as when the older people had regular contact and a variety of interactions. Ineffective interpersonal styles (e.g. taking a controlling position in relationships and being rigid) elicited rejection and isolation, and were associated with a lack of confirmatory interpersonal relationships. It is recommended that greater emphasis should be placed on creating awareness of unhealthy group dynamics as well as on psychosocial interventions to develop group support. Interpersonal styles, either effective or ineffective, take place in a social context, which, in this research, was observed to be unsafe, lacking in care, and a non-stimulating environment. PMID:23078747

  19. How older people watch television. Telemetric data on the TV use in Germany in 1996.

    PubMed

    Grajczyk, A; Zöllner, O

    1998-01-01

    This study has been prompted by the relatively small body of knowledge on the media use of the elderly. The aim of this study was to show how people 50 years and older use the medium television in Germany. Therefore, the 1996 television usership data collected in a representative 'peoplemeter' panel of about 4,800 German television households have been surveyed, processed and analyzed using standard audience research software. In 1996, Germans 50 years and above watched on average 233 min television per day. The older a person, the longer he or she watches television. Individuals 65 years and older watch television for 253 min per day. This subgroup appears to comprise the most intensive users of the medium. Men 65 years and above may be depicted as the heaviest weekend TV watchers, older women as the medium's closest followers from Monday to Friday. Television program broadcast late in the afternoon and early in the evening have by far the best chances to be chosen by seniors. The affinity of the elderly for the medium can be explained by its potential for offering entertainment, information, and companionship, being a substitute for primary interpersonal communication, a tool for structuring time patterns and keeping up the rhythms of long-established everyday rituals. On the one hand, television can be a 'lifeline' and a 'window to the outside world' for people with little opportunity for direct, unmediated social contact, thus possibly raising their satisfaction of life. On the other hand, prolonged TV use may be seen as an indicator for the degree of loneliness and neglect of the elderly. PMID:9592692

  20. "Go4Life" exercise counseling, accelerometer feedback, and activity levels in older people.

    PubMed

    Thompson, Warren G; Kuhle, Carol L; Koepp, Gabriel A; McCrady-Spitzer, Shelly K; Levine, James A

    2014-01-01

    Older people are more sedentary than other age groups. We sought to determine if providing an accelerometer with feedback about activity and counseling older subjects using Go4Life educational material would increase activity levels. Participants were recruited from independent living areas within assisted living facilities and the general public in the Rochester, MN area. 49 persons aged 65-95 (79.5±7.0 years) who were ambulatory but sedentary and overweight participated in this randomized controlled crossover trial for one year. After a baseline period of 2 weeks, group 1 received an accelerometer and counseling using Go4Life educational material (www.Go4Life.nia.nih.gov) for 24 weeks and accelerometer alone for the next 24 weeks. Group 2 had no intervention for the first 24 weeks and then received an accelerometer and Go4Life based counseling for 24 weeks. There were no significant baseline differences between the two groups. The intervention was not associated with a significant change in activity, body weight, % body fat, or blood parameters (p>0.05). Older (80-93) subjects were less active than younger (65-79) subjects (p=0.003). Over the course of the 48 week study, an increase in activity level was associated with a decline in % body fat (p=0.008). Increasing activity levels benefits older patients. However, providing an accelerometer and a Go4Life based exercise counseling program did not result in a 15% improvement in activity levels in this elderly population. Alternate approaches to exercise counseling may be needed in elderly people of this age range. PMID:24485546

  1. Talking about colds and flu: the lay diagnosis of two common illnesses among older British people.

    PubMed

    Prior, Lindsay; Evans, Meirion R; Prout, Hayley

    2011-09-01

    This paper reports on a study of the ways in which 54 older people in South Wales (UK) talk about the symptoms and causes of cold and influenza (flu). The study was designed to understand why older people might reject or accept the offer of seasonal flu vaccine, and in the course of the interviews respondents were also asked to express their views about the nature and causes of the two key illnesses. The latter are among the most common infections in human beings. In terms of the biomedical paradigm the common cold is caused by numerous respiratory viruses, whilst flu is caused by the influenza virus. Medical diagnosis is usually made on clinical grounds without laboratory confirmation. Symptoms of flu include sudden onset of fever and cough, and colds are characterized by sneezing, sore throat, and runny nose, but in practice the symptoms often overlap. In this study we examine the degree by which the views of lay people with respect to both diagnosis and epidemiology diverge with that which is evident in biomedical discourse. Our results indicate that whilst most of the identified symptoms are common to lay and professional people, the former integrate symptoms into a markedly different observational frame from the latter. And as far as causation is concerned it is clear that lay people emphasize the role of 'resistance' and 'immunity' at least as much as 'infection' in accounting for the onset of colds and flu. The data are analyzed using novel methods that focus on the co-occurrence of concepts and are displayed as semantic networks. As well as reporting on its findings the authors draw out some implications of the study for social scientific and policy discussions concerning lay diagnosis, lay expertise and the concept of an expert patient. PMID:21186076

  2. Preventing falls among older people with mental health problems: a systematic review

    PubMed Central

    2014-01-01

    Background Falls are a leading cause of mortality and morbidity in older people and the risk of falling is exacerbated by mental health conditions. Existing reviews have focused on people with dementia and cognitive impairment, but not those with other mental health conditions or in mental health settings. The objective of this review is to evaluate the effectiveness of fall prevention interventions for older people with mental health problems being cared for across all settings. Methods A systematic review of fall prevention interventions for older people with mental health conditions. We undertook electronic database and lateral searches to identify studies reporting data on falls or fall related injuries. Searches were initially conducted in February 2011 and updated in November 2012 and October 2013; no date restrictions were applied. Studies were assessed for risk of bias. Due to heterogeneity results were not pooled but are reported narratively. Results Seventeen RCTs and four uncontrolled studies met the inclusion criteria; 11 involved single interventions and ten multifactorial. Evidence relating to fall reduction was inconsistent. Eight of 14 studies found a reduction in fallers (statistically significant in five), and nine of 14 reported a significant reduction in rate or number of falls. Four studies found a non-significant increase in falls. Multifactorial, multi-disciplinary interventions and those involving exercise, medication review and increasing staff awareness appear to reduce the risk of falls but evidence is mixed and study quality varied. Changes to the environment such as increased supervision or sensory stimulation to reduce agitation may be promising for people with dementia but further evaluation is needed. Most of the studies were undertaken in nursing and residential homes, and none in mental health hospital settings. Conclusions There is a dearth of falls research in mental health settings or which focus on patients with mental health

  3. Developing attributes for a generic quality of life measure for older people: preferences or capabilities?

    PubMed

    Grewal, Ini; Lewis, Jane; Flynn, Terry; Brown, Jackie; Bond, John; Coast, Joanna

    2006-04-01

    Current UK policy with respect to the provision of health and social care for older people suggests that greater integration is required. Economists' attempts to assist resource allocation decisions, however, are very health focused, with concentration on the use of health-related quality of life measures. This paper reports an attempt to determine attributes for a new index clearly focusing on quality of life for older people rather than health or other influences on quality of life. In-depth interviews were conducted with 40 purposively selected informants aged 65 and over in private households to explore their views about what is important to them in terms of quality of life. Data were analysed using Framework qualitative analysis. Initial discussions tended to concentrate upon factors influencing quality of life including activities, relationships, health, wealth and surroundings. Further probing and analysis suggested five conceptual attributes: attachment, role, enjoyment, security and control. The data also suggested that the quality of informants' lives was limited by the loss of ability to pursue these attributes. So, for example, it is not poor health in itself, which reduces quality of life, but the influence of that poor health upon each informant's ability to, say, be independent, that is important. Amartya Sen's work on functioning and capability is particularly pertinent here. Using this work, it is possible to interpret the five conceptual attributes as a set of functionings-important for older people in the UK in the 21st century-but noting that it is the capacity to achieve these functionings that appears to be of importance. This suggests that further development of this measure should focus on an index of capability rather than preference-based utility. PMID:16168542

  4. Health begins at home: the housing-health interface for older people.

    PubMed

    Harrison, L; Heywood, F

    2000-01-01

    Housing issues are of fundamental importance to the health and independence of older people in Britain, but this concept is not reflected in planning for health, housing, or community care. An analysis of community care plans and public health reports reflects how little attention the majority give either to the importance of housing or to the potential of primary care as a means of information exchange between older people and planning processes. Interviews with practitioners and policy makers in four cities, combined with a review of the considerable literature on planning and joint planning in the health and social services, helped to identify the problems in achieving more integrated systems. Structural blockages as fundamental as the definitions of 'health' and 'housing', the attitude of society to manual work, the hidden nature of the problems of older people, and the failure of planning to categorize according to the level of need are identified and summarized in a chart showing how these factors are linked and self-reinforcing. The article concludes with a vision of how things might work more effectively without requiring unrealistic changes. The authors offer a challenge to planners and joint commissioners to gather different kinds of information on need; to have long-term, as well as short-term, strategies; to think broadly across categories of issue; and to be prepared to invest money in new ways. Most significantly, by redefining the role of the Director of Public Health, we identify a focal point at which the responsibility and authority for coordinating, championing, and review could lie. PMID:10939090

  5. Dignity in the care of older people – a review of the theoretical and empirical literature

    PubMed Central

    Gallagher, Ann; Li, Sarah; Wainwright, Paul; Jones, Ian Rees; Lee, Diana

    2008-01-01

    Background Dignity has become a central concern in UK health policy in relation to older and vulnerable people. The empirical and theoretical literature relating to dignity is extensive and as likely to confound and confuse as to clarify the meaning of dignity for nurses in practice. The aim of this paper is critically to examine the literature and to address the following questions: What does dignity mean? What promotes and diminishes dignity? And how might dignity be operationalised in the care of older people? This paper critically reviews the theoretical and empirical literature relating to dignity and clarifies the meaning and implications of dignity in relation to the care of older people. If nurses are to provide dignified care clarification is an essential first step. Methods This is a review article, critically examining papers reporting theoretical perspectives and empirical studies relating to dignity. The following databases were searched: Assia, BHI, CINAHL, Social Services Abstracts, IBSS, Web of Knowledge Social Sciences Citation Index and Arts & Humanities Citation Index and location of books a chapters in philosophy literature. An analytical approach was adopted to the publications reviewed, focusing on the objectives of the review. Results and discussion We review a range of theoretical and empirical accounts of dignity and identify key dignity promoting factors evident in the literature, including staff attitudes and behaviour; environment; culture of care; and the performance of specific care activities. Although there is scope to learn more about cultural aspects of dignity we know a good deal about dignity in care in general terms. Conclusion We argue that what is required is to provide sufficient support and education to help nurses understand dignity and adequate resources to operationalise dignity in their everyday practice. Using the themes identified from our review we offer proposals for the direction of future research. PMID:18620561

  6. Correlates of social and emotional loneliness in older people: evidence from an English community study

    PubMed Central

    Dahlberg, Lena; McKee, Kevin J.

    2013-01-01

    Objectives Loneliness is an important influence on quality of life in old age and has been conceptualised as consisting of two dimensions, social and emotional. This article describes analyses that sought to produce models of social and emotional loneliness in older people, using demographic, psychological and health, and social variables. Method Older people (aged 65+, n = 1255) from the Barnsley metropolitan area of the United Kingdom were recruited randomly from within a stratified sampling frame and received a questionnaire-based interview (response rate: 68.1%). The questionnaire contained items and scales on demographic, psychological and health, and social characteristics, and a validated measure of loneliness that assesses both social and emotional loneliness. Results Of the respondents, 7.7% were found to be severely or very severely lonely, while another 38.3% were moderately lonely. Social and emotional loneliness shared 19.36% variance. Being male, being widowed, low well-being, low self-esteem, low-income comfort, low contact with family, low contact with friends, low activity, low perceived community integration, and receipt of community care were significant predictors of social loneliness (R = 0.50, R2 = 0.25, F(18, 979) = 18.17, p < 0.001). Being widowed, low well-being, low self-esteem, high activity restriction, low-income comfort, and non-receipt of informal care were significant predictors of emotional loneliness (R = 0.55, R2 = 0.30, F(18, 973) = 23.00, p < 0.001). Conclusion This study provides further empirical support for the conceptual separation of emotional and social loneliness. Consequently, policy on loneliness in older people should be directed to developing a range of divergent intervention strategies if both emotional and social loneliness are to be reduced. PMID:24251626

  7. Integrating life themes of work in the care of older people.

    PubMed

    Ruler, A J

    1998-12-01

    This paper examines the role that work themes may play in helping the elderly person to improve integrity, self worth and esteem. The life themes of two older individuals who worked beyond retirement age are identified. One individual worked in paid employment and the other worked in a voluntary capacity. These people to review their life and the themes identified have enabled them to cope through their most difficult times. The themes are situated within psychological and narrative theory. The themes have added richness, variety and meaning to the participants' lives. Gender contrasts have been noted along with functional, personal and interpersonal meanings that their work has held for them. PMID:10095502

  8. Alfentanil anesthetic augmentation lengthens seizure duration in electroconvulsive therapy with older people.

    PubMed

    D'Cunha, Craig; Plakiotis, Christos; O'Connor, Daniel W

    2016-06-01

    Electroconvulsive therapy (ECT) prescription rates rise with age, making it important that treatments be made as effective and safe as possible (Plakiotis et al., 2012). Older people are vulnerable to post-treatment confusion and to subsequent deficits in attention, new learning, and autobiographical memory (Gardner and O'Connor, 2008). Strategies to minimize cognitive side-effects include unilateral electrode placement and stimulus dose titration whereby electrical charge is individually calibrated to seizure threshold (Sackeim et al., 2000). It remains the case, however, that threshold levels typically rise over the treatment course, leading to an increase both in delivered charge and the risk of adverse sequelae. PMID:26847795

  9. Evaluation of the accuracy of shoe fitting in older people using three-dimensional foot scanning

    PubMed Central

    2014-01-01

    Background Ill-fitting footwear is a common problem in older people. The objective of this study was to determine the accuracy of shoe fitting in older people by comparing the dimensions of allocated shoes to foot dimensions obtained with a three-dimensional (3D) scanner. Methods The shoe sizes of 56 older people were determined with the Brannock device®, and weightbearing foot scans were obtained with the FotoScan 3D scanner (Precision 3D Ltd, Weston-super-mare, UK). Participants were provided with a pair of shoes (Dr Comfort®, Vista, CA, USA), available in three width fittings (medium, wide and extra wide). The dimensions (length, ball width and ball girth) of the allocated shoes were documented according to the last measurements provided by the manufacturer. Mean differences between last dimensions and foot dimensions obtained with the 3D scanner were calculated to provide an indication of shoe fitting accuracy. Participants were also asked to report their perception of shoe fit and comfort, using 100 mm visual analogue scales (VAS). Results Shoe size ranged from US size 7 to 14 for men and 5.5 to 11 for women. The allocated shoes were significantly longer than the foot (mean 23.6 mm, 95% confidence interval [CI] 22.1 to 25.2; t55 = 30.3, p < 0.001), however there were no significant differences in relation to ball width (mean 1.4 mm, 95% CI −0.1 to 2.9 mm; t55 = 1.9, p = 0.066) or ball girth (mean −0.7 mm, 95% CI −6.1 to 4.8 mm; t55 = −0.2, p = 0.810). Participants reported favourable perceptions of shoe fit (mean VAS = 90.7 mm, 95% CI 88.4 to 93.1 mm) and comfort (mean VAS = 88.4 mm, 95% CI 85.0 to 91.8 mm). Conclusion Shoe size selection using the Brannock device® resulted in the allocation of shoes with last dimensions that were well matched to the dimensions of the foot. Participants also considered the shoes to be well fitted and comfortable. Older people with disabling foot pain can therefore be

  10. Older People and Their Attitude to the Use of Information and Communication Technologies--A Review Study with Special Focus on the Czech Republic (Older People and Their Attitude to ICT)

    ERIC Educational Resources Information Center

    Klimova, Blanka; Simonova, Ivana; Poulova, Petra; Truhlarova, Zuzana; Kuca, Kamil

    2016-01-01

    Rising standards of living and good quality health care have contributed to people living longer. According to the Eurostat agency (Benácová & Valenta, 2009), in the next 50 years there will be twice as many older people worldwide. The aging process, however, brings about new economic and social issues. Therefore, there is constant effort to…

  11. Older People Going Online: Its Value and Before-After Evaluation of Volunteer Support

    PubMed Central

    Ashurst, Emily J; Atkey, Jo; Duffy, Barbara

    2015-01-01

    Background Although Internet usage can benefit older people by reducing social isolation, increasing access to services, and improving health and well-being, only a minority are online. Barriers to Internet uptake include attitude and a lack of knowledge and help. We have evaluated volunteer support in helping older people go online. Knowing what value the Internet has been to older people who have just gone online should guide how it is “sold” to those remaining offline. Objective Objectives of this study are (1) to assess the feasibility of recruiting volunteers aged 50 years and older and supporting them in helping people (ie, beneficiaries) aged 65 years and older go online, (2) to assess the impact of beneficiaries using the Internet on contacts with others, loneliness, and mental health, and (3) to assess the perceived value to beneficiaries of going online. Methods Beneficiaries received help in using the Internet from 32 volunteers in one of two ways: (1) one-on-one in their own homes, receiving an average of 12 hours of help over eight visits, or (2) in small group sessions, receiving 12 hours of help over six visits. We assessed, at registration and follow-up, the number of contacts with others, using Lubben’s 6-item Lubben Social Network Scale (LBNS-6), loneliness, using De Jong Gierveld’s 6-item De Jong Gierveld loneliness scale (DJG-6), and mental well-being, using Tennant’s Short Warwick-Edinburgh Mental Well-Being Scale (SWEMWBS). We also assessed how beneficiaries valued going online using a Social Return on Investment (SROI) approach by postal survey. Results A total of 144 beneficiaries were recruited with the aim of helping them go online via one-on-one (n=58) or small group (n=86) sessions. Data through to follow-up were available on 76.4% (110/144) of participants. From baseline to follow-up, the number of contacts with others was significantly increased—LBNS-6, mean 13.7 to mean 17.6—loneliness scores were reduced—DJG-6, mean 2

  12. Warm homes for older people: aims and methods of a randomised community-based trial for people with COPD

    PubMed Central

    2013-01-01

    Background Chronic Obstructive Pulmonary Disease (COPD) is of increasing importance with about one in four people estimated to be diagnosed with COPD during their lifetime. None of the existing medications for COPD has been shown to have much effect on the long-term decline in lung function and there have been few recent pharmacotherapeutic advances. Identifying preventive interventions that can reduce the frequency and severity of exacerbations could have important public health benefits. The Warm Homes for Elder New Zealanders study is a community-based trial, designed to test whether a NZ$500 electricity voucher paid into the electricity account of older people with COPD, with the expressed aim of enabling them to keep their homes warm, results in reduced exacerbations and hospitalisation rates. It will also examine whether these subsidies are cost-beneficial. Methods Participants had a clinician diagnosis of COPD and had either been hospitalised or taken steroids or antibiotics for COPD in the previous three years; their median age was 71 years. Participants were recruited from three communities between 2009 to early 2011. Where possible, participants’ houses were retrofitted with insulation. After baseline data were received, participants were randomised to either ‘early’ or ‘late’ intervention groups. The intervention was a voucher of $500 directly credited to the participants’ electricity company account. Early group participants received the voucher the first winter they were enrolled in the study, late participants during the second winter. Objective measures included spirometry and indoor temperatures and subjective measures included questions about participant health and wellbeing, heating, medication and visits to health professionals. Objective health care usage data included hospitalisation and primary care visits. Assessments of electricity use were obtained through electricity companies using unique customer numbers. Discussion This

  13. Why older people engage in physical activity: an exploratory study of participants in a community-based walking program.

    PubMed

    Capalb, Darren J; O'Halloran, Paul; Liamputtong, Pranee

    2014-01-01

    While older people experience substantial physical and mental health benefits from regular physical activity, participation rates among older people are low. There is a need to gather more information about why older people do and do not engage in physical activity. This paper aims to examine the reasons why older men and women chose to engage in a community-based physical activity program. Specific issues that were examined included reasons why older people who had been involved in a community-based program on a regular basis: commenced the program; continued with the program; and recommenced the program after they had dropped out. Ten participants (eight females and two males) aged between 62 and 75 years, who had been participating in a community-based physical activity program for a minimum of 6 months, were individually interviewed. Thematic analysis was used to analyse the data. Three major themes emerged, including 'time to bond: social interaction' with sub-themes 'bona fide friendships' and 'freedom from being isolated'; 'I want to be healthy: chronic disease management'; and 'new lease on life'. Two of the primary reasons why older people both commenced and recommenced the program were the promise of social interaction and to be able to better manage their chronic conditions. PMID:23241196

  14. Effects of Postprandial Blood Pressure on Gait Parameters in Older People

    PubMed Central

    Nair, Shailaja; Visvanathan, Renuka; Piscitelli, Diana

    2016-01-01

    Postprandial hypotension (PPH), a fall in systolic blood pressure (SBP) within 2 h of a meal, may detrimentally affect gait parameters and increase the falls risk in older people. We aimed to determine the effects of postprandial SBP on heart rate (HR), gait speed, and stride length, double-support time and swing time variability in older subjects with and without PPH. Twenty-nine subjects were studied on three days: glucose (“G”), water and walk (“WW”), glucose and walk (“GW”). Subjects consumed a glucose drink on “G” and “GW” and water on “WW”. The “G” day determined which subjects had PPH. On “WW” and “GW” gait was analyzed. Sixteen subjects demonstrated PPH. In this group, there were significant changes in gait speed (p = 0.040) on “WW” and double-support time variability (p = 0.027) on “GW”. The area under the curve for the change in gait parameters from baseline was not significant on any study day. Among subjects without PPH, SBP increased on “WW” (p < 0.005) and all gait parameters remained unchanged on all study days. These findings suggest that by changing gait parameters, PPH may contribute to an increased falls risk in the older person with PPH. PMID:27089361

  15. Laughter and Subjective Health Among Community-Dwelling Older People in Japan

    PubMed Central

    Hayashi, Kei; Kawachi, Ichiro; Ohira, Tetsuya; Kondo, Katsunori; Shirai, Kokoro; Kondo, Naoki

    2015-01-01

    Abstract The aim of this study was to evaluate the association of laughter with subjective health independent of socioeconomic status and social participation among older people in Japan. We used the data of 26,368 individuals (men, 12,174; women, 14,194) 65 years or older who participated in the Japan Gerontological Evaluation Study (JAGES) in 2013. Participants provided information on laughter and self-rated health, depression, socioeconomic, and psychosocial factors. We evaluated laughter from three perspectives: frequency, opportunities, and interpersonal interactions. Even after adjustment for depression, sociodemographic factors, and social participation, the prevalence ratio for poor subjective health among women who never or almost never laugh was 1.78 (95% confidence interval, 1.48–2.15) compared with those who reported laughing every day. Similar associations were observed among men. Laughter may be an important factor for the promotion of general and mental health of older adults. The mechanisms linking laughter and health warrant further study. PMID:26649930

  16. Prevalence and Clinical Correlates of Sarcopenia in Community-Dwelling Older People: Application of the EWGSOP Definition and Diagnostic Algorithm

    PubMed Central

    2014-01-01

    Background. Muscle impairment is a common condition in older people and a powerful risk factor for disability and mortality. The aim of this study was to apply the European Working Group on Sarcopenia in Older People criteria to estimate the prevalence and investigate the clinical correlates of sarcopenia, in a sample of Italian community-dwelling older people. Methods. Cross-sectional analysis of 730 participants (74% aged 65 years and older) enrolled in the InCHIANTI study. Sarcopenia was defined according to the European Working Group on Sarcopenia in Older People criteria using bioimpedance analysis for muscle mass assessment. Logistic regression analysis was used to identify the factors independently associated with sarcopenia. Results. Sarcopenia defined by the European Working Group on Sarcopenia in Older People criteria increased steeply with age (p < .001), with 31.6% of women and 17.4% of men aged 80 years or older being affected by this condition. Higher education (odds ratio: 0.85; 95% CI: 0.74–0.98), lower insulin-like growth factor I (lowest vs highest tertile, odds ratio: 3.89; 95% CI: 1.03–14.1), and low bioavailable testosterone (odds ratio: 2.67; 95% CI: 1.31–5.44) were independently associated with the likelihood of being sarcopenic. Nutritional intake, physical activity, and level of comorbidity were not associated with sarcopenia. Conclusions. Sarcopenia identified by the European Working Group on Sarcopenia in Older People criteria is a relatively common condition in Italian octogenarians, and its prevalence increases with aging. Correlates of sarcopenia identified in this study might suggest new approaches for prevention and treatment of sarcopenia. PMID:24085400

  17. Social Connections for Older People with Intellectual Disability in Ireland: Results from Wave One of IDS-TILDA

    ERIC Educational Resources Information Center

    McCausland, Darren; McCallion, Philip; Cleary, Eimear; McCarron, Mary

    2016-01-01

    Background: The literature on influences of community versus congregated settings raises questions about how social inclusion can be optimised for people with intellectual disability. This study examines social contacts for older people with intellectual disability in Ireland, examining differences in social connection for adults with intellectual…

  18. The effect of walking on falls in older people: the 'Easy Steps to Health' randomized controlled trial study protocol

    PubMed Central

    2011-01-01

    Background Falls in older people continue to be a major public health issue in industrialized countries. Extensive research into falls prevention has identified exercise as a proven fall prevention strategy. However, despite over a decade of promoting physical activity, hospitalisation rates due to falls injuries in older people are still increasing. This could be because efforts to increase physical activity amongst older people have been unsuccessful, or the physical activity that older people engage in is insufficient and/or inappropriate. The majority of older people choose walking as their predominant form of exercise. While walking has been shown to lower the risk of many chronic diseases its role in falls prevention remains unclear. This paper outlines the methodology of a study whose aims are to determine: if a home-based walking intervention will reduce the falls rate among healthy but inactive community-dwelling older adults (65 + years) compared to no intervention (usual activity) and; whether such an intervention can improve risk factors for falls, such as balance, strength and reaction time. Methods/Design This study uses a randomised controlled trial design. A total of 484 older people exercising less than 120 minutes per week will be recruited through the community and health care referrals throughout Sydney and neighboring regions. All participants are randomised into either the self-managed walking program group or the health-education waiting list group using a block randomization scheme. Outcome measures include prospective falls and falls injuries, quality of life, and physical activity levels. A subset of participants (n = 194) will also receive physical performance assessments comprising of tests of dynamic balance, strength, reaction time and lower limb functional status. Discussion Certain types of physical activity can reduce the risk of falls. As walking is already the most popular physical activity amongst older people, if walking is

  19. The Influence of Patient Characteristics on Anticholinergic Events in Older People

    PubMed Central

    Salahudeen, Mohammed Saji; Nishtala, Prasad S.; Duffull, Stephen B.

    2015-01-01

    Aims To examine patient characteristics that predict adverse anticholinergic-type events in older people. Methods This retrospective population-level study included 2,248 hospitalised patients. Individual data on medicines that are commonly associated with anticholinergic events (delirium, constipation and urinary retention) were identified. Patient characteristics examined were medicines with anticholinergic effects (ACh burden), age, sex, non-anticholinergic medicines (non-ACM), Charlson comorbidity index scores and ethnicity. The Akaike information criterion was used for model selection. The data were analysed using logistic regression models for anticholinergic events using the software NONMEM. Results ACh burden was found to be a significant independent predictor for developing an anticholinergic event [adjusted odds ratio (aOR): 3.21, 95% CI: 1.23-5.81] for those taking an average of 5 anticholinergic medicines compared to those taking 1. Both non-ACM and age were also independent risk factors (aOR: 1.41, 95% CI: 1.31-1.51 and aOR: 1.08, 95% CI: 1.05-1.10, respectively). Conclusion To our knowledge, this is the first study that has examined population-level data in a nonlinear model framework to predict anticholinergic-type adverse events. This study evaluated the relationship between important patient characteristics and the occurrence of anticholinergic-type events. These findings reinforce the clinical significance of reviewing anticholinergic medicines in older people. PMID:26955385

  20. Long-term care and hospital utilisation by older people: an analysis of substitution rates.

    PubMed

    Forder, Julien

    2009-11-01

    Older people are intensive users of hospital and long-term care services. This paper explores the extent to which these services are substitutes. A small area analysis was used with both care home and (tariff cost-weighted) hospital utilisation for older people aggregated to electoral wards in England.Health and social-care structural equations were specified using a theoretical model. The estimation accounted for the skewed and censored nature of the data. For health utilisation, both a fixed effects instrumental variables GMM model and a generalised estimating equations (GEE) model were fitted, the later on a log dependent variable with predicted values of social care utilisation used to account for endogeneity (bootstrapping was used to derive standard errors). In addition to a GMM model, the social-care estimation used both two-part and tobit models (also with predicted health utilisation and bootstrapping).The results indicate that for each additional pound1 spent on care homes, hospital expenditure falls by pound0.35. Also, pound1 additional hospital spend corresponds to just over pound0.35 reduction on care home spend. With these cost substitution effects offsetting, a transfer of resources to care homes is efficient if the resultant outcome gain is greater than the outcome loss from reduced hospital use. PMID:19206085

  1. How To Build an Integrated Neighborhood Approach to Support Community-Dwelling Older People?

    PubMed Central

    Cramm, Jane Murray; Nieboer, Anna Petra

    2016-01-01

    Background: Although the need for integrated neighborhood approaches (INAs) is widely recognized, we lack insight into strategies like INA. We describe diverse Dutch INA partners’ experiences to provide integrated person- and population-centered support to community-dwelling older people using an adapted version of Valentijn and colleagues’ integrated care model. Our main objective was to explore the experiences with INA participation. We sought to increase our understanding of the challenges facing these partners and identify factors facilitating and inhibiting integration within and among multiple levels. Methods: Twenty-one interviews with INA partners (including local health and social care organizations, older people, municipal officers, and a health insurer) were conducted and subjected to latent content analysis. Results: This study showed that integrated care and support provision through an INA is a complex, dynamic process requiring multilevel alignment of activities. The INA achieved integration at the personal, service, and professional levels only occasionally. Micro-level bottom-up initiatives were not aligned with top-down incentives, forcing community workers to establish integration despite rather than because of meso- and macro-level contexts. Conclusions: Top-down incentives should be better aligned with bottom-up initiatives. This study further demonstrated the importance of community-level engagement in integrated care and support provision. PMID:27616960

  2. Forming a new clinical team for frail older people: can a group development model help?

    PubMed

    Anderson, Elizabeth Susan; Pollard, Lorraine; Conroy, Simon; Clague-Baker, Nicola

    2014-03-01

    Integrated services which utilise the expertise of team members along care pathways are evolving. Changes in service structure and subsequent team working arrangements can be a challenge for practitioners expected to redefine how they work with one another. These services are particularly important for the care of frail older people. This exploratory study of one newly forming team presents the views of staff involved in establishing an interprofessional healthcare advisory team for older people within an acute hospital admissions unit. Staff experiences of forming a new service are aligned to a model of team development. The findings are presented as themes relating to the stages of team development and identify the challenges of setting up an integrated service alongside existing services. In particular, team process issues relating to the clarity of goals, role clarification, leadership, team culture and identity. Managers must allow time to ensure new services evolve before setting up evaluation studies for efficiency and effectiveness which might prove against the potential for interprofessional teamworking. PMID:24199595

  3. Effects of the Change in Working Status on the Health of Older People in Japan

    PubMed Central

    Hasebe, Masami; Nonaka, Kumiko; Koike, Takashi; Suzuki, Hiroyuki; Murayama, Yoh; Uchida, Hayato

    2015-01-01

    Background Working at old ages is regarded as a good way to keep one’s health according to the idea of productive aging. However, there is not enough evidence yet whether retirement is good or bad, or the kind of effects it has on the health of older adults aged 65 and over. We examined it by using a recent data of Wako city, a suburb area near Tokyo in Japan. Methods One thousand seven hundred sixty-eight participants answered to 3 waves of survey questionnaires: 2008, 2010, and 2012, successively. We considered 3 indicators of health; self-rated health, mental health (GDS15) and HLFC (Higher-Level Functional Capacity: TMIG-IC). In cross-sectional analysis, we compared these 3 indicators by three groups: full-time worker, part-time worker, and non-worker. In longitudinal analysis, we compared these three indicators by two groups: subjects who successively worked in 2008, 2010, 2012, and subjects who worked in 2008 but retired before 2010. We used one-way and two way repeated measures ANCOVA for these analyses, respectively. Results It was significantly clear that retirement worsened both mental health and HLFC in people aged 65 years and over; especially, mental health worsened rapidly and HLFC gradually. However, these indicators didn’t worsen in subjects who changed from full-time jobs to part-time jobs. Quitting from part-time jobs deteriorated mental health gradually and HLFC moderately compared to full-time jobs. Conclusion The results support the activity theory that older adults who quit from full-time jobs deteriorated both mental health and HLFC, though at different speeds. If they make a transit to part-time jobs, the deterioration would be moderate. It shows that working is an effective way of social participation for older people aged 65 years and over in Japan. PMID:26633033

  4. Balancing risk prevention and health promotion: towards a harmonizing approach in care for older people in the community.

    PubMed

    Janssen, Bienke M; Van Regenmortel, Tine; Abma, Tineke A

    2014-03-01

    Many older people in western countries express a desire to live independently and stay in control of their lives for as long as possible in spite of the afflictions that may accompany old age. Consequently, older people require care at home and additional support. In some care situations, tension and ambiguity may arise between professionals and clients whose views on risk prevention or health promotion may differ. Following Antonovsky's salutogenic framework, different perspectives between professionals and clients on the pathways that lead to health promotion might lead to mechanisms that explain the origin of these tensions and how they may ultimately lead to reduced responsiveness of older clients to engage in care. This is illustrated with a case study of an older woman living in the community, Mrs Jansen, and her health and social care professionals. The study shows that despite good intentions, engagement, clear division of tasks and tailored care, the responsiveness to receive care can indeed not always be taken for granted. We conclude that to harmonize differences in perspectives between professionals and older people, attention should be given to the way older people endow meaning to the demanding circumstances they encounter (comprehensibility), their perceived feelings of control (manageability), as well as their motivation to comprehend and manage events (meaningfulness). Therefore, it is important that both clients and professionals have an open mind and attempt to understand each others' perspective, and have a dialogue with each other, taking the life narrative of clients into account. PMID:22228192

  5. Interactional perspectives on the mistreatment of older and vulnerable people in long-term care settings.

    PubMed

    Stevens, Martin; Biggs, Simon; Dixon, Josie; Tinker, Anthea; Manthorpe, Jill

    2013-06-01

    This article draws on a study aimed at developing theoretical and methodological understanding of the abuse and neglect (mistreatment) of older people in long-term care settings such as care homes and hospitals. It presents an interactionist account of mistreatment of older people in such establishments. Starting with an outline of definitional issues surrounding the topic, the allied concept of dignity is also briefly explored, and one important model described; we present dignity as the converse of mistreatment. The article argues for the potential of a positioning theory analysis of mistreatment. Positioning theory proposes that interactions are based on taking of 'positions', clusters of rights and duties to act in certain ways and impose particular meanings, which enable or prohibit access to certain storylines. It is argued that 'malignant' positioning can contribute to the creation of a climate that allows mistreatment to take place, or fails to prohibit its development. Mistreatment of people with dementia is used as an illustration, and it is argued that this is potentially generated by negative feedback loops of behaviour patterns, interpretations and malignant positioning by staff or family carers and subsequent response to these interpretations by the person with dementia. Positioning theory also allows for an explanation of the importance and impact of organizational cultures and social factors such as ageism. Individual staff members take positions, use meanings and develop storylines imbued with such factors. This understanding therefore overcomes some of the potential confusions created by concepts such as organizational or institutional abuse, removing the need to ascribe intentions and personal responsibility to such constructs. The article concludes with some suggestions for further research to develop an understanding of the kinds of cultures that allow mistreatment and consequently to inform the development of protective measures. PMID:23713559

  6. A Pilot Study of a Creative Bonding Intervention to Promote Nursing Students' Attitudes towards Taking Care of Older People

    PubMed Central

    Lamet, Ann R.; Sonshine, Rosanne; Walsh, Sandra M.; Molnar, David; Rafalko, Sharon

    2011-01-01

    Although numbers of older people are increasing, nursing students have negative attitudes towards older people and do not plan to care for them following graduation. Multiple strategies have been implemented to reverse students' attitudes with mixed results. The purpose of this pilot quasi-experimental study was to test a Creative-Bonding Intervention (CBI) with students implementing art activities with older people to promote students' willingness to take care of them. Using a self-transcendence conceptual framework, control (n = 56) and experimental (n = 14) student groups were pre- and post-tested on attitudes toward older people, self-transcendence, and willingness to serve. The CBI improved attitudes towards older people with negative attitudes significantly changed (P = .008) but with no significant differences on self-transcendence and willingness to serve. However, willingness to serve results approached significance (P = .08). The willingness measure (one question) should be expanded. Curricula changes that incorporate creative activities such as the CBI with larger and equal numbers in student groups and longitudinal follow up to determine long-term results after graduation are suggested. PMID:21994833

  7. The influence of theory and practice on perceptions about caring for ill older people - A literature review.

    PubMed

    Millns Sizer, Stephanie; Burton, Robert L; Harris, Ann

    2016-07-01

    The increasing longevity of the world's population implies the requirement for a nursing workforce who are appropriately equipped to care for older people when they are ill. Although attitudes toward this field of nursing appear to be positive amongst nursing students, fewer students choose the care of ill older people as a career upon qualification; the need to assure the future nursing workforce in this field has been acknowledged globally. In view of the ageing of the world population, there is a need to encourage the care of ill older people as a positive career choice (Koh, 2012). Factors both within the practical learning environment and the environment where students receive theoretical instruction, may potentially impact upon nursing students' attitudes towards caring for ill older people and their career intentions. It is against this background that this review was conducted, in order to identify reasons for this prevailing negativity. It is intended that the review will shed light on strategies to improve these perceptions, showing a career in caring for ill older people in a more positive light. PMID:27428691

  8. Exploring the impact of austerity-driven policy reforms on the quality of the long-term care provision for older people in Belgium and the Netherlands.

    PubMed

    Janssen, David; Jongen, Wesley; Schröder-Bäck, Peter

    2016-08-01

    In this case study, European quality benchmarks were used to explore the contemporary quality of the long-term care provision for older people in the Belgian region of Flanders and the Netherlands following recent policy reforms. Semi-structured qualitative interviews were conducted with various experts on the long-term care provision. The results show that in the wake of the economic crisis and the reforms that followed, certain vulnerable groups of older people in Belgium and the Netherlands are at risk of being deprived of long-term care that is available, affordable and person-centred. Various suggestions were provided on how to improve the quality of the long-term care provision. The main conclusion drawn in this study is that while national and regional governments set the stage through regulatory frameworks and financing mechanisms, it is subsequently up to long-term care organisations, local social networks and informal caregivers to give substance to a high quality long-term care provision. An increased reliance on social networks and informal caregivers is seen as vital to ensure the sustainability of the long-term care systems in Belgium and in the Netherlands, although this simultaneously introduces new predicaments and difficulties. Structural governmental measures have to be introduced to support and protect informal caregivers and informal care networks. PMID:27531456

  9. The influence of cognition on self-management of type 2 diabetes in older people.

    PubMed

    Tomlin, Ali; Sinclair, Alan

    2016-01-01

    Diabetes is a growing public health issue, increasing in prevalence, eroding quality of life, and burdening health care systems. The complications of diabetes can be avoided or delayed by maintaining good glycemic control, which is achievable through self-management and, where necessary, medication. Older people with diabetes are at increased risk for cognitive impairment. This review aims to bring together current research that has investigated both cognition and diabetes self-management together. The Cumulative Index to Nursing and Allied Health (Cinahl), Excerpta Medica Database (Embase), Medical Literature Analysis and Retrieval System (Medline), and Psychological Information (PsychInfo) databases were searched. Studies were included if they featured older people with type 2 diabetes and had looked for associations between at least one distinct measure of cognition and at least one distinct measure of diabetes self-management. English language publications from the year 2000 were included. Cognitive measures of executive function, memory, and low scores on tests of global cognitive functioning showed significant correlations with multiple areas of diabetes self-management, including diabetes-specific numeracy ability, diabetes knowledge, insulin adjustment skills, ability to learn to perform insulin injections, worse adherence to medications, decreased frequency of self-care activities, missed appointments, decreased frequency of diabetes monitoring, and increased inaccuracies in reporting blood glucose monitoring. The nature of the subjects studied was quite variable in terms of their disease duration, previous medical histories, associated medical comorbidities, and educational level attained prior to being diagnosed with diabetes. The majority of studies were of an associational nature and not findings confirmed by repeat testing or by the effects of an intervention, neither were the majority of studies designed to give a view or conclusion on the clinical

  10. Blood pressure and mortality in elderly people aged 85 and older: community based study

    PubMed Central

    Boshuizen, Hendriek C; Izaks, Gerbrand J; van Buuren, Stef; Ligthart, Gerard J

    1998-01-01

    Objective: To determine whether the inverse relation between blood pressure and all cause mortality in elderly people over 85 years of age can be explained by adjusting for health status, and to determine whether high blood pressure is a risk factor for mortality when the effects of poor health are accounted for. Design: 5 to 7 year follow up of community residents aged 85 years and older. Setting: Leiden, the Netherlands. Subjects: 835 subjects whose blood pressure was recorded between 1987 and 1989. Main outcome measure: All cause mortality. Results: An inverse relation between blood pressure and all cause mortality was observed. For diastolic blood pressure crude 5 year all cause mortality decreased from 88% (52/59) (95% confidence interval 79% to 95%) in those with diastolic blood pressures <65 mm Hg to 59% (27/46) (44% to 72%) in those with diastolic pressures >100 mm Hg. For systolic blood pressure crude 5 year all cause mortality decreased from 85% (95/112) (78% to 91%) in those with systolic pressures <125 mm Hg to 59% (13/22) (38% to 78%) in those with systolic pressures >200 mm Hg. This decrease was no longer significant after adjustment for indicators of poor health. No relation existed between blood pressure and mortality from cardiovascular causes or stroke after adjustment for age and sex, but after adjustment for age, sex, and indicators of poor health there was a positive relation between diastolic blood pressure and mortality from both cardiovascular causes and stroke. Conclusion: The inverse relation between blood pressure and all cause mortality in elderly people over 85 is associated with health status. Key messages Among community residents aged 85 and older there was a paradoxical inverse relation between blood pressure and all cause mortality: higher blood pressure was associated with lower mortality This inverse relation seems mainly to be due to higher mortality in those with low blood pressure; low blood pressure seems to be

  11. The influence of cognition on self-management of type 2 diabetes in older people

    PubMed Central

    Tomlin, Ali; Sinclair, Alan

    2016-01-01

    Diabetes is a growing public health issue, increasing in prevalence, eroding quality of life, and burdening health care systems. The complications of diabetes can be avoided or delayed by maintaining good glycemic control, which is achievable through self-management and, where necessary, medication. Older people with diabetes are at increased risk for cognitive impairment. This review aims to bring together current research that has investigated both cognition and diabetes self-management together. The Cumulative Index to Nursing and Allied Health (Cinahl), Excerpta Medica Database (Embase), Medical Literature Analysis and Retrieval System (Medline), and Psychological Information (PsychInfo) databases were searched. Studies were included if they featured older people with type 2 diabetes and had looked for associations between at least one distinct measure of cognition and at least one distinct measure of diabetes self-management. English language publications from the year 2000 were included. Cognitive measures of executive function, memory, and low scores on tests of global cognitive functioning showed significant correlations with multiple areas of diabetes self-management, including diabetes-specific numeracy ability, diabetes knowledge, insulin adjustment skills, ability to learn to perform insulin injections, worse adherence to medications, decreased frequency of self-care activities, missed appointments, decreased frequency of diabetes monitoring, and increased inaccuracies in reporting blood glucose monitoring. The nature of the subjects studied was quite variable in terms of their disease duration, previous medical histories, associated medical comorbidities, and educational level attained prior to being diagnosed with diabetes. The majority of studies were of an associational nature and not findings confirmed by repeat testing or by the effects of an intervention, neither were the majority of studies designed to give a view or conclusion on the clinical

  12. 'Only old ladies would do that': age stigma and older people's strategies for dealing with winter cold.

    PubMed

    Day, Rosie; Hitchings, Russell

    2011-07-01

    Concerns over the welfare of older people in winter have led to interventions and advice campaigns meant to improve their ability to keep warm, but older people themselves are not always willing to follow these recommendations. In this paper we draw on an in-depth study that followed twenty one older person households in the UK over a cold winter and examined various aspects of their routine warmth-related practices at home and the rationales underpinning them. We find that although certain aspects of ageing did lead participants to feel they had changing warmth needs, their practices were also shaped by the problematic task of negotiating identities in the context of a wider stigmatisation of older age and an evident resistance to ageist discourses. After outlining the various ways in which this was manifest in our study, we conclude by drawing out the implications for future policy and research. PMID:21606000

  13. Characteristics of effective Internet-mediated interventions to change lifestyle in people aged 50 and older: a systematic review.

    PubMed

    Aalbers, T; Baars, M A E; Rikkert, M G M Olde

    2011-09-01

    Worldwide, the number of people aged 60 years and older steadily grows to a predicted 2 billion in 2050. Online interventions increasingly target lifestyle risk factors to promote healthy aging. The objective of this systematic review is to evaluate whether Internet mediated lifestyle interventions can successfully change lifestyle in people aged 50 and older. A PubMed search was conducted resulting in twelve articles, based on ten studies. The studies focused on physical activity, weight loss, nutrition, and diabetes. Nine studies used feasible interventions, with an average small to moderate effect size. The most important result is that there are multiple studies reporting positive lifestyle changes in an older population. On average, complex interventions, whether they present tailored or generic information, and online or offline comparison, are more effective than interventions with only one component. Internet mediated interventions hold great potential in implementing effective lifestyle programs, capable of reaching large populations of older persons at very low costs. PMID:21628005

  14. Predicting Falls and When to Intervene in Older People: A Multilevel Logistical Regression Model and Cost Analysis

    PubMed Central

    Smith, Matthew I.; de Lusignan, Simon; Mullett, David; Correa, Ana; Tickner, Jermaine; Jones, Simon

    2016-01-01

    Introduction Falls are the leading cause of injury in older people. Reducing falls could reduce financial pressures on health services. We carried out this research to develop a falls risk model, using routine primary care and hospital data to identify those at risk of falls, and apply a cost analysis to enable commissioners of health services to identify those in whom savings can be made through referral to a falls prevention service. Methods Multilevel logistical regression was performed on routinely collected general practice and hospital data from 74751 over 65’s, to produce a risk model for falls. Validation measures were carried out. A cost-analysis was performed to identify at which level of risk it would be cost-effective to refer patients to a falls prevention service. 95% confidence intervals were calculated using a Monte Carlo Model (MCM), allowing us to adjust for uncertainty in the estimates of these variables. Results A risk model for falls was produced with an area under the curve of the receiver operating characteristics curve of 0.87. The risk cut-off with the highest combination of sensitivity and specificity was at p = 0.07 (sensitivity of 81% and specificity of 78%). The risk cut-off at which savings outweigh costs was p = 0.27 and the risk cut-off with the maximum savings was p = 0.53, which would result in referral of 1.8% and 0.45% of the over 65’s population respectively. Above a risk cut-off of p = 0.27, costs do not exceed savings. Conclusions This model is the best performing falls predictive tool developed to date; it has been developed on a large UK city population; can be readily run from routine data; and can be implemented in a way that optimises the use of health service resources. Commissioners of health services should use this model to flag and refer patients at risk to their falls service and save resources. PMID:27448280

  15. Nutritional status in cognitively intact older people receiving home care services--a pilot study.

    PubMed

    Soini, H; Routasalo, P; Lagstrom, H

    2005-01-01

    Older adults are a potentially vulnerable group for malnutrition. This cross-sectional pilot study aims to assess the nutritional status of elderly patients living at home and receiving home health care services. The data were collected from patient care plans, the Mini Nutritional Assessment (MNA), and a questionnaire on eating problems. In addition, serum nutritional status indicators were measured, and an oral examination including quantitative saliva measurement was carried out. Out of 71 eligible patients 51 (72%) patients aged 76-93 years participated. MNA results showed that 47% were at risk of malnutrition. Care plans for 26 patients made reference to questions of nutrition but provided no detailed forward planning. The mean serum albumin value was 39.1 +/- 3.8 g/l, seven patients had a value lower than 35 g/l. MNA scores were significantly lower for female patients with haemoglobin values lower than 120 g/l (p = 0.027). The dentist's estimation of dry mouth and subjective problems in energy intake were significantly associated with lower MNA scores (p = 0.049 and p = 0.015). Subjects with functioning natural dentition had higher body mass index (BMI) scores than others (p = 0.0485). The results point at the importance of using screening tools such as the MNA for purposes of nutritional assessment, the estimation of oral problems such as dry mouth, chewing and swallowing problems, and advance planning in nutritional issues within the field of home care. PMID:15980925

  16. Methods used to identify and measure resource use in economic evaluations: a systematic review of questionnaires for older people.

    PubMed

    Martin, Adam; Jones, Alex; Mugford, Miranda; Shemilt, Ian; Hancock, Ruth; Wittenberg, Raphael

    2012-08-01

    This paper presents the findings of a systematic review of full or partial economic evaluations that included questions to service users or their carers to elicit information on the types, amounts or costs of community-based formal social care support provided to people 65 years and older. We have found that studies seldom report use of published validated questions for eliciting information from older people in the UK about their use of formal social care services. Given the political prominence of the debate over funding social care for older people, there remains a need for analysis of policy options. This requires reliable data on the receipt and payment for care. We recommend the development of improved questions on care that are clear, robust and up-to-date with developments in policy and practice. PMID:21751293

  17. An alternative discourse of productive aging: A self-restrained approach in older Chinese people in Hong Kong.

    PubMed

    Luo, Minxia; Chui, Ernest Wing-Tak

    2016-08-01

    While Western discourses regarding productive aging emphasize individuals' contributions to economic productivity, the Confucian cultural heritage of the Chinese community may provide an alternative perspective. This qualitative study explores interpretations of what constitutes productive aging, based on a series of in-depth interviews with older Chinese people in Hong Kong. It shows that some of these individuals adopted a passive and indirect interpretation of productive aging, distinct from that found in Western countries. The Confucianism-based, collectivist, normative order underpinning Hong Kong society disposed these older people to adopting a self-restrained attitude with the aim of avoiding becoming a burden to others, especially family members. Such a tendency toward self-restraint or avoidance also encompassed a compromise between ideals and reality, with the older people opting to compromise their expectations of the younger generation as a whole, their adult children in particular, in terms of respect and reciprocity. PMID:27531450

  18. Home care for older people in Sweden: a universal model in transition.

    PubMed

    Szebehely, Marta; Trydegård, Gun-Britt

    2012-05-01

    One aspect of universalism in Swedish eldercare services is that publicly financed and publicly provided services have been both affordable for the poor and attractive enough to be preferred by the middle class. This article identifies two trends in home care for older people in Sweden: a decline in the coverage of publicly funded services and their increasing marketisation. We explore the mechanisms behind these trends by reviewing policy documents and official reports, and discuss the distributional consequences of the changes by analysing two data sets from Statistics Sweden: the Swedish Level of Living surveys from 1988/1989 and 2004/2005 and a database on all users of tax deductions on household and care services in 2009. The analysis shows that the decline of tax-funded home care is not the result of changing eldercare legislation and was not intended by national policy-makers. Rather the decline was caused by a complex interplay of decision-making at central and local levels, resulting in stricter municipal targeting. The trend towards marketisation has been more clearly intended by national policy-makers. Legislative changes have opened up tax-funded services to private provision, and a customer-choice (voucher) model and a tax deduction for household- and care services have been introduced. As a result of declining tax-funded home-care services, older persons with lower education increasingly receive family care, while those with higher education are more likely to buy private services. The combination of income-related user fees, customer-choice models and the tax deduction has created an incentive for high-income older persons to turn to the market instead of using public home-care services. Thus, Swedish home care, as a universal welfare service, is now under threat and may become increasingly dominated by groups with less education and lower income which, in turn, could jeopardise the quality of care. PMID:22141377

  19. Development of hand phenotypes and changes in hand pain and problems over time in older people

    PubMed Central

    Green, Daniel J.; Jordan, Kelvin P.; Protheroe, Joanne; van der Windt, Danielle A.

    2015-01-01

    Abstract Hand disabilities are frequent causes of pain and disability in older people, yet knowledge regarding the characteristics and patterns of hand pain and problems over time is lacking. The main aim of this study was to identify subgroups of older individuals with distinct presentations (phenotypes) of hand pain and function, investigate how these might change over a 6-year period, and explore what characteristics and factors are associated with long-term status. The study population stemmed from the North Staffordshire Osteoarthritis Project, a large, general population–based, prospective, cohort study of adults aged 50 years and older. Information on hand pain and problems was collected using questionnaires at baseline, 3 years, and 6 years. Overall, 5617 participants responded at all time points and were included in the analysis. Five phenotypes were identified using latent transition analysis (“least affected,” “high pain,” “poor gross function,” “high pain and poor gross function,” and “severely affected”) based on 8 hand pain and functional items. The most common transition between phenotypes was from “high pain” at baseline to “least-affected” group. There was a high level of stability in individuals in the “least-affected” or “severely affected” group at baseline. Individuals with widespread body pain, nodes, sleep problems, and pain in both hands at baseline were more likely to be in a severe hand phenotype at 6 years. The results provide clinically relevant information regarding the pattern of hand pain and problems over time and factors that predict transition to more severe hand phenotypes. PMID:26529269

  20. Caught between intending and doing: older people ideating on a self-chosen death

    PubMed Central

    van Wijngaarden, Els; Leget, Carlo; Goossensen, Anne

    2016-01-01

    Objectives The aim of this paper is to provide insight into what it means to live with the intention to end life at a self-chosen moment from an insider perspective. Setting Participants who lived independent or semidependent throughout the Netherlands. Participants 25 Dutch older citizens (mean age of 82 years) participated. They were ideating on a self-chosen death because they considered their lives to be no longer worth living. Inclusion criteria were that they: (1) considered their lives to be ‘completed’; (2) suffered from the prospect of living on; (3) currently wished to die; (4) were 70 years of age or older; (5) were not terminally ill; (6) considered themselves to be mentally competent; (7) considered their death wish reasonable. Design In this qualitative study, in-depth interviews were carried out in the participants’ everyday home environment (median lasting 1.56 h). Verbatim transcripts were analysed based on the principles of phenomenological thematic analysis. Results The liminality or ‘in-betweenness’ of intending and actually performing self-directed death (or not) is characterised as a constant feeling of being torn explicated by the following pairs of themes: (1) detachment and attachment; (2) rational and non-rational considerations; (3) taking control and lingering uncertainty; (4) resisting interference and longing for support; (5) legitimacy and illegitimacy. Conclusions Our findings show that the in-between period emerges as a considerable, existential challenge with both rational and non-rational concerns and thoughts, rather than a calculative, coherent sum of rational considerations. Our study highlights the need to take due consideration of all ambiguities and ambivalences present after a putatively rational decision has been made in order to develop careful policy and support for this particular group of older people. PMID:26781505

  1. Factors Associated With Cancer Worry Among People Aged 50 or Older, Spain, 2012–2014

    PubMed Central

    Sotos, Joseba Rabanales; Herráez, María José Simarro; Rosa, Monchi Campos; López, Jaime López-Torres; Ortiz, María Pilar Sánchez

    2015-01-01

    Introduction Cancer worry varies among patients and may influence their participation in preventive activities. We tested whether sociodemographic characteristics, lifestyle, locus of control, comorbidity, and perceived health status were associated with the level of cancer worry among adults aged 50 or older. Methods We conducted an observational cross-sectional study of 666 adults in Spain aged 50 or older. Participants were selected by simple random sampling and asked to visit their designated health center for a personal interview. The study variables were level of cancer worry (measured by Cancer Worry Scale [CWS]), sociodemographic characteristics, lifestyle, personal history or family history of cancer, comorbidity, self-perceived health, locus of control, and social support. Results More than half of participants, 58.1%, were women; mean age was 60.5 years (standard deviation [SD], 6.8 y). Measurement of the frequency and severity of cancer worry (possible scale of 6–24 points) yielded a mean CWS score of 9.3 (95% confidence interval, 9.0–9.5); 31.9% of participants reported being concerned about cancer. Scores were higher among women (9.7 [SD, 3.3]) than men (8.7 [SD, 2.7]) (P < .001) and among participants in rural settings (10.0 [SD, 3.4]) than in urban settings (9.0 [SD, 3.0]) (P < .001). Multiple linear regression showed a greater degree of cancer worry among people with personal or family history of cancer, more health problems, worse self-perceived health, and lower social support. Conclusion Cancer worry is frequent among older adults, and the level of such concern is related not only to personal characteristics but also to lifestyle and health status. Further research is required to understand how contextual factors can influence cancer worry and how such concern changes behavior patterns related to cancer prevention activities. PMID:26704444

  2. [Application of music therapy for managing agitated behavior in older people with dementia].

    PubMed

    Sung, Huei-Chuan; Chang, Anne M; Abbey, Jennifer

    2006-10-01

    Older people with dementia may display negative emotions, memory problems, sleep disturbance, and agitated behavior. Among these symptoms, agitated behavior has been identified by families and nursing staff as the care problem that presents the greatest challenge. Several studies have found that music therapy reduced agitated behaviors in those with dementia and recommended use of music as an effective strategy in managing this behavioral problem. Music therapy represents a lower cost, effective care approach that nursing staff can easily learn and apply to those with dementia. Furthermore, reductions in agitated behavior in dementia patients that result from music therapy can also alleviate caregiver stress and burden of care, leading to improvements in the health and quality of life of both dementia patients and their caregivers. This paper aims to introduce the principles and application of music therapy in the management of agitated behavior in those with dementia. PMID:17004208

  3. Sleep and aging: 2. Management of sleep disorders in older people.

    PubMed

    Wolkove, Norman; Elkholy, Osama; Baltzan, Marc; Palayew, Mark

    2007-05-01

    The treatment of sleep-related illness in older patients must be undertaken with an appreciation of the physiologic changes associated with aging. Insomnia is common among older people. When it occurs secondary to another medical condition, treatment of the underlying disorder is imperative. Benzodiazepines, although potentially effective, must be used with care and in conservative doses. Daytime sedation, a common side effect, may limit use of benzodiazepines. Newer non-benzodiazepine drugs appear to be promising. Rapid eye movement (REM) sleep behaviour disorder can be treated with clonazepam, levodopa-carbidopa or newer dopaminergic agents such as pramipexole. Sleep hygiene is important to patients with narcolepsy. Excessive daytime sleepiness can be treated with central stimulants; cataplexy may be improved with an antidepressant. Restless legs syndrome and periodic leg-movement disorder are treated with benzodiazepines or dopaminergic agents such as levodopa-carbidopa and, more recently, newer dopamine agonists. Treatment of obstructive sleep apnea includes weight reduction and proper sleep positioning (on one's side), but may frequently necessitate the use of a continuous positive air-pressure (CPAP) device. When used regularly, CPAP machines are very effective in reducing daytime fatigue and the sequelae of untreated obstructive sleep apnea. PMID:17485699

  4. Functional decline and herpes zoster in older people: an interplay of multiple factors.

    PubMed

    2015-12-01

    Herpes zoster is a frequent painful infectious disease whose incidence and severity increase with age. In older people, there is a strong bidirectional link between herpes zoster and functional decline, which refers to a decrement in ability to perform activities of daily living due to ageing and disabilities. However, the exact nature of such link remains poorly established. Based on the opinion from a multidisciplinary group of experts, we here propose a new model to account for the interplay between infection, somatic/psychiatric comorbidity, coping skills, polypharmacy, and age, which may account for the functional decline related to herpes zoster in older patients. This model integrates the risk of decompensation of underlying disease; the risk of pain becoming chronic (e.g. postherpetic neuralgia); the risk of herpes zoster non-pain complications; the detrimental impact of herpes zoster on quality of life, functioning, and mood; the therapeutic difficulties due to multimorbidity, polypharmacy, and ageing; and the role of stressful life events in the infection itself and comorbid depression. This model underlines the importance of early treatment, strengthening coping, and vaccine prevention. PMID:26440662

  5. Sex differences in the response to resistance exercise training in older people.

    PubMed

    Da Boit, Mariasole; Sibson, Rachael; Meakin, Judith R; Aspden, Richard M; Thies, Frank; Mangoni, Arduino A; Gray, Stuart Robert

    2016-06-01

    Resistance exercise training is known to be effective in increasing muscle mass in older people. Acute measurement of protein metabolism data has indicated that the magnitude of response may differ between sexes. We compared adaptive responses in muscle mass and function to 18 weeks resistance exercise training in a cohort of older (>65 years) men and women. Resistance exercise training improved knee extensor maximal torque, 4 m walk time, time to complete five chair rises, muscle anatomical cross-sectional area (ACSA) and muscle quality with no effect on muscle fat/water ratio or plasma glucose, insulin, triacylglycerol, IL-6, and TNF-α Differences between sexes were observed for knee extensor maximal torque and muscle quality with greater increases observed in men versus women (P < 0.05). Maximal torque increased by 15.8 ± 10.6% in women and 41.7 ± 25.5% in men, whereas muscle quality increased by 8.8 ± 17.5% in women and by 33.7 ± 25.6% in men. In conclusion, this study has demonstrated a difference in the magnitude of adaptation, of some of the outcome measures employed, in response to 18 weeks of resistance exercise training between men and women. The mechanisms underlying this observation remain to be established. PMID:27354538

  6. Poor Lower Extremity Function Was Associated with Pre-Diabetes and Diabetes in Older Chinese People

    PubMed Central

    Wang, Wei; Zhou, Chunling; Xu, Limin; Qiu, Jiahe; Wang, Jiaqi; Meng, Xiangxue; Liang, Yixiong; Niu, Kaijun; Guo, Qi

    2014-01-01

    Objective To determine whether a relationship exists between performance-based physical assessments and pre-diabetes/diabetes in an older Chinese population. Methods Our study population comprised 976 subjects (mean ± SD age: 67.6±6.0 years; 44.5% men) from the Hangu area of Tianjin, China. Diabetes was defined by self-reporting of a physician's diagnosis, or a fasting plasma glucose level ≥126 mg/dL; and pre-diabetes was defined as a fasting plasma glucose level ≥100 mg/dL and <126 mg/dL. Results When all other variables were adjusted for, men needing longer to finish a Timed Up and Go Test and a decreased usual walking speed had higher odds of pre-diabetes (P for trend = 0.007 and 0.008, respectively) and diabetes (P for trend = 0.012 and 0.014, respectively). However, women needing longer to finish the test and a decreased usual walking speed had a higher odds of diabetes (P for trend = 0.020 and 0.034, respectively) but not of pre-diabetes. There was no apparent association between grip strength and pre-diabetes/diabetes in both sexes. Conclusions In this study, poor lower extremity function was associated with pre-diabetes/diabetes in older people. PMID:25531769

  7. Effects of Tai Chi exercise on physical and psychological health of older people.

    PubMed

    Blake, Holly; Hawley, Helen

    2012-02-01

    Tai Chi is a traditional Chinese form of conditioning exercise derived from martial arts and rooted in eastern philosophy and Chinese Medicine. Based on the inter-relatedness of mind, body and spirit this form of exercise focuses on producing an inner calmness which is thought to have both physical and psychological therapeutic value. This article provides a brief overview of selected current evidence examining the relationship between Tai Chi and physical, neurocognitive and psychosocial outcomes in older people. This is an emerging and growing area of research and improvements have often been reported in health functioning, physical and emotional health, reducing falls, fear of falling and risk of falls, and possibly enhancing cardiovascular functioning in older adults although the effects on bone density, cognitive and immunological functioning are less clear. Results overall are inconsistent and health improvements have not been evident in all studies. Tai Chi is becoming increasingly popular in practice, and more recent evidence is emerging which is based on experimental and longitudinal designs, although many of the proposed benefits of Tai Chi are yet to be validated in large, randomised controlled trials. PMID:21762093

  8. Social Determinants of Discharge Outcomes in Older People Admitted to a Geriatric Medicine Ward.

    PubMed

    Hawker, M; Romero-Ortuno, R

    2016-01-01

    The factors determining hospital discharge outcomes in older people are complex. This retrospective study was carried out in an in-patient geriatric ward over a month in 2015 and aimed to explore if self-reported feeling of loneliness and clinical frailty contribute to longer hospital stays or higher rates of readmission to hospital after discharge in the older population. Twenty-two men and twenty-five women (mean age 85.1 years) were assessed. There was a significant multivariate association between both self-reported loneliness (p=0.021) and the Clinical Frailty Scale (p=0.010) with length of stay, after adjusting for age, dementia and living alone. In multivariate analysis, patients who lived alone were more likely to be readmitted to hospital within 30 days (p=0.036). Loneliness, living alone and clinical frailty were associated with adverse discharge outcomes. Lower thresholds for referral to voluntary organisations and for psychosocial interventions in patients who report loneliness or live alone may be beneficial. PMID:27224503

  9. Living with constipation—older people's experiences and strategies with constipation before and during hospitalization

    PubMed Central

    Munch, Lene; Tvistholm, Nina; Trosborg, Ingelise; Konradsen, Hanne

    2016-01-01

    Background Constipation is a common problem among older people. This study aimed to explore how older patients experience constipation and which strategies they used in handling the condition before and during hospitalization. Methods A qualitative exploratory research design was used. Fourteen semi-structured interviews were conducted with patients (61–91 years of age) during hospitalization. Data were analyzed by using content analysis. Results Themes concerning experiences were Bodily signs and symptoms of constipation; the participants described severe pain during constipation, as well as pronounced relief after bowel movements, Impact on well-being and social activities; being constipated negatively impacted their mood and limited social activities, Striving for bowel balance; the participants experienced an ongoing strive for balancing between constipation and diarrhea. Themes related to strategies were Struggling to find a solution; they were aware of different strategies to prevent and treat constipation, though the most common solution described was the use of laxatives, Wait and see; the participants were awaiting to take action until they experienced constipation symptoms, Constipation is a private problem being challenged during hospitalization; constipation was considered a private issue rarely discussed with health-care professionals. Conclusion This study illuminates the need for health-care professionals to be attentive to this issue and initiate the conversation with patients in order to advise on the management of constipation. PMID:27121271

  10. Preventing aspiration pneumonia in older people: do we have the 'know-how'?

    PubMed

    Luk, James K H; Chan, Daniel K Y

    2014-10-01

    Aspiration pneumonia is common in older people. To reduce the risk of aspiration pneumonia, maintenance of good oral hygiene is important and medications affecting salivary flow or causing sedation are best avoided, if possible. The use of H2 blockers and proton-pump inhibitors should be minimised. Different compensatory and facilitation techniques can be applied during oral feeding. Hand feeding should be tried before consideration of tube feeding. The use of tube feeding is the last resort and is mainly for improving nutrition and hydration. Prevention of aspiration pneumonia and increasing survival rates should not be the rationales for tube feeding. Feeding via both gastrostomy and nasogastric tube has similar risks for aspiration pneumonia, and continuous pump feeding is not better than intermittent feeding. Jejunal feeding might decrease the chance of aspiration pneumonia in selected high-risk patients. If older patients are on angiotensin-converting enzyme inhibitors without intolerable cough, continuing the drug may be beneficial. Folate deficiency, if present, needs to be promptly corrected. Further better-designed studies are warranted to find the best ways for prevention of aspiration pneumonia. PMID:24993858

  11. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2

    PubMed Central

    O'Mahony, Denis; O'Sullivan, David; Byrne, Stephen; O'Connor, Marie Noelle; Ryan, Cristin; Gallagher, Paul

    2015-01-01

    Purpose: screening tool of older people's prescriptions (STOPP) and screening tool to alert to right treatment (START) criteria were first published in 2008. Due to an expanding therapeutics evidence base, updating of the criteria was required. Methods: we reviewed the 2008 STOPP/START criteria to add new evidence-based criteria and remove any obsolete criteria. A thorough literature review was performed to reassess the evidence base of the 2008 criteria and the proposed new criteria. Nineteen experts from 13 European countries reviewed a new draft of STOPP & START criteria including proposed new criteria. These experts were also asked to propose additional criteria they considered important to include in the revised STOPP & START criteria and to highlight any criteria from the 2008 list they considered less important or lacking an evidence base. The revised list of criteria was then validated using the Delphi consensus methodology. Results: the expert panel agreed a final list of 114 criteria after two Delphi validation rounds, i.e. 80 STOPP criteria and 34 START criteria. This represents an overall 31% increase in STOPP/START criteria compared with version 1. Several new STOPP categories were created in version 2, namely antiplatelet/anticoagulant drugs, drugs affecting, or affected by, renal function and drugs that increase anticholinergic burden; new START categories include urogenital system drugs, analgesics and vaccines. Conclusion: STOPP/START version 2 criteria have been expanded and updated for the purpose of minimizing inappropriate prescribing in older people. These criteria are based on an up-to-date literature review and consensus validation among a European panel of experts. PMID:25324330

  12. Access to primary care for socioeconomically disadvantaged older people in rural areas: a realist review

    PubMed Central

    Ford, John A; Wong, Geoff; Jones, Andy P; Steel, Nick

    2016-01-01

    Objective The aim of this review is to identify and understand the contexts that effect access to high-quality primary care for socioeconomically disadvantaged older people in rural areas. Design A realist review. Data sources MEDLINE and EMBASE electronic databases and grey literature (from inception to December 2014). Eligibility criteria for selecting studies Broad inclusion criteria were used to allow articles which were not specific, but might be relevant to the population of interest to be considered. Studies meeting the inclusion criteria were assessed for rigour and relevance and coded for concepts relating to context, mechanism or outcome. Analysis An overarching patient pathway was generated and used as the basis to explore contexts, causal mechanisms and outcomes. Results 162 articles were included. Most were from the USA or the UK, cross-sectional in design and presented subgroup data by age, rurality or deprivation. From these studies, a patient pathway was generated which included 7 steps (problem identified, decision to seek help, actively seek help, obtain appointment, get to appointment, primary care interaction and outcome). Important contexts were stoicism, education status, expectations of ageing, financial resources, understanding the healthcare system, access to suitable transport, capacity within practice, the booking system and experience of healthcare. Prominent causal mechanisms were health literacy, perceived convenience, patient empowerment and responsiveness of the practice. Conclusions Socioeconomically disadvantaged older people in rural areas face personal, community and healthcare barriers that limit their access to primary care. Initiatives should be targeted at local contextual factors to help individuals recognise problems, feel welcome, navigate the healthcare system, book appointments easily, access appropriate transport and have sufficient time with professional staff to improve their experience of healthcare; all of which

  13. Recruiting older people to a randomised controlled dietary intervention trial - how hard can it be?

    PubMed Central

    2010-01-01

    Background The success of a human intervention trial depends upon the ability to recruit eligible volunteers. Many trials fail because of unrealistic recruitment targets and flawed recruitment strategies. In order to predict recruitment rates accurately, researchers need information on the relative success of various recruitment strategies. Few published trials include such information and the number of participants screened or approached is not always cited. Methods This paper will describe in detail the recruitment strategies employed to identify older adults for recruitment to a 6-month randomised controlled dietary intervention trial which aimed to explore the relationship between diet and immune function (The FIT study). The number of people approached and recruited, and the reasons for exclusion, will be discussed. Results Two hundred and seventeen participants were recruited to the trial. A total of 7,482 letters were sent to potential recruits using names and addresses that had been supplied by local Family (General) Practices. Eight hundred and forty three potential recruits replied to all methods of recruitment (528 from GP letters and 315 from other methods). The eligibility of those who replied was determined using a screening telephone interview, 217 of whom were found to be suitable and agreed to take part in the study. Conclusion The study demonstrates the application of multiple recruitment methods to successfully recruit older people to a randomised controlled trial. The most successful recruitment method was by contacting potential recruits by letter on NHS headed note paper using contacts provided from General Practices. Ninety percent of recruitment was achieved using this method. Adequate recruitment is fundamental to the success of a research project, and appropriate strategies must therefore be adopted in order to identify eligible individuals and achieve recruitment targets. Trial registration number ISRCTN45031464. PMID:20175903

  14. Ethnographic process evaluation of a quality improvement project to improve transitions of care for older people

    PubMed Central

    Sutton, Elizabeth; Dixon-Woods, Mary; Tarrant, Carolyn

    2016-01-01

    Objectives Quality improvement projects to address transitions of care across care boundaries are increasingly common but meet with mixed success for reasons that are poorly understood. We aimed to characterise challenges in a project to improve transitions for older people between hospital and care homes. Design Independent process evaluation, using ethnographic observations and interviews, of a quality improvement project. Setting and participants An English hospital and two residential care homes for older people. Data 32 hours of non-participant observations and 12 semistructured interviews with project members, hospital and care home staff. Results A hospital-based improvement team sought to reduce unplanned readmissions from residential care homes using interventions including a community-based geriatric team that could be accessed directly by care homes and a communication tool intended to facilitate transfer of information between homes and hospital. Only very modest (if any) impacts of these interventions on readmission rates could be detected. The process evaluation identified multiple challenges in implementing interventions and securing improvement. Many of these arose because of lack of consensus on the nature of the problem and the proper solutions: while the hospital team was keen to reduce readmissions and saw the problems as lying in poor communication and lack of community-based support for care homes, the care home staff had different priorities. Care home staff were unconvinced that the improvement interventions were aligned with their needs or addressed their concerns, resulting in compromised implementation. Conclusions Process evaluations have a valuable role in quality improvement. Our study suggests that a key task for quality improvement projects aimed at transitions of care is that of developing a shared view of the problem to be addressed. A more participatory approach could help to surface assumptions, interpretations and interests

  15. Barriers faced by healthcare professionals when managing falls in older people in Kuala Lumpur, Malaysia: a qualitative study

    PubMed Central

    Loganathan, Annaletchumy; Ng, Chirk Jenn; Tan, Maw Pin; Low, Wah Yun

    2015-01-01

    Objective To explore the barriers faced by healthcare professionals (HCPs) in managing falls among older people (aged above 60 years) who have a high risk of falling. Research design The study used a qualitative methodology, comprising 10 in-depth interviews and two focus group discussions. A semistructured topic guide was used to facilitate the interviews, which were audio recorded, transcribed verbatim and checked for accuracy. Data were analysed thematically using WeftQDA software. Participants 20 HCPs who managed falls in older people. Setting This study was conducted at the Primary Care Clinic in the University Malaya Medical Centre (UMMC), Malaysia. Results Four categories of barriers emerged—these were related to perceived barriers for older people, HCPs’ barriers, lack of caregiver support and healthcare system barriers. HCPs perceived that older people normalised falls, felt stigmatised, were fatalistic, as well as in denial regarding falls-related advice. HCPs themselves trivialised falls and lacked the skills to manage falls. Rehabilitation was impeded by premature decisions to admit older people to nursing homes. Lastly, there was a lack of healthcare providers as well as a dearth of fall education and training on fall prevention for HCPs. Conclusions This study identified barriers that explain poor fall management in older people with a high risk of falls. The lack of structured fall prevention guidelines and insufficient training in fall management made HCPs unable to advise patients on how to prevent falls. The findings of this study warrant evidence-based structured fall prevention intervention targeted to patients as well as to HCPs. PMID:26546140

  16. Do home-based exercise interventions improve outcomes for frail older people? Findings from a systematic review

    PubMed Central

    Barber, Sally E; Young, John B; Forster, Anne; Iliffe, Steve J

    2016-01-01

    Background Frailty is common in older age, and is associated with important adverse health outcomes including increased risk of disability and long-term care admission. Objectives To evaluate whether home-based exercise interventions improve outcomes for frail older people. Data sources We searched systematically for randomised controlled trials (RCTs) and cluster RCTs, with literature searching to February 2010. Study selection All trials that evaluated home-based exercise interventions for frail older people were eligible. Primary outcomes were mobility, quality of life and daily living activities. Secondary outcomes included long-term care admission and hospitalisation. Results Six RCTs involving 987 participants met the inclusion criteria. Four trials were considered of high quality. One high quality trial reported improved disability in those with moderate but not severe frailty. Meta-analysis of long-term care admission rates identified a trend towards reduced risk. Inconsistent effects on other primary and secondary outcomes were reported in the other studies. Conclusions There is preliminary evidence that home-based exercise interventions may improve disability in older people with moderate, but not severe, frailty. There is considerable uncertainty regarding effects on important outcomes including quality of life and long-term care admission. Home-based exercises are a potentially simple, safe and widely applicable intervention to prevent dependency decline for frail older people.

  17. Ability of older people with dementia or cognitive impairment to manage medicine regimens: a narrative review.

    PubMed

    Elliott, Rohan A; Goeman, Dianne; Beanland, Christine; Koch, Susan

    2015-01-01

    Impaired cognition has a significant impact on a person's ability to manage their medicines. The aim of this paper is to provide a narrative review of contemporary literature on medicines management by people with dementia or cognitive impairment living in the community, methods for assessing their capacity to safely manage medicines, and strategies for supporting independent medicines management. Studies and reviews addressing medicines management by people with dementia or cognitive impairment published between 2003 and 2013 were identified via searches of Medline and other databases. The literature indicates that as cognitive impairment progresses, the ability to plan, organise, and execute medicine management tasks is impaired, leading to increased risk of unintentional non-adherence, medication errors, preventable medication-related hospital admissions and dependence on family carers or community nursing services to assist with medicines management. Impaired functional capacity may not be detected by health professionals in routine clinical encounters. Assessment of patients' (or carers') ability to safely manage medicines is not undertaken routinely, and when it is there is variability in the methods used. Self-report and informant report may be helpful, but can be unreliable or prone to bias. Measures of cognitive function are useful, but may lack sensitivity and specificity. Direct observation, using a structured, standardised performance-based tool, may help to determine whether a person is able to manage their medicines and identify barriers to adherence such as inability to open medicine packaging. A range of strategies have been used to support independent medicines management in people with cognitive impairment, but there is little high-quality research underpinning these strategies. Further studies are needed to develop and evaluate approaches to facilitate safe medicines management by older people with cognitive impairment and their carers. PMID

  18. Associations Between Alzheimer Disease Biomarkers, Neurodegeneration, and Cognition in Cognitively Normal Older People

    PubMed Central

    Wirth, Miranka; Villeneuve, Sylvia; Haase, Claudia M.; Madison, Cindee M.; Oh, Hwamee; Landau, Susan M.; Rabinovici, Gil D.; Jagust, William J.

    2016-01-01

    elderly individuals, 40% (n = 29) displayed at least 1 abnormal neurodegenerative biomarker, 26% (n = 19) of whom had no evidence of elevated Pittsburgh compound B retention. In those people who were classified as having abnormal cortical thickness, degree and topographic specificity of neurodegenerative abnormalities were similar to patients with AD. Accumulation of neurodegenerative abnormalities was related to poor memory and executive functions as well as larger WML volumes but not elevated Pittsburgh compound B retention. Conclusions and Relevance Our study confirms that a substantial proportion of cognitively normal older adults harbor neurodegeneration, without Aβ burden. Associations of neurodegenerative abnormalities with cerebrovascular disease and cognitive performance indicate that neurodegenerative pathology can emerge through non-Aβ pathways within regions most affected by AD. PMID:24166579

  19. Blood-Brain Barrier Dysfunction and Cerebral Small Vessel Disease (Arteriolosclerosis) in Brains of Older People

    PubMed Central

    Khoong, Cheryl H.L.; Poon, Wayne; Esiri, Margaret M.; Markus, Hugh S.; Hainsworth, Atticus H.

    2014-01-01

    The blood-brain barrier (BBB) protects brain tissue from potentially harmful plasma components. Small vessel disease ([SVD], arteriolosclerosis) is common in the brains of older people and is associated with lacunar infarcts, leukoaraiosis and vascular dementia. To determine whether plasma extravasation is associated with SVD, we immunolabeled the plasma proteins fibrinogen and IgG, which are assumed to reflect BBB dysfunction, in deep grey matter (anterior caudate-putamen, [DGM]) and deep subcortical white matter (DWM) in the brains of a well-characterized patient cohort with minimal Alzheimer disease pathology (Braak stage 0-II) (n = 84; age ≥65 years). Morphometric measures of fibrinogen labeling were compared between people with neuropathologically defined SVD and aged control subjects. Parenchymal cellular labeling with fibrinogen and IgG was detectable in DGM and DWM in many subjects (>70%). Quantitative measures of fibrinogen were not associated with SVD in DGM or DWM; SVD severity was correlated between DGM and DWM (p < 0.0001). Fibrinogen in DGM showed a modest association with a history of hypertension; DWM fibrinogen was associated with dementia and cerebral amyloid angiopathy (all p < 0.05). In DWM, SVD was associated with leukoaraiosis identified in life (p < 0.05), but fibrinogen was not. Our data suggest that in aged brains plasma extravasation and hence local BBB dysfunction is common but do not support an association with SVD. PMID:25289893

  20. Structural violence in long-term, residential care for older people: Comparing Canada and Scandinavia

    PubMed Central

    Banerjee, Albert; Daly, Tamara; Armstrong, Pat; Szebehely, Marta; Armstrong, Hugh; LaFrance, Stirling

    2014-01-01

    Canadian frontline careworkers are six times more likely to experience daily physical violence than their Scandinavian counterparts. This paper draws on a comparative survey of residential careworkers serving older people across three Canadian provinces (Manitoba, Nova Scotia, Ontario) and four countries that follow a Scandinavian model of social care (Denmark, Finland, Norway, Sweden) conducted between 2005 and 2006. Ninety percent of Canadian frontline careworkers experienced physical violence from residents or their relatives and 43 percent reported physical violence on a daily basis. Canadian focus groups conducted in 2007 reveal violence was often normalized as an inevitable part of elder-care. We use the concept of “structural violence” (Galtung, 1969) to raise questions about the role that systemic and organizational factors play in setting the context for violence. Structural violence refers to indirect forms of violence that are built into social structures and that prevent people from meeting their basic needs or fulfilling their potential. We applied the concept to long-term residential care and found that the poor quality of the working conditions and inadequate levels of support experienced by Canadian careworkers constitute a form of structural violence. Working conditions are detrimental to careworker’s physical and mental health, and prevent careworkers from providing the quality of care they are capable of providing and understand to be part of their job. These conditions may also contribute to the violence workers experience, and further investigation is warranted. PMID:22204839

  1. Narratives of continuity among older people with late stage chronic kidney disease who decline dialysis.

    PubMed

    Llewellyn, Henry; Low, Joe; Smith, Glenn; Hopkins, Katherine; Burns, Aine; Jones, Louise

    2014-08-01

    Chronic and life-threatening conditions are widely thought to shatter the lives of those affected. In this article, we examine the accounts of 19 older people diagnosed with late stage chronic kidney disease who declined dialysis. Accounts were collected through in-depth interview in the United Kingdom (March-November, 2010). Drawing on a phenomenological approach, we focus particularly on the embodied and lived experience of the condition and on how participants constructed treatment modalities and approached treatment choice. We look toward contemporary elaborations of the conceptual framework of biographical disruption to illustrate how participants managed to contain the intrusion of illness and maintain continuity in their lives. We argue that three interactive phenomena mitigated the potential for disruption and allowed participants to maintain continuity: (a) the framing of illness as "old age"; (b) the prior experience of serious illness; and (c) the choice of the treatment with the least potential for disruption. We conclude that a diagnosis of chronic illness in late life does not inevitably shatter lives or engender biographical disruption. Instead, people are able to construct continuity owing to complex narrative interpretations of diagnosis, sensation and treatment choices. PMID:24911508

  2. Influence of history of smoking on the physical capacity of older people.

    PubMed

    Ricci, Natalia Aquaroni; Francisco, Cristina Oliveira; Rebelatto, Marcelo Nascimento; Rebelatto, José Rubens

    2011-01-01

    Among the elderly, smoking is related to death and it contributes to disability associated with chronic diseases. This study aims to verify the influence of a history of smoking on the physical capacity of elderly people, and its relationship with the gender. Elderly people beginning to practice physical activity reported questions about their smoking history and underwent a physical evaluation, consisted by hemodynamic data (blood pressure, heart rate and maximum oxygen consumption), body mass index (BMI), muscular strength, flexibility and balance. Mann-Whitney test and Spearman's test was used to data analysis. The sample consisted of 127 subjects, among whom 26.8% were ex-smokers. There were a higher number of nonsmoking women (p<0.001) than others, and women smoked fewer packets per day (p=0.047). Among the women, those ex-smokers were younger and more flexible in comparison with those nonsmokers (p<0.05). Among the men, the ex-smokers were older and walked more slowly than nonsmokers (p<0.05). There was a correlation between the BMI and duration of smoking time. Smoking cessation benefits the elderly, since the physical variables showed no long-term harm associated with the history of smoking when compared with those of elderly without this habit. PMID:20202702

  3. The association between objectively measured physical activity and life-space mobility among older people.

    PubMed

    Tsai, L-T; Portegijs, E; Rantakokko, M; Viljanen, A; Saajanaho, M; Eronen, J; Rantanen, T

    2015-08-01

    The purpose of this cross-sectional study was to investigate the association between objectively measured physical activity and life-space mobility in community-dwelling older people. Life-space refers to the spatial area a person purposefully moves through in daily life (bedroom, home, yard, neighborhood, town, and beyond) and life-space mobility to the frequency of travel and the help needed when moving through different life-space areas. The study population comprised community-living 75- to 90-year-old people {n = 174; median age 79.7 [interquartile range (IQR) 7.1]}, participating in the accelerometer substudy of Life-Space Mobility in Old Age (LISPE) project. Step counts and activity time were measured by an accelerometer (Hookie "AM20 Activity Meter") for 7 days. Life-space mobility was assessed with Life-Space Assessment (LSA) questionnaire. Altogether, 16% had a life-space area restricted to the neighborhood when moving independently. Participants with a restricted life space were less physically active and about 70% of them had exceptionally low values in daily step counts (≤ 615 steps) and moderate activity time (≤ 6.8 min). Higher step counts and activity time correlated positively with life-space mobility. Prospective studies are needed to clarify the temporal order of low physical activity level and restriction in life-space mobility. PMID:26152855

  4. Health, wellbeing, and disability among older people infected or affected by HIV in Uganda and South Africa

    PubMed Central

    Nyirenda, Makandwe; Newell, Marie-Louise; Mugisha, Joseph; Mutevedzi, Portia C.; Seeley, Janet; Scholten, Francien; Kowal, Paul

    2013-01-01

    Objective To describe and compare the health status, emotional wellbeing, and functional status of older people in Uganda and South Africa who are HIV infected or affected by HIV in their families. Methods Data came from the general population cohort and Entebbe cohort of the Medical Research Council/Uganda Virus Research Institute, and from the Africa Centre Demographic Information System through cross-sectional surveys in 2009/10 using instruments adapted from the World Health Organization (WHO) Study on Global Ageing and adult health (SAGE). Analysis was based on 932 people aged 50 years or older (510 Uganda, 422 South Africa). Results Participants in South Africa were slightly younger (median age − 60 years in South Africa, 63 in Uganda), and more were currently married, had no formal education, were not working, and were residing in a rural area. Adjusting for socio-demographic factors, older people in South Africa were significantly less likely to have good functional ability [adjusted odds ratio (aOR) 0.72, 95% CI 0.53–0.98] than those in Uganda, but were more likely to be in good subjective wellbeing (aOR 2.15, 95% CI 1.60–2.90). South Africans were more likely to be obese (aOR 5.26, 95% CI 3.46–8.00) or to be diagnosed with hypertension (aOR 2.77, 95% CI 2.06–3.73). Discussion and conclusions While older people’s health problems are similar in the two countries, marked socio-demographic differences influence the extent to which older people are affected by poorer health. It is therefore imperative when designing policies to improve the health and wellbeing of older people in sub-Saharan Africa that the region is not treated as a homogenous entity. PMID:23364075

  5. Randomised factorial trial of falls prevention among older people living in their own homes

    PubMed Central

    Day, Lesley; Fildes, Brian; Gordon, Ian; Fitzharris, Michael; Flamer, Harold; Lord, Stephen

    2002-01-01

    Objective To test the effectiveness of, and explore interactions between, three interventions to prevent falls among older people. Design A randomised controlled trial with a full factorial design. Setting Urban community in Melbourne, Australia. Participants 1090 aged 70 years and over and living at home. Most were Australian born and rated their health as good to excellent; just over half lived alone. Interventions Three interventions (group based exercise, home hazard management, and vision improvement) delivered to eight groups defined by the presence or absence of each intervention. Main outcome measure Time to first fall ascertained by an 18 month falls calendar and analysed with survival analysis techniques. Changes to targeted risk factors were assessed by using measures of quadriceps strength, balance, vision, and number of hazards in the home. Results The rate ratio for exercise was 0.82 (95% confidence interval 0.70 to 0.97, P=0.02), and a significant effect (P<0.05) was observed for the combinations of interventions that involved exercise. Balance measures improved significantly among the exercise group. Neither home hazard management nor treatment of poor vision showed a significant effect. The strongest effect was observed for all three interventions combined (rate ratio 0.67 (0.51 to 0.88, P=0.004)), producing an estimated 14.0% reduction in the annual fall rate. The number of people needed to be treated to prevent one fall a year ranged from 32 for home hazard management to 7 for all three interventions combined. Conclusions Group based exercise was the most potent single intervention tested, and the reduction in falls among this group seems to have been associated with improved balance. Falls were further reduced by the addition of home hazard management or reduced vision management, or both of these. Cost effectiveness is yet to be examined. These findings are most applicable to Australian born adults aged 70-84 years living at home who rate their

  6. Visually Impaired OLder people's Exercise programme for falls prevenTion (VIOLET): a feasibility study protocol

    PubMed Central

    Skelton, Dawn A; Bailey, Cathy; Howel, Denise; Cattan, Mima; Deary, Vincent; Coe, Dot; de Jong, Lex D; Gawler, Sheena; Gray, Joanne; Lampitt, Rosy; Wilkinson, Jennifer; Adams, Nicola

    2016-01-01

    Introduction In the UK, 1 in 5 people aged 75 and over live with sight loss. Visually impaired older people (VIOP) have an above average incidence of falls and 1.3–1.9 times more likely to experience hip fractures, than the general population. Older people with eye diseases are ∼3 times more likely than those with good vision, to limit activities due to fear of falling. This feasibility study aims to adapt the group-based Falls Management Exercise (FaME) programme to the needs of VIOP and carry out an external pilot trial to inform the design of a future definitive randomised controlled trial. Methods and design A UK based 2-centre mixed methods, randomised, feasibility study will be conducted over 28 months. Stakeholder panels, including VIOP, will make recommendations for adaptations to an existing exercise programme (FaME), to meet the needs of VIOP, promoting uptake and adherence, while retaining required effective components of the exercise programme. 80 VIOP aged 60 and over, living at home, ambulant with or without a walking aid, will be recruited in Newcastle (n=40) and Glasgow (n=40) through National Health Service (NHS) Trusts and third sector partners. Participants randomised into the intervention arm will receive the adapted FaME programme. Participants randomised into the control arm will continue with usual activity. Outcomes are, recruitment rate, adherence and validated measures including fear of falling and quality of life. Postintervention in-depth qualitative interviews will be conducted with a purposive sample of VIOP (N=10). Postural stability instructors will be interviewed, before trial-specific training and following the intervention. Ethics and dissemination Ethics approval was secured through the National Research Ethics Service (NRES) Committee North East, Newcastle and North Tyneside 2. Glasgow Caledonian University was approved as a non-NHS site with local ethics approval. Findings will be disseminated through peer

  7. A review of the safety of anticoagulants in older people using the medicines management pathway: weighing the benefits against the risks

    PubMed Central

    2011-01-01

    Anticoagulant drugs maintain a high potential for adverse events due to their inherent risk of haemorrhage and/or complex pharmacology. In addition, compromising the safety of these agents is the context in which they are principally used; that is, in the long-term prevention of thromboembolic diseases in an older patient population. These challenges are especially pronounced in the prevention of stroke in older persons with atrial fibrillation (AF), where the need for thromboprophylaxis is paramount and in whom the arrhythmia is most prevalent, but where the target population is simultaneously at high risk of adverse drug events. Essentially, this translates to the use of high-risk therapies on an indefinite basis, in persons who have multiple comorbidities, use polypharmacy, and who may have age-related functional and cognitive decline, culminating in a higher potential for medication misadventure. For this reason, anticoagulants mandate extra pharmacovigilance, and therefore the aim of this review is to address some of the key safety considerations in the use of anticoagulant drugs (warfarin, dabigatran, rivaroxaban), spanning the initiation of therapy to its ongoing management. Using the Medication Management Pathway (MMP) as a framework, in this review we canvas and highlight specific developments in practical strategies to facilitate the safe use of anticoagulants (particularly warfarin) in ‘at-risk' elderly patients including: comprehensive risk/benefit assessment using novel risk stratification tools; focused medicines review services; therapeutic drug monitoring services delivered in the primary care setting; and practical education strategies and resources targeting the older patient population. Until newer alternative anticoagulants become viable options for widespread use, clinicians will necessarily need to rely on specific resources and interventions to facilitate the safe use of currently available anticoagulants (i.e. warfarin) in

  8. Improving skills and care standards in the support workforce for older people: a realist synthesis of workforce development interventions

    PubMed Central

    Williams, L; Rycroft-Malone, J; Burton, C R; Edwards, S; Fisher, D; Hall, B; McCormack, B; Nutley, S M; Seddon, D; Williams, R

    2016-01-01

    Objectives This evidence review was conducted to understand how and why workforce development interventions can improve the skills and care standards of support workers in older people's services. Design Following recognised realist synthesis principles, the review was completed by (1) development of an initial programme theory; (2) retrieval, review and synthesis of evidence relating to interventions designed to develop the support workforce; (3) ‘testing out’ the synthesis findings to refine the programme theories, and establish their practical relevance/potential for implementation through stakeholder interviews; and (4) forming actionable recommendations. Participants Stakeholders who represented services, commissioners and older people were involved in workshops in an advisory capacity, and 10 participants were interviewed during the theory refinement process. Results Eight context–mechanism–outcome (CMO) configurations were identified which cumulatively comprise a new programme theory about ‘what works’ to support workforce development in older people's services. The CMOs indicate that the design and delivery of workforce development includes how to make it real to the work of those delivering support to older people; the individual support worker's personal starting points and expectations of the role; how to tap into support workers' motivations; the use of incentivisation; joining things up around workforce development; getting the right mix of people engaged in the design and delivery of workforce development programmes/interventions; taking a planned approach to workforce development, and the ways in which components of interventions reinforce one another, increasing the potential for impacts to embed and spread across organisations. Conclusions It is important to take a tailored approach to the design and delivery of workforce development that is mindful of the needs of older people, support workers, health and social care services and the

  9. Out-of-School and "At Risk?" Socio-Demographic Characteristics, AIDS Knowledge and Risk Perception among Young People in Northern Tanzania

    ERIC Educational Resources Information Center

    Bastien, Sheri

    2008-01-01

    This paper investigates the reasons why young people in urban and rural Kilimanjaro, Tanzania do not attend school, their socio-demographic characteristics, AIDS knowledge and risk perception. A structured face-to-face interview was conducted with 1007 young people between the ages of 13 and 18. Findings suggest that non-attendance is the product…

  10. The Validity of Goal Achievement as an Outcome Measure in Physical Rehabilitation Day Hospitals for Older People

    ERIC Educational Resources Information Center

    Kneebone, Ian I.; Hurn, Jane S.; Raisbeck, Elizabeth; Cropley, Mark; Khoshnaw, Hiro; Milton, Jane E.

    2010-01-01

    Physical rehabilitation day hospitals are widely used community-based services designed to meet the medical and rehabilitation needs of older people. While there is evidence for the effectiveness of these services, concerns about the shortcomings of how this is measured have led to the recommendation that the achievement of individually tailored…

  11. A literature review exploring how healthcare professionals contribute to the assessment and control of postoperative pain in older people.

    PubMed

    Brown, Donna

    2004-09-01

    Little research has examined the care older people receive in the acute surgical setting. Although pain assessment and management are judged to be a priority in nursing, often pain, in older people, is undermanaged for a variety of reasons. Factors such as stoicism, communication and ageism can shape both the patients' and nurses' attitude towards the perception of pain which subsequently affects pain management. Through a review of the literature, this paper aims to: (i) identify how healthcare professionals contribute to the assessment and control of postoperative pain in older people and (ii) explore potential barriers to achieving more advantageous pain control in this group. It is suggested that to improve pain management there is a need to individualize pain assessment for older people and to assist clinicians with enhancing their education and decision-making abilities in this field. This may best be achieved by supporting a programme of change to develop the skills of staff and encouraging learning through reflective practice. There is however a need for further research in this area. PMID:15724822

  12. Older People's Perceptions of Pedestrian Friendliness and Traffic Safety: An Experiment Using Computer-Simulated Walking Environments.

    PubMed

    Kahlert, Daniela; Schlicht, Wolfgang

    2015-08-01

    Traffic safety and pedestrian friendliness are considered to be important conditions for older people's motivation to walk through their environment. This study uses an experimental study design with computer-simulated living environments to investigate the effect of micro-scale environmental factors (parking spaces and green verges with trees) on older people's perceptions of both motivational antecedents (dependent variables). Seventy-four consecutively recruited older people were randomly assigned watching one of two scenarios (independent variable) on a computer screen. The scenarios simulated a stroll on a sidewalk, as it is 'typical' for a German city. In version 'A,' the subjects take a fictive walk on a sidewalk where a number of cars are parked partially on it. In version 'B', cars are in parking spaces separated from the sidewalk by grass verges and trees. Subjects assessed their impressions of both dependent variables. A multivariate analysis of covariance showed that subjects' ratings on perceived traffic safety and pedestrian friendliness were higher for Version 'B' compared to version 'A'. Cohen's d indicates medium (d = 0.73) and large (d = 1.23) effect sizes for traffic safety and pedestrian friendliness, respectively. The study suggests that elements of the built environment might affect motivational antecedents of older people's walking behavior. PMID:26308026

  13. "A Story to Tell:" Learning from the Life-Stories of Older People with Intellectual Disabilities in Ireland

    ERIC Educational Resources Information Center

    Hamilton, Carol; Atkinson, Dorothy

    2009-01-01

    This article draws on life-stories told by older people with intellectual disabilities for a research study in the Republic of Ireland. Research participants recalled their experiences of confinement, coercion and exclusion that resulted from their being labelled as having intellectual disabilities. Participants also recalled the positive…

  14. Associations of Symptoms of Anxiety and Depression with Diabetes and Cardiovascular Risk Factors in Older People with Intellectual Disability

    ERIC Educational Resources Information Center

    Winter, C. F.; Hermans, H.; Evenhuis, H. M.; Echteld, M. A.

    2015-01-01

    Background: Depression, anxiety, diabetes and cardiovascular risk factors are frequent health problems among older people with intellectual disability (ID). These conditions may be bidirectionally related. Depression and anxiety may have biological effects causing glucose intolerance, fat accumulation and also lifestyle changes causing metabolic…

  15. Can a Website-Delivered Computer-Tailored Physical Activity Intervention Be Acceptable, Usable, and Effective for Older People?

    ERIC Educational Resources Information Center

    Ammann, Rahel; Vandelanotte, Corneel; de Vries, Hein; Mummery, W. Kerry

    2013-01-01

    Despite the numerous health benefits, population physical activity levels are low and declining with age. A continued increase of Internet access allows for website-delivered interventions to be implemented across age-groups, though older people have typically not been considered for this type of intervention. Therefore, the purpose of this study…

  16. Re-Imagining the Care Home: A Spatially Responsive Approach to Arts Practice with Older People in Residential Care

    ERIC Educational Resources Information Center

    Hatton, Nicola

    2014-01-01

    This paper considers some of the spatial challenges of doing arts projects with older people in care homes, including those living with dementia. It reflects on the author's own experience of running a performance project with residents with at a care home in North London. Drawing on Lefebvre's concept of socially produced space, it argues that…

  17. From Provider to Enabler of Care? Reconfiguring Local Authority Support for Older People and Carers in Leeds, 2008 to 2013

    PubMed Central

    Yeandle, Sue

    2016-01-01

    Abstract This article explores developments in the support available to older people and carers (i.e., caregivers) in the city of Leeds, United Kingdom, and examines provision changes during a period characterized by unprecedented resource constraint and new developments in national-local governance. Using documentary evidence, official statistics, and findings from recent studies led by the author, the effects of these changes on service planning and delivery and the approach taken by local actors to mitigate their impact are highlighted. The statistical data show a marked decline in some types of services for older people during a 5-year period during which the city council took steps to mobilize citizens and develop new services and system improvements. The analysis focuses on theories of social quality as a framework for analysis of the complex picture of change related to service provision. It concludes that although citizen involvement and consultations exerted a positive influence in delivering support to some older people and carers, research over a longer timescale is needed to show if these changes are adequate to protect older people and carers from the effects of ongoing budgetary constraints. PMID:27019540

  18. Defenders against Threats or Enablers of Opportunities: The Screening Role Played by Gatekeepers in Researching Older People in Care Homes

    ERIC Educational Resources Information Center

    Scourfield, Peter

    2012-01-01

    This paper emerges from a case study of the system of statutory reviews in older people's care homes in the UK. Informed by a review of selected literature on gaining access, this paper provides a critical account of the process of negotiating access with gatekeepers (chiefly, care home managers). The negotiations were time-consuming and largely…

  19. The Impact of Socioeconomic Conditions, Social Networks, and Health on Frail Older People's Life Satisfaction: A Cross-Sectional Study.

    PubMed

    Berglund, Helene; Hasson, Henna; Wilhelmson, Katarina; Dunér, Anna; Dahlin-Ivanoff, Synneve

    2016-06-23

    It has been shown that frailty is associated with low levels of well-being and life satisfaction. Further exploration is needed, however, to better understand which components constitute life satisfaction for frail older people and how satisfaction is related to other life circumstances. The aim of this study was to examine relationships between frail older people's life satisfaction and their socioeconomic conditions, social networks, and health-related conditions. A cross-sectional study was conducted (n=179). A logistic regression analysis was performed, including life satisfaction as the dependent variable and 12 items as independent variables. Four of the independent variables made statistically significant contributions: financial situation (OR 3.53), social contacts (OR 2.44), risk of depression (OR 2.26), and self-rated health (OR 2.79). This study demonstrates that financial situation, self-rated health conditions and social networks are important components for frail older people's life satisfaction. Health and social care professionals and policy makers should consider this knowledge in the care and service for frail older people; and actions that benefit life satisfaction - such as social support - should be promoted. PMID:27403463

  20. Quality of University Programs for Older People in Spain: Innovations, Tendencies, and Ethics in European Higher Education

    ERIC Educational Resources Information Center

    Camara, C. Palmero; Eguizabal, A. Jimenez

    2008-01-01

    This article examines the innovative regulations, methodologies, and institutions involved in the development of the European Higher Education Area and their implications for teaching, research, and management of University Programs for Older People. It also identifies the main tendencies, creative dimensions, and ethical commitments implicit in…

  1. The prevalence of type 2 diabetes among older people in Africa: a systematic review.

    PubMed

    Werfalli, Mahmoud; Engel, Mark E; Musekiwa, Alfred; Kengne, Andre P; Levitt, Naomi S

    2016-01-01

    Little information is available on the prevalence of diabetes in people aged 55 years or older living on the African continent. We did a systematic review of the prevalence of type 2 diabetes in studies reported from Jan 1, 2000, to June 30, 2015, to provide accurate data for monitoring future trends. We did a comprehensive literature search using an African search filter and extracted and synthesised data from full papers. Among 1473 identified citations, 41 studies providing 49 separate data contributions involving 16 086 individuals met the inclusion criteria. The overall prevalence of diabetes was 13·7% (95% CI 11·3-16·3) and was higher in studies based on the oral glucose tolerance test (23·9%, 17·7-30·7, 12 contributions with 3415 participants) than fasting blood glucose criteria (10·9%, 8·9-13·0, 37 contributions with 12 671 participants; p<0·001). Prevalence was also higher in non-STEPS than in STEPS studies (17·1%, 95% CI 13·6-20·9) vs 9·6%, 6·6-13·0, p=0·003) and in urban than in rural settings (19·7%, 15·0-24·9 vs 7·9%, 4·6-12·0, p=0·0002), but did not differ significantly across age groups, sex, sample size, year of publication, region, or population coverage. These data highlight the need to reduce diabetes risk factors and implement adequate management strategies. In addition, they suggest that uniform diagnostic methods should be used across African countries and elsewhere to enable assessment of trends in diabetes prevalence and the success of diabetes prevention strategies. A collaborative initiative is required between key international and national diabetes and geriatric organisations to improve diabetes care for the older population in Africa and worldwide. PMID:26548379

  2. Social support and the self-rated health of older people

    PubMed Central

    Dai, Yue; Zhang, Chen-Yun; Zhang, Bao-Quan; Li, Zhanzhan; Jiang, Caixiao; Huang, Hui-Ling

    2016-01-01

    Abstract The lack of social support in elderly populations incurs real societal costs and can lead to their poor health. The aim of this study is to investigate the self-rated health (SRH) and social support among older people as well as its associated factors. We conducted a cross-sectional study among 312 urban community-dwelling elderly aged 65 to 90 years in Tainan Taiwan and Fuzhou Fujian Province from March 2012 to October 2012. A Spearson correlation test, independent t test, a Pearson χ2 test, a linear regression analysis, and a multiple-level model were performed to analyze the results. The participants identified children as the most important source of objective and subjective support, followed by spouse and relatives. Tainan's elderly received more daily life assistance and emotional support, showed stronger awareness of the need to seek help, and maintained a higher frequency of social interactions compared with the elderly in Fuzhou. The mean objective support, subjective support, and support utilization scores as well as the overall social support among Tainan's elderly were significantly high compared with the scores among Fuzhou's elderly. Further, Tainan's elderly rated better SRH than Fuzhou's elderly. Correlation analysis showed that social support was significantly correlated with city, age, living conditions, marital status, and SRH. Multiple linear regression analysis, with social support as a dependent variable, retained the following independent predictors in the final regression model: city (4.792, 95% confidence interval [CI]: 3.068–6.516, P = 0.000), age (−0.805, 95% CI: −1.394 to −0.135, P = 0.013), marital status (−1.260, 95% CI: −1.891 to −0.629, P = 0.000), living conditions (4.069, 95% CI: 3.022–5.116, P = 0.000), and SRH −1.941, 95% CI: −3.194 to −0.688, P = 0.003). The multiple-level model showed that city would impact older people's social support (χ2 = 5.103, P < 0.001). Marital status (−2.133, 95

  3. They are not always a burden: Older people and child fostering in Uganda during the HIV epidemic

    PubMed Central

    Kasedde, Susan; Doyle, Aoife M.; Seeley, Janet A.; Ross, David A.

    2014-01-01

    This qualitative study examines the role of older people (60 years and above) in fostering decisions for orphans and non-orphans within extended families in a rural Ugandan community heavily affected by HIV. Fieldwork conducted in 2006 provided information on the influence of HIV on fostering decisions through 48 individual in-depth interviews and two group interviews with foster-children and family members to develop detailed case studies related to 13 fostered adolescents. The adolescents included five non-orphans and eight orphans (five were double orphans because they had lost both parents). Older people play a very important role in fostering decisions as potential foster-parents, advisers, mediators and gatekeepers. They have a high level of authority over the foster-children, who are regarded as important resources within the extended family. With fewer potential caregivers available because of HIV-related deaths, the responsibility for fostering orphans has often fallen to surviving older people. Fostering is used by older people and the child's extended family as a strategy to ensure the welfare of the foster-child. When the foster-parent is an older person, it is also used to ensure physical and emotional support for the older person themselves. Support from the extended family towards foster households is widely reported to have been reduced by HIV by diminishing resources that would otherwise have been made available to support foster care. New initiatives and investment are required to complement community and family resources within well-managed social protection and welfare programmes. To be effective, such programmes will require adequate investment in administrative capacity and monitoring. They must aim to strengthen families and, recognizing that resources are limited, should prioritize the community's poorest households, rather than specifically targeting households with orphans or other foster-children. PMID:24880658

  4. They are not always a burden: older people and child fostering in Uganda during the HIV epidemic.

    PubMed

    Kasedde, Susan; Doyle, Aoife M; Seeley, Janet A; Ross, David A

    2014-07-01

    This qualitative study examines the role of older people (60 years and above) in fostering decisions for orphans and non-orphans within extended families in a rural Ugandan community heavily affected by HIV. Fieldwork conducted in 2006 provided information on the influence of HIV on fostering decisions through 48 individual in-depth interviews and two group interviews with foster-children and family members to develop detailed case studies related to 13 fostered adolescents. The adolescents included five non-orphans and eight orphans (five were double orphans because they had lost both parents). Older people play a very important role in fostering decisions as potential foster-parents, advisers, mediators and gatekeepers. They have a high level of authority over the foster-children, who are regarded as important resources within the extended family. With fewer potential caregivers available because of HIV-related deaths, the responsibility for fostering orphans has often fallen to surviving older people. Fostering is used by older people and the child's extended family as a strategy to ensure the welfare of the foster-child. When the foster-parent is an older person, it is also used to ensure physical and emotional support for the older person themselves. Support from the extended family towards foster households is widely reported to have been reduced by HIV by diminishing resources that would otherwise have been made available to support foster care. New initiatives and investment are required to complement community and family resources within well-managed social protection and welfare programmes. To be effective, such programmes will require adequate investment in administrative capacity and monitoring. They must aim to strengthen families and, recognizing that resources are limited, should prioritize the community's poorest households, rather than specifically targeting households with orphans or other foster-children. PMID:24880658

  5. Six-Year Training Improves Everyday Memory in Healthy Older People. Randomized Controlled Trial

    PubMed Central

    Requena, Carmen; Turrero, Agustín; Ortiz, Tomás

    2016-01-01

    Purpose of the study: Everyday memory of older persons does not improve with intensive memory training programs. This study proposes a change in these programs based on a time-extended and massive intervention format. Design and Methods: The sample of 1007 healthy older persons (mean age 71.85; SD = 5.12) was randomized into 2 groups. The experimental group followed an extended 6 years of training (192 sessions over 192 weeks) whereas the control group received an intensive training (3 sessions per week for a total of 32 sessions in 11 weeks). The program included cognitive and emotional content whose effects were assessed with the Rivermead Behavioral Memory Test (RBMT) and with the Mini-Mental State Examination (MMSE). Both groups were evaluated initially, after 32 sessions, and again after 6 years. Results: The relative improvements measured with Blom’s derivative showed that everyday memory and mental status of the experimental group were significantly better both in the short (Δ% 8.31 in RBMT and Δ% 1.51 in MMSE) and in the long term (Δ% 12.54 in RBMT and Δ% 2.56 in MMSE). For everyday memory and mental level, the overall gain estimate representing the mean difference in pre-post change between time-extended and intensive groups was 0.27 (95% CI: 0.13–0.40) and 0.54 (95% CI: 0.40–0.67), respectively. Time-extended programs have significantly improved everyday memory in contrast with the usual intensive programs whose effects decay with time. There are also significant increases in mental level scores while daily life functionality is preserved in all subjects who completed the training. Implications: These results suggest that it is possible to preserve everyday memory in the long term with continuous training and practice. Massive and time-extended formats may contribute in the future to a paradigm shift in memory programs for healthy older people. PMID:27375479

  6. Predictors of exercise participation in ambulatory and non-ambulatory older people with multiple sclerosis.

    PubMed

    Ploughman, Michelle; Harris, Chelsea; Wallack, Elizabeth M; Drodge, Olivia; Beaulieu, Serge; Mayo, Nancy

    2015-01-01

    Background. Exercise at moderate intensity may confer neuroprotective benefits in multiple sclerosis (MS), however it has been reported that people with MS (PwMS) exercise less than national guideline recommendations. We aimed to determine predictors of moderate to vigorous exercise among a sample of older Canadians with MS who were divided into ambulatory (less disabled) and non-ambulatory (more disabled) groups. Methods. We analysed data collected as part of a national survey of health, lifestyle and aging with MS. Participants (n = 743) were Canadians over 55 years of age with MS for 20 or more years. We identified 'a priori' variables (demographic, personal, socioeconomic, physical health, exercise history and health care support) that may predict exercise at moderate to vigorous intensity (>6.75 metabolic equivalent hours/week). Predictive variables were entered into stepwise logistic regression until best fit was achieved. Results. There was no difference in explanatory models between ambulatory and non-ambulatory groups. The model predicting exercise included the ability to walk independently (OR 1.90, 95% CI [1.24-2.91]); low disability (OR 1.50, 95% CI [1.34-1.68] for each 10 point difference in Barthel Index score), perseverance (OR 1.17, 95% CI [1.08-1.26] for each additional point on the scale of 0-14), less fatigue (OR 2.01, 95% CI [1.32-3.07] for those in the lowest quartile), fewer years since MS diagnosis (OR 1.58, 95% CI [1.11-2.23] below the median of 23 years) and fewer cardiovascular comorbidities (OR 1.55 95% CI [1.02-2.35] one or no comorbidities). It was also notable that the factors, age, gender, social support, health care support and financial status were not predictive of exercise. Conclusions. This is the first examination of exercise and exercise predictors among older, more disabled PwMS. Disability is a major predictor of exercise participation (at moderate to vigorous levels) in both ambulatory and non-ambulatory groups suggesting

  7. Predictors of exercise participation in ambulatory and non-ambulatory older people with multiple sclerosis

    PubMed Central

    Harris, Chelsea; Wallack, Elizabeth M.; Drodge, Olivia; Beaulieu, Serge; Mayo, Nancy

    2015-01-01

    Background. Exercise at moderate intensity may confer neuroprotective benefits in multiple sclerosis (MS), however it has been reported that people with MS (PwMS) exercise less than national guideline recommendations. We aimed to determine predictors of moderate to vigorous exercise among a sample of older Canadians with MS who were divided into ambulatory (less disabled) and non-ambulatory (more disabled) groups. Methods. We analysed data collected as part of a national survey of health, lifestyle and aging with MS. Participants (n = 743) were Canadians over 55 years of age with MS for 20 or more years. We identified ‘a priori’ variables (demographic, personal, socioeconomic, physical health, exercise history and health care support) that may predict exercise at moderate to vigorous intensity (>6.75 metabolic equivalent hours/week). Predictive variables were entered into stepwise logistic regression until best fit was achieved. Results. There was no difference in explanatory models between ambulatory and non-ambulatory groups. The model predicting exercise included the ability to walk independently (OR 1.90, 95% CI [1.24–2.91]); low disability (OR 1.50, 95% CI [1.34–1.68] for each 10 point difference in Barthel Index score), perseverance (OR 1.17, 95% CI [1.08–1.26] for each additional point on the scale of 0–14), less fatigue (OR 2.01, 95% CI [1.32–3.07] for those in the lowest quartile), fewer years since MS diagnosis (OR 1.58, 95% CI [1.11–2.23] below the median of 23 years) and fewer cardiovascular comorbidities (OR 1.55 95% CI [1.02–2.35] one or no comorbidities). It was also notable that the factors, age, gender, social support, health care support and financial status were not predictive of exercise. Conclusions. This is the first examination of exercise and exercise predictors among older, more disabled PwMS. Disability is a major predictor of exercise participation (at moderate to vigorous levels) in both ambulatory and non

  8. The contribution of home-based technology to older people's quality of life in extra care housing

    PubMed Central

    2011-01-01

    Background British government policy for older people focuses on a vision of active ageing and independent living. In the face of diminishing personal capacities, the use of appropriate home-based technology (HBT) devices could potentially meet a wide range of needs and consequently improve many aspects of older people's quality of life such as physical health, psychosocial well-being, social relationships, and their physical or living environment. This study aimed to examine the use of HBT devices and the correlation between use of such devices and quality of life among older people living in extra-care housing (ECH). Methods A structured questionnaire was administered for this study. Using purposive sampling 160 older people living in extra-care housing schemes were selected from 23 schemes in England. A face-to-face interview was conducted in each participant's living unit. In order to measure quality of life, the SEIQoL-Adapted and CASP-19 were used. Results Although most basic appliances and emergency call systems were used in the living units, communally provided facilities such as personal computers, washing machines, and assisted bathing equipment in the schemes were not well utilised. Multiple regression analysis adjusted for confounders including age, sex, marital status, living arrangement and mobility use indicated a coefficient of 1.17 with 95% CI (0.05, 2.29) and p = 0.04 [SEIQoL-Adapted] and 2.83 with 95% CI (1.17, 4.50) and p = 0.001 [CASP-19]. Conclusions The findings of the present study will be value to those who are developing new form of specialised housing for older people with functional limitations and, in particular, guiding investments in technological aids. The results of the present study also indicate that the home is an essential site for developing residential technologies. PMID:22040111

  9. Reappraising prosthodontic treatment goals for older, partially dentate people: Part II. Case for a sustainable dentition?

    PubMed

    Omar, Ridwaan

    2004-07-01

    The second of this two-part series, on the theme of estimating prosthodontic treatment needs and goals for older, partially dentate people, examines the roles of patient-perceived functional impairment, treatment outcome and changing demographic profiles in influencing these goals. In contradistinction with the lack of compelling evidence for the basis of the traditional, morphologically-driven prosthodontic treatment strategy, the evidence that the assessment of treatment need should take greater account of individuals' felt oral functional concerns, and thereby assuming a more problem-oriented, outcomes-based approach to prosthodontic decision-making, is gaining strength. Furthermore, the current blueprint guiding prosthodontic planning and procedures cannot be exempt from the far-reaching changes in society brought about by new economic and social realities, and will need to transform itself in the light of new evidence. How these realities translate in a developing country context is not certain, but it is known that inequalities in access to, and the provision of healthcare are related to socio-economic factors, be they prevailing or of residual nature from past structural conditions. Such conditions adversely affect peoples' health status and add urgency to the pursuit of viable and appropriate management strategies. In the context of a reappraisal of current prosthodontic paradigms, the shortened dental arch concept is presented as a potentially compelling strategy for the appropriate management of the ageing, partially dentate patients in South Africa, whose access to healthcare is inequitable. Since dental and oral health status is variable, the management strategy highlighted here should be seen as one, albeit an important one, within a range of available options. PMID:15457908

  10. Factors that influence intent to adopt a hearing aid among older people in Italy.

    PubMed

    Cobelli, Nicola; Gill, Liz; Cassia, Fabio; Ugolini, Marta

    2014-11-01

    Hearing loss is one of the most prevalent health impairments associated with ageing in developed countries, and it can result in social, emotional and communication dysfunction. Hearing loss in Italy is increasing, yet, despite the availability of free hearing aids and access to qualified community-based health professionals specialising in audiology services, their uptake remains low (about 15%-20%). This paper presents an investigation of the possible reasons why older people in Italy resist adopting a hearing aid. We used the literature to identify factors influencing people with hearing loss's decision-making, and drew on the theory of reasoned action to create an explanatory model. To test our hypotheses, we applied a cross-sectional design. We developed a questionnaire including 13 items related to adopting a hearing aid. Health professionals identified 400 persons aged 60-90 who were candidates for a free hearing aid. Those willing to participate were sent a copy of the questionnaire and telephoned between August and September 2009; a total of 243 responded (response rate of 60.8%). Linear regression analysis highlighted that a person's intention to adopt a hearing aid was positively related to their attitude towards its adoption, but negatively linked to their perceived subjective norms. It was found that trust in the health professional does not moderate the relationship between a person's attitude and their intention to adopt a hearing aid, but trust mitigates the relationship between a person's perceived subjective norms and their intentions. These findings underline the importance of the potential role that the healthcare professional could play in reducing the uncertainty created by external social pressures. For this purpose, stronger collaboration between the various health professionals involved in hearing aid provision, from diagnosis to fitting, is recommended. PMID:25251979

  11. The effect of living alone on the costs and benefits of surgery amongst older people.

    PubMed

    Turner, Alex J; Nikolova, Silviya; Sutton, Matt

    2016-02-01

    Older people who live alone are a growing, high-cost group for health and social services. The literature on how living alone affects health and the costs and benefits of healthcare has focused on crude measures of health and utilisation and gives little consideration to other cost determinants and aspects of patient experience. We study the effect of living alone at each stage along an entire treatment pathway using a large dataset which provides information on pre-treatment experience, treatment benefits and costs of surgery for 105,843 patients receiving elective hip and knee replacements in England in 2009 and 2010. We find that patients who live alone are healthier prior to treatment and experience the same gains from treatment. However, living alone is associated with a 9.2% longer length of in-hospital stay and increased probabilities of readmission and discharge to expensive destinations. These increase the costs per patient by £179.88 (3.12%) and amount to an additional £4.9 million per annum. A lack of post-discharge support for those living alone is likely to be a key driver of these additional costs. PMID:26741271

  12. Health issues of older people with intellectual disability in group homes†

    PubMed Central

    BOWERS, BARBARA; WEBBER, RUTH; BIGBY, CHRISTINE

    2014-01-01

    Background This paper explores how group home staff in Victoria, Australia, responded to residents with an intellectual disability (ID) as they developed age-related health conditions. Method The analysis was based on a longitudinal study that followed 17 ageing group home residents over a 3-year period. Eighty-three interviews were conducted with 30 group home staff in 17 group homes. Dimensional analysis, a variant of grounded theory, guided data collection and analysis. Results Findings revealed that the organisations all had systems in place to address health issues. However, the results also suggest an inability of staff to differentiate between significant health conditions and normal age-related changes, thus contributing to delays in care for serious medical conditions. Conclusions Lack of knowledge about normal ageing and an absence of organisational policies influence timeliness of diagnosis and treatment for people with ID. Group home staff could be more effective advocates for older residents, leading to improvements in health outcomes, if they had basic knowledge about normal ageing and symptoms of common age-related illnesses and if group home agencies provided clearer guidance to their staff. The study has implications for staff education and organisational policy development for group homes. PMID:25750581

  13. 'I don't think they knew we could do these sorts of things': social representations of community and participation in community arts by older people.

    PubMed

    Murray, Michael; Crummett, Amanda

    2010-07-01

    As people age the character of their social relationships change. There is evidence that older people who reside in disadvantaged communities often experience social isolation, which in turn has been found to be associated with a variety of health problems. This article reports the initial findings from a participatory arts project with a group of older residents of a disadvantaged urban community. It describes how the older residents represented their community and how they perceived the community arts intervention. PMID:20603301

  14. Awareness of vitamin D deficiency among at-risk patients

    PubMed Central

    2012-01-01

    Background Vitamin D deficiency is a significant problem for a growing proportion of the UK population. Individuals with dark or covered skin are at particularly high risk due to ethno-cultural, environmental and genetic factors. We assessed the level of awareness of vitamin D deficiency among at-risk patients in order to identify groups most in need of education. Findings A cross-sectional survey using a piloted questionnaire was conducted among consecutive at-risk patients without a diagnosis of Vitamin D deficiency arriving at a large inner city general practice in the North West of England over a five day period. The survey was completed by 221 patients. The mean age was 35 years. 28% of them (n = 61) had never heard about vitamin D. Older patients (p = 0.003) were less likely to have heard about vitamin D. 54% of participants were unaware of the commonest symptoms of vitamin D deficiency. 34% did not expose their skin other than their face in the last one year, and 11% did not include vitamin D rich foods in their diet. Conclusion The majority of at-risk patients are aware of vitamin D; nevertheless, there is a significant lack of knowledge among older people, who have higher morbidity. A programme of targeted education of the at-risk population is recommended. PMID:22230819

  15. Consequences of lower extremity and trunk muscle fatigue on balance and functional tasks in older people: A systematic literature review

    PubMed Central

    2010-01-01

    Background Muscle fatigue reduces muscle strength and balance control in young people. It is not clear whether fatigue resistance seen in older persons leads to different effects. In order to understand whether muscle fatigue may increase fall risk in older persons, a systematic literature review aimed to summarize knowledge on the effects of lower extremity and trunk muscle fatigue on balance and functional tasks in older people was performed. Methods Studies were identified with searches of the PUBMED and SCOPUS data bases. Papers describing effects of lower extremity or trunk muscle fatigue protocols on balance or functional tasks in older people were included. Studies were compared with regards to study population characteristics, fatigue protocol, and balance and functional task outcomes. Results Seven out of 266 studies met the inclusion criteria. Primary findings were: fatigue via resistance exercises to lower limb and trunk muscles induces postural instability during quiet standing; induced hip, knee and ankle muscle fatigue impairs functional reach, reduces the speed and power of sit-to-stand repetitions, and produces less stable and more variable walking patterns; effects of age on degree of fatigue and rate of recovery from fatigue are inconsistent across studies, with these disparities likely due to differences in the fatigue protocols, study populations and outcome measures. Conclusion Taken together, the findings suggest that balance and functional task performance are impaired with fatigue. Future studies should assess whether fatigue is related to increased risk of falling and whether exercise interventions may decrease fatigue effects. PMID:20716373

  16. Effectiveness of Non-Pharmacological Interventions to Prevent Falls in Older People: A Systematic Overview. The SENATOR Project ONTOP Series

    PubMed Central

    Rimland, Joseph M.; Abraha, Iosief; Dell’Aquila, Giuseppina; Cruz-Jentoft, Alfonso; Soiza, Roy; Gudmusson, Adalsteinn; Petrovic, Mirko; O’Mahony, Denis; Todd, Chris; Cherubini, Antonio

    2016-01-01

    Background Falls are common events in older people, which cause considerable morbidity and mortality. Non-pharmacological interventions are an important approach to prevent falls. There are a large number of systematic reviews of non-pharmacological interventions, whose evidence needs to be synthesized in order to facilitate evidence-based clinical decision making. Objectives To systematically examine reviews and meta-analyses that evaluated non-pharmacological interventions to prevent falls in older adults in the community, care facilities and hospitals. Methods We searched the electronic databases Pubmed, the Cochrane Database of Systematic Reviews, EMBASE, CINAHL, PsycINFO, PEDRO and TRIP from January 2009 to March 2015, for systematic reviews that included at least one comparative study, evaluating any non-pharmacological intervention, to prevent falls amongst older adults. The quality of the reviews was assessed using AMSTAR and ProFaNE taxonomy was used to organize the interventions. Results Fifty-nine systematic reviews were identified which consisted of single, multiple and multifactorial non-pharmacological interventions to prevent falls in older people. The most frequent ProFaNE defined interventions were exercises either alone or combined with other interventions, followed by environment/assistive technology interventions comprising environmental modifications, assistive and protective aids, staff education and vision assessment/correction. Knowledge was the third principle class of interventions as patient education. Exercise and multifactorial interventions were the most effective treatments to reduce falls in older adults, although not all types of exercise were equally effective in all subjects and in all settings. Effective exercise programs combined balance and strength training. Reviews with a higher AMSTAR score were more likely to contain more primary studies, to be updated and to perform meta-analysis. Conclusions The aim of this overview of

  17. Association of polypharmacy with fall-related fractures in older Taiwanese people: age- and gender-specific analyses

    PubMed Central

    Pan, Hsueh-Hsing; Li, Chung-Yi; Chen, Tzeng-Ji; Su, Tung-Ping; Wang, Kwua-Yun

    2014-01-01

    Objective To elucidate the associations between polypharmacy and age- and gender-specific risks of admission for fall-related fractures. Design Nested case–control study. Setting This analysis was randomly selected from all elderly beneficiaries in 2007–2008, and represents some 30% of the whole older insurers using Taiwan's National Health Insurance Research Database. Participants We identified 5933 cases newly admitted for fall-related fractures during 2007–2008, and 29 665 random controls free from fracture. Primary and secondary outcome measures Polypharmacy was defined as the use of fall-related drugs of four or more categories of medications and prescribed related to fall within a 1-year period. Logistic regression models were employed to estimate the ORs and related 95% CIs. The interaction of polypharmacy with age and sex was assessed separately. Results Compared with those who consumed no category of medication, older people who consumed 1, 2, 3 and ≥4 categories of medications were all at significantly increased odds of developing fall-related fractures, with a significant dose–gradient pattern (β=0.7953; p for trend <0.0001). There were significant interactions between polypharmacy and age, but no significant interactions between polypharmacy and gender. The dose–gradient relationship between number of medications category and risk of fall-related fractures was more obvious in women than in men (β=0.1962 vs β=0.1873). Additionally, it was most evident in older people aged 75–84 years (β=0.2338). Conclusions This population-based study in Taiwan confirms the link between polypharmacy and increased risk of fall-related fractures in older people; and highlights that elderly women and older people aged 75–84 years will be the targeted participants for further prevention from fall-related fractures caused by polypharmacy. PMID:24682575

  18. A cross-sectional study on person-centred communication in the care of older people: the COMHOME study protocol

    PubMed Central

    Hafskjold, Linda; Sundler, Annelie J; Holmström, Inger K; Sundling, Vibeke; van Dulmen, Sandra

    2015-01-01

    Introduction This paper presents an international cross-sectional study on person-centred communication with older people receiving healthcare (COMHOME). Person-centred care relies on effective communication, but few studies have explored this with a specific focus on older people. The main aim of the COMHOME study is to generate knowledge on person-centred communication with older people (>65 years) in home healthcare services, radiographic and optometric practice. Methods and analysis This study will explore the communication between care providers and older persons in home care services. Home healthcare visits will be audiorecorded (n=500) in Norway, the Netherlands and Sweden. Analyses will be performed with the Verona Coding Definitions for Emotional Sequences (VR-CoDES), the Roter Interaction Analysis System (RIAS) and qualitative methods. The content of the communication, communicative challenging situations as well as empathy, power distance, decision-making, preservation of dignity and respect will be explored. In Norway, an additional 100 encounters, 50 in optometric practice (video recorded) and 50 in radiographic practice (audiorecorded), will be analysed. Furthermore, healthcare providers’ self-reported communication skills, empathy, mindfulness and emotional intelligence in relation to observed person-centred communication skills will be assessed using well-established standardised instruments. Ethics and dissemination Depending on national legislation, approval of either the central ethical committees (eg, nation or university), the national data protection officials or the local ethical committees (eg, units of home healthcare) was obtained. Study findings will be disseminated widely through peer-reviewed publications and conference presentations. The research findings will add knowledge to improve services provided to this vulnerable group of patients. Additionally, the findings will underpin a training programme for healthcare students and

  19. Qualitative study investigating the commissioning process for older people's services provided by third sector organisations: SOPRANO study protocol

    PubMed Central

    Sands, Gina; Chadborn, Neil; Craig, Chris; Gladman, John

    2016-01-01

    Introduction The commissioning of third sector services for older people may influence the quality, availability and coordination of services for older people. The SOPRANO study aims to understand the relationships between and processes of commissioning bodies and third sector organisations providing health and social care services for older people. Methods and analysis This qualitative study will be based in the East Midlands region of England. An initial scoping survey of commissioners will give an overview of services to maintain the health and well-being of older people in the community that are commissioned. Following this, semistructured interviews will be conducted with 4 sample groups: health and social care commissioners, service provider managers, service provider case workers and older service users. A sample size of 10–15 participants in each of the 4 groups is expected to be sufficient to reach data saturation, resulting in a final expected sample size of 40–60 participants. Informed consent will be gained from all participants, and those unable to provide informed consent will be excluded. The interview data will be analysed by 2 researchers using framework content analysis. Ethics and dissemination Approval for the study has been gained from the University of Nottingham School of Medicine ethical review board, and the relevant approvals have been gained from the National Health Service (NHS) research and development departments for interviewing NHS staff. Early engagement with a wide range of stakeholders will ensure that the research findings are extensively disseminated to relevant stakeholders (including commissioners and third sector providers) in an accessible format using the extensive communication networks available to the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care CLAHRCs (applied health research organisations covering all of England). The study will also be disseminated

  20. Issues in aging. The role of the nurse in the care of older people with intellectual and developmental disabilities.

    PubMed

    Service, Kathryn Pekala; Hahn, Joan Earle

    2003-06-01

    Many people with I/DD are growing older and in increasing numbers. Generally people with I/DD experience the same physical process of aging as do individuals without lifelong disabilities with the exception of those individuals who have Down syndrome who may show physical signs of aging as much as 20 years earlier. Individuals with I/DD may experience some unique concerns associated with aging with similar or even higher rates of age-related conditions than do older persons without lifelong disabilities [20]. Geriatric care principles will guide nurses caring for older people with I/DD, beginning with the assessment of functional status to determine interventions for developmental, aging, and health concerns and health promotion. Nursing interventions must be individualized both according to the person's preferences and health status. A primary goal is to prevent acute exacerbation of any underlying pathological process, prevent unnecessary deterioration of the older individual's physical condition, and maintain optimum physical and mental function. Nurses can provide individuals who are aging and their families or caregivers the needed anticipatory guidance about life transitions during the aging years, including palliative end-of-life care. This is an exciting and challenging time for nurses who care for aging people with I/DD. John F. Kennedy once said, "It is not enough for a great nation to have added new years to life. Our objective must be to add new life to those years." As a profession, nurses have historically added years to life. The challenge of nursing is now to add quality life to those years for all older persons with I/DD. PMID:12914309

  1. Development and Validation of a Risk Model for Predicting Adverse Drug Reactions in Older People during Hospital Stay: Brighton Adverse Drug Reactions Risk (BADRI) Model

    PubMed Central

    Tangiisuran, Balamurugan; Scutt, Greg; Stevenson, Jennifer; Wright, Juliet; Onder, G.; Petrovic, M.; van der Cammen, T. J.; Rajkumar, Chakravarthi; Davies, Graham

    2014-01-01

    Background Older patients are at an increased risk of developing adverse drug reactions (ADR). Of particular concern are the oldest old, which constitute an increasingly growing population. Having a validated clinical tool to identify those older patients at risk of developing an ADR during hospital stay would enable healthcare staff to put measures in place to reduce the risk of such an event developing. The current study aimed to (1) develop and (2) validate an ADR risk prediction model. Methods We used a combination of univariate analysis and multivariate binary logistic regression to identify clinical risk factors for developing an ADR in a population of older people from a UK teaching hospital. The final ADR risk model was then validated in a European population (European dataset). Results Six-hundred-ninety patients (median age 85 years) were enrolled in the development stage of the study. Ninety-five reports of ADR were confirmed by independent review in these patients. Five clinical variables were identified through multivariate analysis and included in our final model; each variable was attributed a score of 1. Internal validation produced an AUROC of 0.74, a sensitivity of 80%, and specificity of 55%. During the external validation stage the AUROC was 0.73, with sensitivity and specificity values of 84% and 43% respectively. Conclusions We have developed and successfully validated a simple model to use ADR risk score in a population of patients with a median age of 85, i.e. the oldest old. The model is based on 5 clinical variables (≥8 drugs, hyperlipidaemia, raised white cell count, use of anti-diabetic agents, length of stay ≥12 days), some of which have not been previously reported. PMID:25356898

  2. Medication administration errors for older people in long-term residential care

    PubMed Central

    2011-01-01

    Background Older people in long-term residential care are at increased risk of medication prescribing and administration errors. The main aim of this study was to measure the incidence of medication administration errors in nursing and residential homes using a barcode medication administration (BCMA) system. Methods A prospective study was conducted in 13 care homes (9 residential and 4 nursing). Data on all medication administrations for a cohort of 345 older residents were recorded in real-time using a disguised observation technique. Every attempt by social care and nursing staff to administer medication over a 3-month observation period was analysed using BCMA records to determine the incidence and types of potential medication administration errors (MAEs) and whether errors were averted. Error classifications included attempts to administer medication at the wrong time, to the wrong person or discontinued medication. Further analysis compared data for residential and nursing homes. In addition, staff were surveyed prior to BCMA system implementation to assess their awareness of administration errors. Results A total of 188,249 medication administration attempts were analysed using BCMA data. Typically each resident was receiving nine different drugs and was exposed to 206 medication administration episodes every month. During the observation period, 2,289 potential MAEs were recorded for the 345 residents; 90% of residents were exposed to at least one error. The most common (n = 1,021, 45% of errors) was attempting to give medication at the wrong time. Over the 3-month observation period, half (52%) of residents were exposed to a serious error such as attempting to give medication to the wrong resident. Error incidence rates were 1.43 as high (95% CI 1.32-1.56 p < 0.001) in nursing homes as in residential homes. The level of non-compliance with system alerts was very low in both settings (0.075% of administrations). The pre-study survey revealed that only 12

  3. Unmet health care needs of older people: prevalence and predictors in a French cross-sectional survey

    PubMed Central

    Arvieu, Jean-Jacques; Aegerter, Philippe; Robine, Jean-Marie; Ankri, Joël

    2014-01-01

    Background: Unmet health care needs are associated with negative health outcomes, yet there is a paucity of data on this problem among older people. Objective: To identify unmet health care needs and associated factors among older people in France. Methods: This is a cross-sectional population study of people aged 70 years or older in which 2350 respondents were interviewed in 2008–10. During a standardized interview, a nurse examined health problems, functional abilities and use of health care resources. Unmet health care needs were defined as situations in which a participant needed health care and did not receive it. Results: The mean age was 83.2 ± 7.4 years. Almost all participants reporting a chronic disease (98.6%) had consulted a physician in the previous 6 months. Unmet health care needs were found in 23.0% of the sample and mainly consisted of lack of dental care (prevalence of 17.7%), followed by lack of management of visual or hearing impairments (prevalence of 4.4% and 3.1%, respectively). Age was the main factor associated with unmet health care needs [compared with people aged 70–79: odds ratio80–89 years = 2.26 (1.70–3.03), odds ratio90 years and over = 3.85 (2.71–5.45)]. Other associated factors were regular smoking, homebound status, poor socioeconomic conditions, depression, limitations in instrumental activities of daily living and low medical density. Conclusion: Unmet health care needs affect almost one-quarter of older people in France. Efforts should be made to improve oral health and develop home care, especially for the oldest-olds. PMID:24287029

  4. The impact of having natural teeth on the QoL of frail dentulous older people. A qualitative study

    PubMed Central

    2012-01-01

    Background In order to adapt oral care and treatment to the demands of the growing group of frail dentulous older people, it is important to understand how and to which extent having natural teeth contributes to the quality of life (QoL) of frail older people and how frailty influences their perspective. Methods A qualitative approach was used. Interviews with 38 Dutch frail older dentulous people were tape-recorded, transcribed, coded for content and analyzed. Additional information was collected which included age, gender, living situation, use of dental prostheses, self-reported oral health status, chronic disorders, and an index for frailty. Results Seven themes were identified in the relationship between natural teeth and the QoL of the participants: pride and achievement; intactness; sense of control; oral function; appearance; comfort; along with coping and adapting to disabilities. Having natural teeth generally had a positive effect on QoL. Positive effects through pride and achievement, intactness, and sense of control were most apparent for the most severely frail. They compared themselves with peers who are more often edentate, and valued the good state of their teeth against the background of their declining health, especially those with disabilities causing severe chronic pain or impaired fine-motor skills. The effect of coping with and adaptation to tooth loss was also most apparent for the most severely frail. There was a gender effect in that the men generally cared less about having natural teeth than women, regardless of their level of frailty. Conclusions QoL of frail older people is positively influenced by natural teeth, and this effect seems to increase with increasing frailty. Preservation of teeth contributes to a positive body image and self-worth. Oral care for frail people should aim to preserve natural teeth if possible. PMID:23031489

  5. Perceptions of Speed and Risk: Experimental Studies of Road Crossing by Older People

    PubMed Central

    Butler, Annie A.

    2016-01-01

    Crossing a road safely is a complex task requiring good sensorimotor function and integration of information about traffic speed, distances and one’s own speed. Poor judgement through age-related sensorimotor or cognitive impairment or a predisposition to take risks could lead to errors with serious consequences. On a simulated road, 85 participants (age ≥70 years) were asked to cross in front of an approaching car with a clearance as small as considered safe in two conditions; (1) with nothing else to attend to (free crossing) and (2) with an additional ball-gathering task while waiting to cross (task crossing). Participants were categorised according to their crossing outcome (failed to cross, ‘hit’, exact, safe, cautious). Participants also performed two sub-studies; (1) the perception of the time-to-arrival of moving objects and (2) the perception of own gait speed. Physical and cognitive function and everyday risk-taking behaviour were also assessed. In free crossing, clearances varied but no participants were “hit” by the car. In task crossing, participants allowed smaller clearances and 10% of participants would have been hit while 13% missed the opportunity to cross altogether. Across a wide range of physical and cognitive measures, including perceived and actual gait speed, a consistent pattern was observed in the task crossing condition. The exact group performed best, the ‘hit’, safe and cautious groups performed less well while those who missed the opportunity (fail) performed worst. The exact group reported taking the greatest risks in everyday life whereas the remaining groups reported being cautious. In conclusion, we found older people with poorer perceptual, physical and cognitive function made inappropriate and risky decisions in a divided attention road-crossing task despite self-reports of cautious behaviour in everyday life. PMID:27054918

  6. Medicines management support to older people: understanding the context of systems failure

    PubMed Central

    Rogers, Stephen; Martin, Graham; Rai, Gurcharan

    2014-01-01

    Objectives Changing demographics and pressures on the healthcare system mean that more older people with complex medical problems need to be supported in primary and community care settings. The challenge of managing medicines effectively in frail elderly patients is considerable. Our research investigates what can go wrong and why, and seeks insight into the context that might set the scene for system failure. Setting North London; a district general hospital and surrounding health authorities. Participants 7 patients who had been admitted to hospital and 16 informants involved in their care. Design Patients with preventable medication-related admissions were identified in an occurrence screening study. An accident investigation approach was used to create case studies from accounts of staff involved in each patient's care prior to their admission. Structured analysis of case studies according to the accident investigation approach was complemented by a separate analysis of interviews using open coding with constant comparison to identify and illustrate higher-level contextual themes. Outcomes The study sheds light on care management problems, their causes and the context in which care management problems and their causes have occurred. Results Care management problems were rooted in issues with decision-making, information support and communications among staff members and between staff, patients and carers. Poor judgement, slips and deviations from best practice were attributed to task overload and complexity. Within general practice, at the interface with community services and with hospitals, we identified disruption to traditional intraprofessional and interprofessional roles, assumptions, channels and media of communication which together created conditions that might compromise patient safety. Conclusions New ways of working driven by the ethos of productivity are disrupting traditional intraprofessional and interprofessional roles, assumptions, channels

  7. Neurovascular coupling, cerebral white matter integrity, and response to cocoa in older people

    PubMed Central

    Hurwitz, Shelley; Salat, David H.; Greve, Douglas N.; Fisher, Naomi D.L.

    2013-01-01

    Objective: To investigate the relationship between neurovascular coupling and cognitive function in elderly individuals with vascular risk factors and to determine whether neurovascular coupling could be modified by cocoa consumption. Methods: Sixty older people (aged 72.9 ± 5.4 years) were studied in a parallel-arm, double-blind clinical trial of neurovascular coupling and cognition in response to 24 hours and 30 days of cocoa consumption. Cognitive measures included Mini-Mental State Examination and Trail Making Test A and B. Neurovascular coupling was measured from the beat-to-beat blood flow velocity responses in the middle cerebral arteries to the N-Back Task. In a subset of MRI-eligible participants, cerebral white matter structural integrity was also measured. Results: Neurovascular coupling was associated with Trails B scores (p = 0.002) and performance on the 2-Back Task. Higher neurovascular coupling was also associated with significantly higher fractional anisotropy in cerebral white matter hyperintensities (p = 0.02). Finally, 30 days of cocoa consumption was associated with increased neurovascular coupling (5.6% ± 7.2% vs −2.4% ± 4.8%; p = 0.001) and improved Trails B times (116 ± 78 seconds vs 167 ± 110 seconds; p = 0.007) in those with impaired neurovascular coupling at baseline. Conclusion: There is a strong correlation between neurovascular coupling and cognitive function, and both can be improved by regular cocoa consumption in individuals with baseline impairments. Better neurovascular coupling is also associated with greater white matter structural integrity. PMID:23925758

  8. Perceived autonomy support, psychological needs satisfaction, depressive symptoms and apathy in French hospitalized older people.

    PubMed

    Souesme, Guillaume; Martinent, Guillaume; Ferrand, Claude

    2016-01-01

    Based on the self-determination theory, the aim of the present study was (1) to provide a better understanding of older people's psychological needs satisfaction in geriatric care units, then to link this information with depressive symptoms and apathy; (2) to examine whether the perceived autonomy support from health care professionals differs between needs satisfaction profiles; and (3) to investigate for all participants how each need satisfaction was related to depressive symptoms and apathy. Participants (N=100; Mage=83.33years, SD=7.78, 61% female) completed the measures of psychological needs satisfaction, perceived autonomy support, geriatric depression and apathy. Sociodemographic data were also collected. Cluster analyses showed three distinct profiles: one profile with low-moderate need satisfaction, one profile with high-moderate need satisfaction and one profile with high need satisfaction. These profiles are distinct, and did not differ in terms of participants' characteristics, except gender. Multivariate analysis of covariance (MANCOVA) revealed that participants with low-moderate need satisfaction profile have significantly higher level of depressive symptoms and apathy, and lower levels of perceived autonomy support than participants of the two other profiles. Moreover, for all participants, regression analyses revealed that both competence and relatedness needs satisfaction significantly and negatively explained 28% of the variance in depressive symptoms score and 44% of the variance in apathy score. Our results highlight the interest to examine more thoroughly the variables fostering autonomy-supportive environment in geriatric care units, and to deepen the relationship between competence and relatedness needs satisfaction and depressive symptoms and apathy. PMID:27002495

  9. Exploring the mealtime experience in residential care settings for older people: an observational study.

    PubMed

    Barnes, Sarah; Wasielewska, Anna; Raiswell, Christine; Drummond, Barbara

    2013-07-01

    Improving the mealtime experience in residential care can be a major facilitator in improving care, well-being and QoL. Evidence suggests that, despite guidance on the subject of food, nutrition and hydration, there are still concerns. Although there is a range of methods to research and assess the quality of food provision, there is a challenge in capturing the experiences of those residents who are unable or unwilling to describe their feelings and experiences because of frailty, impaired communication or other vulnerability. The aim of this exploratory study was to capture and describe individual residents' mealtime experience. In spring 2011, a small-scale, observational study was carried out in seven dining settings in four residential care homes in Manchester. An adapted dementia care mapping tool was used alongside field notes. Observations showed two major differences in the way the mealtimes were organised: 'pre-plated' and 'family-style' (where either bowls of food are placed in the centre of the table or food is served directly from a hotplate by a chef). These two styles of service are discussed in relation to the emerging themes of 'task versus resident-centred mealtimes', 'fostering resident independence' and 'levels of interaction'. Although improving mealtimes alone is not enough to improve quality of life in care homes, findings showed that relatively small changes to mealtime delivery can potentially have an impact on resident well-being in these homes. Observation is a useful method of engaging residents in care settings for older people who may not otherwise be able to take part in research. PMID:23638872

  10. Dementia in older people admitted to hospital: a regional multi-hospital observational study of prevalence, associations and case recognition

    PubMed Central

    Timmons, Suzanne; Manning, Edmund; Barrett, Aoife; Brady, Noeleen M.; Browne, Vanessa; O’Shea, Emma; Molloy, David William; O'Regan, Niamh A.; Trawley, Steven; Cahill, Suzanne; O'Sullivan, Kathleen; Woods, Noel; Meagher, David; Ni Chorcorain, Aoife M.; Linehan, John G.

    2015-01-01

    Background: previous studies have indicated a prevalence of dementia in older admissions of ∼42% in a single London teaching hospital, and 21% in four Queensland hospitals. However, there is a lack of published data from any European country on the prevalence of dementia across hospitals and between patient groups. Objective: to determine the prevalence and associations of dementia in older patients admitted to acute hospitals in Ireland. Methods: six hundred and six patients aged ≥70 years were recruited on admission to six hospitals in Cork County. Screening consisted of Standardised Mini-Mental State Examination (SMMSE); patients with scores <27/30 had further assessment with the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Final expert diagnosis was based on SMMSE, IQCODE and relevant medical and demographic history. Patients were screened for delirium and depression, and assessed for co-morbidity, functional ability and nutritional status. Results: of 598 older patients admitted to acute hospitals, 25% overall had dementia; with 29% in public hospitals. Prevalence varied between hospitals (P < 0.001); most common in rural hospitals and acute medical admissions. Only 35.6% of patients with dementia had a previous diagnosis. Patients with dementia were older and frailer, with higher co-morbidity, malnutrition and lower functional status (P < 0.001). Delirium was commonly superimposed on dementia (57%) on admission. Conclusion: dementia is common in older people admitted to acute hospitals, particularly in acute medical admissions, and rural hospitals, where services may be less available. Most dementia is not previously diagnosed, emphasising the necessity for cognitive assessment in older people on presentation to hospital. PMID:26420638

  11. Access to a Car and the Self-Reported Health and Mental Health of People Aged 65 and Older in Northern Ireland.

    PubMed

    Doebler, Stefanie

    2016-05-01

    This article examines relationships between access to a car and the self-reported health and mental health of older people. The analysis is based on a sample of N = 65,601 individuals aged 65 years and older from the Northern Ireland Longitudinal Study linked to 2001 and 2011 census returns. The findings from hierarchical linear and binary logistic multilevel path models indicate that having no access to a car is related to a considerable health and mental health disadvantage particularly for older people who live alone. Rural-urban health and mental health differences are mediated by access to a car. The findings support approaches that emphasize the importance of autonomy and independence for the well-being of older people and indicate that not having access to a car can be a problem for older people not only in rural but also in intermediate and urban areas, if no sufficient alternative forms of mobility are provided. PMID:26055983

  12. Cognitive impairment is a risk factor for delayed analgesia in older people with long bone fracture: a multicenter exploratory study.

    PubMed

    Fry, Margaret; Arendts, Glenn; Chenoweth, Lynn; MacGregor, Casimir

    2014-08-27

    ABSTRACT Background: Older people who present to the emergency department (ED) often experience a significant delay to analgesia. This study compares the time to analgesia for cognitively impaired and cognitively intact older people diagnosed with a long bone fracture. Methods: The aim of the study was to determine if cognitive impairment is associated with a delayed analgesic response. A 12-month exploratory study, using patient data, was conducted across four EDs. Medical records of 264 patients with long bone fractures were randomly selected. Results: The majority of patients waited longer than 60 minutes for analgesia. The median time to analgesia was longer for the cognitively impaired (149 minutes) compared with cognitively intact (72 minutes; Mann-Whitney U test: p < 0.001). Conclusions: This study suggests that cognitive impairment is a significant risk factor for delayed analgesia response in the ED. PMID:25162158

  13. Funny things happen at the Grange: introducing comedy activities in day services to older people with dementia--innovative practice.

    PubMed

    Hafford-Letchfield, Trish

    2013-11-01

    This paper shares outcomes from the evaluation of a community project where comedy activities were introduced into a day centre for older people with dementia as a result of a partnership between the day centre, a local university and a specialist comedy provider. Four workshops were provided using improvisatory activities and comedy, as a medium to engage older people in reflecting on aspects of their care environment. The main output resulted in a 30 minute 'mockumentary' of the 'Her Majesty the Queen' visiting the day centre, in the form of a digital reusable learning object to be used by social work and mental health professionals. The evaluation demonstrated some additional outcomes for those involved and highlighted the benefits of laughter and fun in promoting a positive climate. PMID:24337643

  14. Legislating for Filial Piety: An Indirect Approach to Promoting Family Support and Responsibility for Older People in Korea.

    PubMed

    Park, Hong-Jae

    2015-01-01

    Although every culture follows its own indigenous elder care practices, Korea has retained a unique way of supporting elder parents, specifically, and older people in general. When the care of older people in Korea became significantly challenging, it was determined to launch a controversial law to promote the tradition of filial piety. The main content of the law consists of requiring the government to take action to encourage filial piety and to support those adult children who care for their parents. Although this legislation has the potential to promote the practice of filial piety, the nature of the law is largely rhetorical and symbolic rather than practical, and as a result, its workability and efficiency are limited. PMID:25941771

  15. A randomized controlled trial exploring the effect of music on quality of life and depression in older people with dementia.

    PubMed

    Cooke, Marie; Moyle, Wendy; Shum, David; Harrison, Scott; Murfield, Jenny

    2010-07-01

    This randomized controlled trial investigated the effect of live music on quality of life and depression in 47 older people with dementia using the Dementia Quality of Life and Geriatric Depression Scale. The control/reading group reported higher mid-point feelings of belonging than the music group (F(1, 45) = 6.672, p < .05). Sub-analyses of >or= 50 per cent music session attendance found improvements in self-esteem over time (F(2, 46) = 4.471, p < .05). Participants with scores that were suggestive of increased depressive symptoms had fewer depressive symptoms over time (F(2, 22) = 8.129, p < .01). Findings suggest music and reading activities can improve self-esteem, belonging and depression in some older people with dementia. PMID:20603300

  16. Stimulus-response compatibility tests of implicit preference for food and body image to identify people at risk for disordered eating: a validation study.

    PubMed

    Khan, Saira; Petróczi, Andrea

    2015-01-01

    The aim of this study was to incorporate implicit measures of relevant social cognition into eating disorder research. Fifty-three females diagnosed with an eating disorder (ED), and 41 at-risk females were recruited via ED support websites, along with 23 healthy females for comparison. Computerised online tests assessing subconscious normative ideal body image (IBI-BIAT) and personalised self-identification body image (PBI-BIAT) associations and food preferences (FP-AAT) were administered, followed by the modified version of the Eating Disorder Examination Questionnaire (EDE-Q). Anthropometric data, age, need for social approval, self-reported measures of self-esteem, normative perception and body image satisfaction were recorded. Self-reported diagnosed ED status was corroborated with BMI and EDE-Q. Diagnostic performance of the implicit measures was assessed with ROC analysis. Those diagnosed with ED showed significantly stronger automatic preferences for and self-identification with thin body image, compared to healthy females, but no differences were found in food preferences. The IBI-BIAT showed better diagnostic power than PBI-BIAT, correctly classifying 87% of the diagnosed participants. No correlation was found between IBI-BIAT and the explicit measures. The results suggest that the underlying subconscious social cognitive factors of pathological eating are linked to body image, not to food items per se. PMID:25464068

  17. Effectiveness of a Batteryless and Wireless Wearable Sensor System for Identifying Bed and Chair Exits in Healthy Older People.

    PubMed

    Torres, Roberto Luis Shinmoto; Visvanathan, Renuka; Hoskins, Stephen; van den Hengel, Anton; Ranasinghe, Damith C

    2016-01-01

    Aging populations are increasing worldwide and strategies to minimize the impact of falls on older people need to be examined. Falls in hospitals are common and current hospital technological implementations use localized sensors on beds and chairs to alert caregivers of unsupervised patient ambulations; however, such systems have high false alarm rates. We investigate the recognition of bed and chair exits in real-time using a wireless wearable sensor worn by healthy older volunteers. Fourteen healthy older participants joined in supervised trials. They wore a batteryless, lightweight and wireless sensor over their attire and performed a set of broadly scripted activities. We developed a movement monitoring approach for the recognition of bed and chair exits based on a machine learning activity predictor. We investigated the effectiveness of our approach in generating bed and chair exit alerts in two possible clinical deployments (Room 1 and Room 2). The system obtained recall results above 93% (Room 2) and 94% (Room 1) for bed and chair exits, respectively. Precision was >78% and 67%, respectively, while F-score was >84% and 77% for bed and chair exits, respectively. This system has potential for real-time monitoring but further research in the final target population of older people is necessary. PMID:27092506

  18. Effectiveness of a Batteryless and Wireless Wearable Sensor System for Identifying Bed and Chair Exits in Healthy Older People

    PubMed Central

    Shinmoto Torres, Roberto Luis; Visvanathan, Renuka; Hoskins, Stephen; van den Hengel, Anton; Ranasinghe, Damith C.

    2016-01-01

    Aging populations are increasing worldwide and strategies to minimize the impact of falls on older people need to be examined. Falls in hospitals are common and current hospital technological implementations use localized sensors on beds and chairs to alert caregivers of unsupervised patient ambulations; however, such systems have high false alarm rates. We investigate the recognition of bed and chair exits in real-time using a wireless wearable sensor worn by healthy older volunteers. Fourteen healthy older participants joined in supervised trials. They wore a batteryless, lightweight and wireless sensor over their attire and performed a set of broadly scripted activities. We developed a movement monitoring approach for the recognition of bed and chair exits based on a machine learning activity predictor. We investigated the effectiveness of our approach in generating bed and chair exit alerts in two possible clinical deployments (Room 1 and Room 2). The system obtained recall results above 93% (Room 2) and 94% (Room 1) for bed and chair exits, respectively. Precision was >78% and 67%, respectively, while F-score was >84% and 77% for bed and chair exits, respectively. This system has potential for real-time monitoring but further research in the final target population of older people is necessary. PMID:27092506

  19. The Impact of Socioeconomic Conditions, Social Networks, and Health on Frail Older People's Life Satisfaction: A Cross-Sectional Study

    PubMed Central

    Berglund, Helene; Hasson, Henna; Wilhelmson, Katarina; Dunér, Anna; Dahlin-Ivanoff, Synneve

    2016-01-01

    It has been shown that frailty is associated with low levels of well-being and life satisfaction. Further exploration is needed, however, to better understand which components constitute life satisfaction for frail older people and how satisfaction is related to other life circumstances. The aim of this study was to examine relationships between frail older people’s life satisfaction and their socioeconomic conditions, social networks, and health-related conditions. A cross-sectional study was conducted (n=179). A logistic regression analysis was performed, including life satisfaction as the dependent variable and 12 items as independent variables. Four of the independent variables made statistically significant contributions: financial situation (OR 3.53), social contacts (OR 2.44), risk of depression (OR 2.26), and self-rated health (OR 2.79). This study demonstrates that financial situation, self-rated health conditions and social networks are important components for frail older people’s life satisfaction. Health and social care professionals and policy makers should consider this knowledge in the care and service for frail older people; and actions that benefit life satisfaction – such as social support – should be promoted. PMID:27403463

  20. Assessing the needs of older gay, lesbian, bisexual, and transgender people: a service-learning and agency partnership approach.

    PubMed

    Smith, Laurie A; McCaslin, Rosemary; Chang, Janet; Martinez, Paulina; McGrew, Paula

    2010-01-01

    A county agency and a social work research class partnered to conduct a state-mandated needs assessment of older gay, lesbian, bisexual, and transgendered people (GLBT). A survey design with purposive sampling of GLBT people over 60 yielded 38 participants. Findings included that the Internet was a viable means to reach this population and student awareness increased. Areas of greatest unmet need were GLBT-oriented/friendly legal advice, social events, grief and loss counseling, social workers, and assisted living. Some participants perceived existing senior services as unfriendly or hostile to GLBT persons. Recommendations include continued use of service-learning research and expanded needs assessment efforts. PMID:20603750

  1. The epidemiology of dependency among urban-dwelling older people in the Dominican Republic; a cross-sectional survey

    PubMed Central

    Acosta, Daisy; Rottbeck, Ruth; Rodríguez, Guillermina; Ferri, Cleusa P; Prince, Martin J

    2008-01-01

    Background Demographic ageing, and the health transition will soon lead to large increases in the number of dependent older people in low and middle income countries. Despite its importance, this topic has not previously been studied. Methods A cross sectional catchment area one-phase survey of health conditions, dependency, care arrangements and caregiver strain among 2011 people aged 65 years and over in Santo Domingo, Dominican Republic Results 7.1% of participants required much care and a further 4.7% required at least some care. The prevalence of dependency increased sharply with increasing age. Dependent older people were less likely than others to have a pension and much less likely to have paid work, but no more likely to benefit from financial support from their family. Needing much care was strongly associated with comorbidity between cognitive, psychological and physical health problems. However, dementia made the strongest independent contribution. Among those needing care, those with dementia stood out as being more disabled, as needing more care (particularly support with core activities of daily living), and as being more likely to have paid caregivers. Dementia caregivers experienced more strain than caregivers of those with other health conditions, an effect mediated by behavioural and psychological symptoms. Conclusion Dependency among older people is nearly as prevalent in Dominican Republic as in developed western settings. Non-communicable diseases, particularly dementia are the main contributing factors. Attention needs to be directed towards the development of age-appropriate healthcare, a long-term care policy, and mechanisms for ensuring the social protection of older persons. PMID:18700967

  2. Is there an association of vitamin B12 status with neurological function in older people? A systematic review.

    PubMed

    Miles, Lisa M; Mills, Kerry; Clarke, Robert; Dangour, Alan D

    2015-08-28

    Low vitamin B12 status is common in older people; however, its public health significance in terms of neurological manifestations remains unclear. The present systematic review evaluated the association of vitamin B12 status with neurological function and clinically relevant neurological outcomes in adults aged 50+ years. A systematic search of nine bibliographic databases (up to March 2013) identified twelve published articles describing two longitudinal and ten cross-sectional analyses. The included study populations ranged in size (n 28-2287) and mean/median age (range 65-81 years). Studies reported various neurological outcomes: nerve function; clinically measured signs and symptoms of nerve function; self-reported neurological symptoms. Studies were assessed for risk of bias, and results were synthesised qualitatively. Among the general population groups of older people, one longitudinal study reported no association, and four of seven cross-sectional studies reported limited evidence of an association of vitamin B12 status with some, but not all, neurological outcomes. Among groups with clinical and/or biochemical evidence of low vitamin B12 status, one longitudinal study reported an association of vitamin B12 status with some, but not all, neurological outcomes and three cross-sectional analyses reported no association. Overall, there is limited evidence from observational studies to suggest an association of vitamin B12 status with neurological function in older people. The heterogeneity and quality of the evidence base preclude more definitive conclusions, and further high-quality research is needed to better inform understanding of public health significance in terms of neurological function of vitamin B12 status in older people. PMID:26202329

  3. A Physical Activity Program to Mobilize Older People: A Practical and Sustainable Approach

    ERIC Educational Resources Information Center

    Jancey, Jonine M.; Clarke, Ann; Howat, Peter A.; Lee, Andy H.; Shilton, Trevor; Fisher, John

    2008-01-01

    Purpose: Despite the documented benefits of physical activity, it remains difficult to motivate older adults to start and maintain regular physical activity. This study tested an innovative intervention for mobilizing older adults into a neighborhood-based walking program. Design and Methods: Researchers recruited a total of 260 healthy but…

  4. "It's Never Too Late." A Learning Pack for Older People with Few or No Formal Qualifications.

    ERIC Educational Resources Information Center

    Oxford Univ. (England). Ruskin Coll.

    This learning pack, which was developed in Britain primarily for use with small groups of older adults who have had little formal education, contains nine self-contained units of learning activities dealing with topics related to older adults' everyday lives. The following topics are covered: techniques for organizing and running a group; myths…

  5. Transport-Related Social Exclusion amongst Older People in Rural Southwest England and Wales

    ERIC Educational Resources Information Center

    Shergold, Ian; Parkhurst, Graham

    2012-01-01

    Rural dwelling and older age are both associated with a higher risk of social exclusion, with accessibility identified as having an important facilitating role. The interactions between transport-related exclusion and older age, particularly in a rural context, are considered though analysis of quantitative and qualitative data collected from over…

  6. Reasons Given by Older People for Limitation or Avoidance of Driving

    ERIC Educational Resources Information Center

    Ragland, David R.; Satariano, William A.; MacLeod, Kara E.

    2004-01-01

    Purpose: To understand the driving behavior of older adults, this study examines self-reported reasons for driving limitation or avoidance. Design and Methods: Baseline interviews were conducted (n = 2,046) as part of a community-based study of aging and physical performance in persons aged 55 years or older in Sonoma, California. Twenty-one…

  7. Set-Shifting Ability Is Associated with Gray Matter Volume in Older People with Mild Cognitive Impairment

    PubMed Central

    Tsutsumimoto, Kota; Makizako, Hyuma; Shimada, Hiroyuki; Doi, Takehiko; Suzuki, Takao

    2015-01-01

    Background/Aims An understanding of the association between gray matter volume and executive functioning could provide strategies to reduce dementia risk in older people with mild cognitive impairment (MCI). Methods In a cross-sectional analysis, we assessed executive functioning in 83 older people with MCI using three standard neuropsychological tests: set shifting (difference between Trail Making Test Parts B and A), working memory (difference between Digit Span forward and backward from the Wechsler Adult Intelligence Scale-IV), and selective attention/response inhibition (difference between the second and third conditions of the color- and picture-word Stroop test). Gray matter volume was computed from brain MRIs and SIENAX from FSL software. Results Gray matter volume was significantly associated with set-shifting performance after accounting for age, gender, body mass index, education, and global cognition (standardized β = −0.376, p = 0.001), but not with working memory or selective attention/response inhibition. Conclusion The executive function of set-shifting ability was correlated with gray matter volume in older people with MCI. PMID:26628898

  8. A randomized controlled trial evaluating the effectiveness of a web-based, computer-tailored self-management intervention for people with or at risk for COPD

    PubMed Central

    Voncken-Brewster, Viola; Tange, Huibert; de Vries, Hein; Nagykaldi, Zsolt; Winkens, Bjorn; van der Weijden, Trudy

    2015-01-01

    Introduction COPD is a leading cause of morbidity and mortality. Self-management interventions are considered important in order to limit the progression of the disease. Computer-tailored interventions could be an effective tool to facilitate self-management. Methods This randomized controlled trial tested the effectiveness of a web-based, computer-tailored COPD self-management intervention on physical activity and smoking behavior. Participants were recruited from an online panel and through primary care practices. Those at risk for or diagnosed with COPD, between 40 and 70 years of age, proficient in Dutch, with access to the Internet, and with basic computer skills (n=1,325), were randomly assigned to either the intervention group (n=662) or control group (n=663). The intervention group received the web-based self-management application, while the control group received no intervention. Participants were not blinded to group assignment. After 6 months, the effect of the intervention was assessed for the primary outcomes, smoking cessation and physical activity, by self-reported 7-day point prevalence abstinence and the International Physical Activity Questionnaire – Short Form. Results Of the 1,325 participants, 1,071 (80.8%) completed the 6-month follow-up questionnaire. No significant treatment effect was found on either outcome. The application however, was used by only 36% of the participants in the experimental group. Conclusion A possible explanation for the nonsignificant effect on the primary outcomes, smoking cessation and physical activity, could be the low exposure to the application as engagement with the program has been shown to be crucial for the effectiveness of computer-tailored interventions. (Netherlands Trial Registry number: NTR3421.) PMID:26089656

  9. Life memories and the ability to act: the meaning of autonomy and participation for older people when living with chronic illness.

    PubMed

    Hedman, Maria; Pöder, Ulrika; Mamhidir, Anna-Greta; Nilsson, Annika; Kristofferzon, Marja-Leena; Häggström, Elisabeth

    2015-12-01

    There is a lack of knowledge about how older people living with chronic illness describe the meaning of autonomy and participation, indicating a risk for reduced autonomy and participation in their everyday life. The purpose of this study was to describe the meaning of autonomy and participation among older people living with chronic illness in accordance with their lived experience. The design was descriptive with a phenomenological approach guided by Giorgi's descriptive phenomenological psychological method. Purposive sampling was used, and 16 older people living with chronic illness who lived in an ordinary home participated in individual interviews. The findings showed that the meaning of autonomy and participation among the older people emerged when it was challenged and evoked emotional considerations of the lived experience of having a chronic illness. It involved living a life apart, yet still being someone who is able, trustworthy and given responsibility--still being seen and acknowledged. The meaning of autonomy and participation was derived through life memories and used by the older people in everyday life for adjustment or adaption to the present life and the future. Our conclusion is that autonomy and participation were considered in relation to older people's life memories in the past, in their present situation and also their future wishes. Ability or disability is of less importance than the meaning of everyday life among older people. We suggest using fewer labels for limitations in everyday life when caring for older people and more use of the phrase 'ability to act' in different ways, based on older people's descriptions of the meaning of autonomy and participation. PMID:25856656

  10. The health, social care and housing needs of lesbian, gay, bisexual and transgender older people: a review of the literature.

    PubMed

    Addis, Samia; Davies, Myfanwy; Greene, Giles; Macbride-Stewart, Sara; Shepherd, Michael

    2009-11-01

    This paper reports the findings of a literature review of the health, social care and housing needs of older lesbian, gay, bisexual and transgender (LGBT) adults undertaken in 2006 for the Welsh Assembly Government. Peer-reviewed literature was identified through database searches of BNI, PubMed, CINAHL, DARE, ASSIA and PsychInfo. Follow-up searches were conducted using references to key papers and journals as well as specific authors who had published key papers. A total of 187 papers or chapters were retrieved, of which 66 were included in the study; major themes were identified and the findings synthesised using a meta-narrative approach. The main themes that emerged from the review were isolation, health behaviours, mental health and sexual health behaviours. The literature indicates that the health, social care and housing needs of LGBT older people is influenced by a number of forms of discrimination which may impact upon the provision of, access to and take up of health, social care and housing services. Understanding of the health, social care and housing needs of older LGBT people is limited and research in this area is scarce. The research which exists has been criticised for using small samples and for tending to exclude participants from less affluent backgrounds. The focus of research tends to be on gay men and lesbians; consequently, the needs of bisexual and transgender people remain largely unknown. Additionally, research which does exist tends to focus on a narrow range of health issues, often related to the health needs of younger LGBT people. Discrimination in various forms has a major impact on needs and experiences, leading to marginalisation of LGBT people both in the provision of health and social care services and neglect of these groups in public health research. PMID:19519872

  11. Concepts of illness causation and attitudes to health care among older people in the Republic of Ireland.

    PubMed

    MacFarlane, Anne; Kelleher, Cecily

    2002-05-01

    Fifty-one older people (26 of them women) in the Republic of Ireland were interviewed using a semi-structured schedule on their health and illness experiences at three different time points in their lives; as children, as young adults and presently. Of particular interest were their views about the causes of heart disease, cancer and tuberculosis and their experiences of the prevailing health care system during their lifetime. Participants were recruited by letter from a database of respondents to a previous national quantitative survey of older people. Of 247 people originally contacted 127 (51%) responded by letter and 51 of these took part in the interview study. Data were analysed according to principles of content analysis using NUDIST software. Reported ideas about causes of illnesses were multicausal. These were categorised as behavioural, biological, psychosocial or other explanations. While respondents placed most emphasis on behavioural explanations, this was accompanied by more complex views and critical questioning of formal health education messages. There was a strong allegiance to current biomedical concepts and practices. This appeared to be explained in part by reported negative experiences of health care treatments during childhood, particularly in hospitals, now perceived to be much improved. Advances in biomedicine were discussed with accounts of benefits received or observed by participants. An analysis of the history of health services in Ireland suggests that some of the attitudes reported reflect the experiences of the respondents as a generation rather than as older people per se and hence highlights the impact of public policy on people's experiences of and attitudes toward health and health care systems. PMID:12058855

  12. Diagnostic accuracy of calculated serum osmolarity to predict dehydration in older people: adding value to pathology laboratory reports

    PubMed Central

    Hooper, Lee; Abdelhamid, Asmaa; Ali, Adam; Bunn, Diane K; Jennings, Amy; John, W Garry; Kerry, Susan; Lindner, Gregor; Pfortmueller, Carmen A; Sjöstrand, Fredrik; Walsh, Neil P; Fairweather-Tait, Susan J; Potter, John F; Hunter, Paul R; Shepstone, Lee

    2015-01-01

    Objectives To assess which osmolarity equation best predicts directly measured serum/plasma osmolality and whether its use could add value to routine blood test results through screening for dehydration in older people. Design Diagnostic accuracy study. Participants Older people (≥65 years) in 5 cohorts: Dietary Strategies for Healthy Ageing in Europe (NU-AGE, living in the community), Dehydration Recognition In our Elders (DRIE, living in residential care), Fortes (admitted to acute medical care), Sjöstrand (emergency room) or Pfortmueller cohorts (hospitalised with liver cirrhosis). Reference standard for hydration status Directly measured serum/plasma osmolality: current dehydration (serum osmolality >300 mOsm/kg), impending/current dehydration (≥295 mOsm/kg). Index tests 39 osmolarity equations calculated using serum indices from the same blood draw as directly measured osmolality. Results Across 5 cohorts 595 older people were included, of whom 19% were dehydrated (directly measured osmolality >300 mOsm/kg). Of 39 osmolarity equations, 5 showed reasonable agreement with directly measured osmolality and 3 had good predictive accuracy in subgroups with diabetes and poor renal function. Two equations were characterised by narrower limits of agreement, low levels of differential bias and good diagnostic accuracy in receiver operating characteristic plots (areas under the curve >0.8). The best equation was osmolarity=1.86×(Na++ K+)+1.15×glucose+urea+14 (all measured in mmol/L). It appeared useful in people aged ≥65 years with and without diabetes, poor renal function, dehydration, in men and women, with a range of ages, health, cognitive and functional status. Conclusions Some commonly used osmolarity equations work poorly, and should not be used. Given costs and prevalence of dehydration in older people we suggest use of the best formula by pathology laboratories using a cutpoint of 295 mOsm/L (sensitivity 85%, specificity 59%), to report

  13. Is Self-Rated Health an Independent Index for Mortality among Older People in Indonesia?

    PubMed Central

    Ng, Nawi; Hakimi, Mohammad; Santosa, Ailiana; Byass, Peter; Wilopo, Siswanto Agus; Wall, Stig

    2012-01-01

    Background Empirical studies on the association between self-rated health (SRH) and subsequent mortality are generally lacking in low- and middle-income countries. The evidence on whether socio-economic status and education modify this association is inconsistent. This study aims to fill these gaps using longitudinal data from a Health and Demographic Surveillance System (HDSS) site in Indonesia. Methods In 2010, we assessed the mortality status of 11,753 men and women aged 50+ who lived in Purworejo HDSS and participated in the INDEPTH WHO SAGE baseline in 2007. Information on self-rated health, socio-demographic indicators, disability and chronic disease were collected through face-to-face interview at baseline. We used Cox-proportional hazards regression for mortality and included all variables measured at baseline, including interaction terms between SRH and both education and socio-economic status (SES). Results During an average of 36 months follow-up, 11% of men and 9.5% of women died, resulting in death rates of 3.1 and 2.6 per 1,000 person-months, respectively. The age-adjusted Hazard Ratio (HR) for mortality was 17% higher in men than women (HR = 1.17; 95% CI = 1.04–1.31). After adjustment for covariates, the hazard ratios for mortality in men and women reporting bad health were 3.0 (95% CI = 2.0–4.4) and 4.9 (95% CI = 3.2–7.4), respectively. Education and SES did not modify this association for either sex. Conclusions This study supports the predictive power of bad self-rated health for subsequent mortality in rural Indonesian men and women 50 years old and over. In these analyses, education and household socio-economic status do not modify the relationship between SRH and mortality. This means that older people who rate their own health poorly should be an important target group for health service interventions. PMID:22523584

  14. Exercise in preventing falls and fall related injuries in older people: a review of randomised controlled trials

    PubMed Central

    Gardner, M.; Robertson, M; Campbell, A

    2000-01-01

    Objective—To assess the effectiveness of exercise programmes in preventing falls (and/or lowering the risk of falls and fall related injuries) in older people. Design—A review of controlled clinical trials designed with the aim of lowering the risk of falling and/or fall injuries through an exercise only intervention or an intervention that included an exercise component Main outcome measures—Falls, fall related injuries, time between falls, costs, cost effectiveness. Subjects—A total of 4933 men and women aged 60 years and older. Results—Eleven trials meeting the criteria for inclusion were reviewed. Eight of these trials had separate exercise interventions, and three used interventions with an exercise programme component. Five trials showed a significant reduction in the rate of falls or the risk of falling in the intervention group. Conclusions—Exercise is effective in lowering falls risk in selected groups and should form part of falls prevention programmes. Lowering fall related injuries will reduce health care costs but there is little available information on the costs associated with programme replication or the cost effectiveness of exercise programmes aimed at preventing falls in older people. Key Words: exercise; elderly; falls; cost effectiveness PMID:10690444

  15. Religiosity and depression in older people: Evidence from underprivileged refugee and non-refugee communities in Lebanon

    PubMed Central

    CHAAYA, M.; SIBAI, A. M.; FAYAD, R.; EL-ROUEIHEB, Z.

    2007-01-01

    Religiosity is an important aspect of the life of older people, particularly in the Arab region where religiosity is an important part of daily social and political life. Studies have documented the relationship between religiosity and depression among older people, but none in the region. A total of 740 persons aged 60 + were interviewed in three poor urban areas of Lebanon, one of which was a Palestinian refugee camp. The questionnaire included five items on religiosity covering organizational and intrinsic religiosity. Depression was assessed using the 15-item Geriatric Depression Score (GDS-15). Depression was prevalent in 24% of the older persons interviewed with the highest proportion being from the Palestinian refugee camp (31%). Results suggest that only organizational religiosity was related to depression and this pattern was only significant among the refugee population. Religious practice is discussed as an indicator of social solidarity rather than an aspect of religiosity. Minority groups may rely on religious stratagems to cope with their distress more than other groups. PMID:17164156

  16. Our Children at Risk.

    ERIC Educational Resources Information Center

    Organisation for Economic Cooperation and Development, Paris (France). Centre for Educational Research and Innovation.

    This report is concerned with at risk children and youth. Synthesizing data based on country reports and case studies from 17 countries and 3 foundations, the report covers issues relating to the preschool, school age, and transition to work periods. At risk children and youth have become key issues not only from claims of social justice, but also…

  17. Who Is at Risk for Sarcoidosis?

    MedlinePlus

    ... NHLBI on Twitter. Who Is at Risk for Sarcoidosis? Sarcoidosis affects people of all ages and races. ... Content: NEXT >> Featured Video Living With and Managing Sarcoidosis 05/18/2011 This video—presented by the ...

  18. Who Is at Risk for Atrial Fibrillation?

    MedlinePlus

    ... from the NHLBI on Twitter. Who Is at Risk for Atrial Fibrillation? Atrial fibrillation (AF) affects millions ... than 75. AF is uncommon in children. Major Risk Factors AF is more common in people who ...

  19. Falls after Discharge from Hospital: Is There a Gap between Older Peoples' Knowledge about Falls Prevention Strategies and the Research Evidence?

    ERIC Educational Resources Information Center

    Hill, Anne-Marie; Hoffmann, Tammy; Beer, Christopher; McPhail, Steven; Hill, Keith D.; Oliver, David; Brauer, Sandra G.; Haines, Terry P.

    2011-01-01

    Purpose: The aim of this study was to examine whether older people are prepared to engage in appropriate falls prevention strategies after discharge from hospital. Design and Methods: We used a semi-structured interview to survey older patients about to be discharged from hospital and examined their knowledge regarding falls prevention strategies…

  20. The Portrayal of Older People in Television Advertisements: A Cross-Cultural Content Analysis of the United States and South Korea

    ERIC Educational Resources Information Center

    Lee, Byoungkwan; Kim, Bong-Chul; Han, Sangpil

    2006-01-01

    A cross-cultural content analysis of 2,295 prime-time television ads--859 ads from the United States and 1,436 ads from South Korea--was conducted to examine the differences in the portrayal of older people between U.S. and Korean ads. In two countries, the underrepresentation of older people in ads was found in terms of proportions of the actual…