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Sample records for age older patients

  1. Outcome of Silicone Ring Vertical Gastroplasty in Patients Aged 50 Years and Older.

    PubMed

    Kyzer; Ramadan; Avraham; Belavsky; Hopp; Chaimoff

    1996-08-01

    BACKGROUND: The authors studied the results Of silicone ring vertical gastroplasty (SRVG) in Patients aged 50 years and older. METHODS: The early and late Postoperative results in 28 patients aged.50 Years or older undergoing SRVG were reviewed retrospectively, The results were compared to those of 370 Patients Younger than 50 years operated during the same period. RESULTS: There was no Postoperative mortality among patients aged 50 years and older. There was a significantly higher incidence Of Pulmonary embolus and wound infection among patients aged 50 years and older (P < 0.05). The weight loss did not differ significantly between the two studied age groups. CONCLUSION: SRVG may performed on patients aged 50 years or older with acceptable complication rate and favorable postoperative results. PMID:10729875

  2. Characteristics and Outcome of Patients Diagnosed With HIV at Older Age.

    PubMed

    Asher, Ilan; Guri, Keren Mahlab; Elbirt, Daniel; Bezalel, Shira Rosenberg; Maldarelli, Frank; Mor, Orna; Grossman, Zehava; Sthoeger, Zev M

    2016-01-01

    To characterize the clinical, virological, and immunological status at presentation as well as the outcome of patients diagnosed with HIV above the age of 50. A retrospective study of 418 patients newly diagnosed with HIV in 1 Israeli center, between the years 2004 and 2013. Patients with new HIV diagnosis ≥ 50 years of age defined as "older' and < 50 defined as "younger.' Patients were evaluated every 1 to 3 months (mean follow-up 53 ± 33 months). Patients with < 2 CD4/viral-load measurements or with < 1 year of follow-up were excluded. Time of HIV infection was estimated by HIV sequence ambiguity assay. Ambiguity index ≤ 0.43 indicated recent (≤ 1 year) HIV infection. Eighty nine (21%) patients were diagnosed with HIV at an older age. Those older patients presented with significant lower CD4 cell counts and higher viral-load compared with the younger patients. At the end of the study, the older patients had higher mortality rate (21% vs 3.5%; P < 0.001) and lower CD4 cell counts (381 ± 228 vs 483 ± 26 cells/μL; P < 0.001) compared with the younger patients. This difference was also observed between older and younger patients with similar CD4 cell counts and viral load at the time of HIV diagnosis and among patients with a recent (≤ 1 year) HIV infection. One-fifth of HIV patients are diagnosed at older age (≥ 50 years). Those older patients have less favorable outcome compared with the younger patients. This point to the need of educational and screening programs within older populations and for a closer follow-up of older HIV patients. PMID:26735534

  3. Breast Cancer Subtypes in Patients Aged 70 Years and Older.

    PubMed

    Königsberg, Robert; Pfeiler, Georg; Hammerschmid, Nicole; Holub, Oliver; Glössmann, Kerstin; Larcher-Senn, Julian; Dittrich, Christian

    2016-05-27

    Recurrence and survival pattern in breast cancer (bc) patients (pts) ≥ 70 years subcategorized according to subtype and age are still an area of uncertainty. Tumor characteristics, patient demographics, therapies applied, and recurrence pattern were compared between luminal A (LA), luminal B (LB), Her2/neu overexpressing (Her+) and triple-negative (TN) bc subtypes and the age subcategories 70-74, 75-79, ≥80 years. Based on univariate Cox-regression-analyses distant-disease-free-survival (DDFS) differed significantly for bc subtypes (p = 0.0002), notably for Her+ vs. LA (p = 0.0014), TN vs. LA (p < 0.001), and TN vs. LB (p = 0.0086). Not age, but Her+ and TN represented prognostic factors for DDFS. PMID:27215407

  4. Factors associated with quality of life in middle-aged and older patients living with HIV

    PubMed Central

    Monteiro, Fabiana; Canavarro, Maria Cristina; Pereira, Marco

    2016-01-01

    ABSTRACT HIV infection has been historically considered a disease of young adults; however, adults aged 50 years and older represent now an increasing proportion of HIV cases worldwide, including in Portugal. In this context, given the considerable burden associated with living with HIV, the topic of quality-of-life (QoL) assessment has become increasingly relevant. The aims of this study were to examine the age-related differences in QoL and depressive symptoms of younger and middle-aged and older adults with HIV as well as the sociodemographic, HIV-related and depressive symptoms (cognitive-affective and somatic) associated with QoL domains. The sample consisted of 1194 HIV-infected patients, recruited from 10 Portuguese hospitals. QoL data were collected using the WHOQOL-HIV-Bref questionnaire. Patients also completed the Beck Depression Inventory. Of the 1194 patients, 185 (15.5%) were over 50 years old. Middle-aged and older patients reported significantly lower QoL in the physical, independence and social relationships domains. Regarding the specific facets of QoL, middle-aged and older patients reported significantly lower scores in seven of the 29 specific facets of the WHOQOL-HIV-Bref and higher scores in one facet (financial resources). Overall, among middle-aged and older patients, higher education, being employed, a shorter time since HIV diagnosis, use of combination anti-retroviral therapy and fewer depressive symptoms were significantly associated with higher QoL ratings. Our findings suggest that both cognitive-affective and somatic depressive symptoms account for significant variability in QoL scores in middle-aged and older patients. Because an important feature of healthy ageing is maintaining QoL, these data may provide useful information for tailoring age-appropriate and effective interventions to improve the mental health and QoL of middle-aged and older patients living with HIV. PMID:26881294

  5. Factors associated with quality of life in middle-aged and older patients living with HIV.

    PubMed

    Monteiro, Fabiana; Canavarro, Maria Cristina; Pereira, Marco

    2016-01-01

    HIV infection has been historically considered a disease of young adults; however, adults aged 50 years and older represent now an increasing proportion of HIV cases worldwide, including in Portugal. In this context, given the considerable burden associated with living with HIV, the topic of quality-of-life (QoL) assessment has become increasingly relevant. The aims of this study were to examine the age-related differences in QoL and depressive symptoms of younger and middle-aged and older adults with HIV as well as the sociodemographic, HIV-related and depressive symptoms (cognitive-affective and somatic) associated with QoL domains. The sample consisted of 1194 HIV-infected patients, recruited from 10 Portuguese hospitals. QoL data were collected using the WHOQOL-HIV-Bref questionnaire. Patients also completed the Beck Depression Inventory. Of the 1194 patients, 185 (15.5%) were over 50 years old. Middle-aged and older patients reported significantly lower QoL in the physical, independence and social relationships domains. Regarding the specific facets of QoL, middle-aged and older patients reported significantly lower scores in seven of the 29 specific facets of the WHOQOL-HIV-Bref and higher scores in one facet (financial resources). Overall, among middle-aged and older patients, higher education, being employed, a shorter time since HIV diagnosis, use of combination anti-retroviral therapy and fewer depressive symptoms were significantly associated with higher QoL ratings. Our findings suggest that both cognitive-affective and somatic depressive symptoms account for significant variability in QoL scores in middle-aged and older patients. Because an important feature of healthy ageing is maintaining QoL, these data may provide useful information for tailoring age-appropriate and effective interventions to improve the mental health and QoL of middle-aged and older patients living with HIV. PMID:26881294

  6. Effect of older age on treatment decisions and outcomes among patients with traumatic spinal cord injury

    PubMed Central

    Ahn, Henry; Bailey, Christopher S.; Rivers, Carly S.; Noonan, Vanessa K.; Tsai, Eve C.; Fourney, Daryl R.; Attabib, Najmedden; Kwon, Brian K.; Christie, Sean D.; Fehlings, Michael G.; Finkelstein, Joel; Hurlbert, R. John; Townson, Andrea; Parent, Stefan; Drew, Brian; Chen, Jason; Dvorak, Marcel F.

    2015-01-01

    Background: Older people are at increased risk of traumatic spinal cord injury from falls. We evaluated the impact of older age (≥ 70 yr) on treatment decisions and outcomes. Methods: We identified patients with traumatic spinal cord injury for whom consent and detailed data were available from among patients recruited (2004–2013) at any of the 31 acute care and rehabilitation hospitals participating in the Rick Hansen Spinal Cord Injury Registry. Patients were assessed by age group (< 70 v. ≥ 70 yr). The primary outcome was the rate of acute surgical treatment. We used bivariate and multivariate regression models to assess patient and injury-related factors associated with receiving surgical treatment and with the timing of surgery after arrival to a participating centre. Results: Of the 1440 patients included in our study cohort, 167 (11.6%) were 70 years or older at the time of injury. Older patients were more likely than younger patients to be injured by falling (83.1% v. 37.4%; p < 0.001), to have a cervical injury (78.0% v. 61.6%; p = 0.001), to have less severe injuries on admission (American Spinal Injury Association Impairment Scale grade C or D: 70.5% v. 46.9%; p < 0.001), to have a longer stay in an acute care hospital (median 35 v. 28 d; p < 0.005) and to have a higher in-hospital mortality (4.2% v. 0.6%; p < 0.001). Multivariate analysis did not show that age of 70 years or more at injury was associated with a decreased likelihood of surgical treatment (adjusted odds ratio [OR] 0.48, 95% confidence interval [CI] 0.22–1.07). An unplanned sensitivity analysis with different age thresholds showed that a threshold of 65 years was associated with a decreased chance of surgical treatment (OR 0.39, 95% CI 0.19–0.80). Older patients who underwent surgical treatment had a significantly longer wait time from admission to surgery than younger patients (37 v. 19 h; p < 0.001). Interpretation: We found chronological age to be a factor influencing

  7. Private Prayer and Optimism in Middle-Aged and Older Patients Awaiting Cardiac Surgery

    ERIC Educational Resources Information Center

    Ai, Amy L.; Peterson, Christopher; Bolling, Steven F.; Koenig, Harold

    2002-01-01

    Purpose: This study investigated the use of private prayer among middle-aged and older patients as a way of coping with cardiac surgery and prayer's relationship to optimism. Design and Methods: The measure of prayer included three aspects: (a) belief in the importance of private prayer, (b) faith in the efficacy of prayer on the basis of previous…

  8. Is prosthodontic treatment age-dependent in patients 60 years and older in Public Dental Services?

    PubMed

    Hiltunen, K; Vehkalahti, M M; Mäntylä, P

    2015-06-01

    Prosthodontic treatment is a common procedure for the elderly as tooth loss is a reality in old age. Dentists take care of increasingly older patients with physiological age manifesting as cognitive impairment, frailty or multiple chronic diseases or who have side effects of medicines. We evaluated how patients' age affects prosthodontic treatment choice and whether we could identify the age when a change in practice occurs. In addition, we determined how common the treatment method of fixed prostheses is among patients aged 60 years or over in Public Dental Services (PDS) and how common rehabilitation of dentition with new dentures is compared with repair of existing dentures. Our data cover all patients aged 60 years and older (n = 130,060) treated in Helsinki PDS in 2007-2012. Data were aggregated into seven groups: 60-64, 65-69, 70-74, 75-79, 80-84, 85-89, and 90 years and over. During the 6-year period, the mean annual number of the population was about 114,000 and the mean annual number of patients treated with prosthodontics 1700. Prosthodontic treatment choices (repair, removable prosthodontics, fixed prostheses, fibre-reinforced composite fixed prostheses) vary by age; the older the patient, the rarer fixed or fibre-reinforced composite fixed prostheses and removable prostheses and the more frequent repairs (P < 0.001). Denture repair was virtually the only treatment that patients over 90 years received. Based on our results, the age at which prosthodontic treatment practices in PDS change is around 70 years. Beyond this age, fixed prosthodontic treatment modalities are very rare and repairs are more common.

  9. [Analysis of Pancreaticoduodenectomy for Elderly Patients Aged 75 Years or Older].

    PubMed

    Murakami, Masahiro; Shimizu, Junzo; Koga, Chikato; Hitora, Toshiki; Kawabata, Ryohei; Oda, Naofumi; Hirota, Masaki; Yoshikawa, Masato; Morishima, Hirotaka; Ikenaga, Masakazu; Matsunami, Nobuteru; Hasegawa, Junichi

    2015-11-01

    The feasibility of pancreaticoduodenectomy (PD) for elderly patients is controversial. Of 51 patients with pancreatic or bile duct tumor who underwent PD (except portal vein resection), the surgical results of 27 elderly patients aged 75 years or older (elderly group) we retrospectively evaluated and compared with those of 24 patients younger than 75 years (younger group). Although ASA-PS was significantly higher in the elderly group, we did not observe any significant difference in other background characteristics, complications, or length of hospital stay between the two groups. This study suggests that PD is probably safe and feasible with the appropriate surgical indication for elderly patients.

  10. Transsphenoidal surgical treatment of pituitary adenomas in patients aged 80 years or older.

    PubMed

    Yunoue, Shunji; Tokimura, Hiroshi; Tominaga, Atsushi; Fujio, Shingo; Karki, Prasanna; Usui, Satoshi; Kinoshita, Yasuyuki; Habu, Mika; Moinuddin, F M; Hirano, Hirofumi; Arita, Kazunori

    2014-04-01

    To know the clinical characteristics of pituitary adenomas in the elderly patients aged 80 years or older who were surgically treated. From 1995 through 2012, 907 patients underwent surgery for the pituitary adenomas at Kagoshima- and Hiroshima University hospitals in Japan. Ten (1.1%) patients were aged 80 years or older. We retrospectively assessed the clinical characteristics including preoperative comorbidities, manifestations, neuroimaging findings, and endocrinologic features of these ten patients. The subjects included eight males and two females. Their ages ranged from 80 to 86 with mean of 83.1 years. Of these, besides one case of growth hormone-producing adenoma, others were clinically nonfunctioning adenoma. Six patients had modest comorbidities such as hypertension, cardiovascular diseases, diabetes mellitus, or chronic kidney dysfunction, and all patients were classified into grade 2-3 on American Society of Anesthesiologists' Physical Status grading. Transsphenoidal surgery was performed in all due to visual disturbance in eight, diabetes mellitus as an intercurrent illness of acromegaly in one, and for the purpose of preventing visual disturbance in one patient who had an adenoma impinging optic chiasm but still had normal visual field. The surgeries provided sufficient decompression of the optic pathways and improved visual disorder in all. In an acromegalic male, his comorbidities considerably improved. No permanent surgical morbidity ensued. More than three axes of anterior pituitary hormones were preoperatively impaired in all, which were rarely recovered. Transsphenoidal surgery is safe and efficient treatment way for patients aged 80 years or older with pituitary adenomas with chiasmatic symptoms when the patients' general condition is well preserved and pituitary hormonal deficiency is adequately replaced. PMID:24233259

  11. Endovascular treatment of ruptured intracranial aneurysms in patients 70 years of age and older

    PubMed Central

    Watanabe, Daisuke; Hashimoto, Takao; Koyama, Shunichi; Ohashi, H. Tomoo; Okada, Hirohumi; Ichimasu, Norio; Kohno, Michihiro

    2014-01-01

    Background: An increasing number of elderly patients present with intracranial aneurysms. In addition to female gender, an older age is associated with a higher risk of developing a subarachnoid hemorrhage (SAH), and these patients often fare poorly in terms of long-term outcome. It is often thought that elderly patients would especially benefit from endovascular aneurysm treatment. We assessed the clinical outcomes in elderly patients with ruptured intracranial aneurysms (RIAs) who were treated by endovascular procedures. Methods: We performed a retrospective review of a prospective database of elderly patients treated with coil embolization for RIAs. The clinical outcomes were assessed using the modified Glasgow Outcome Scale. The rates of procedural complications and adverse events were also recorded. Results: During a period of 5 years, 162 patients with 183 intracranial aneurysms were treated in our hospital by means of an endovascular approach. Among them, 51 patients (31.5%) with a ruptured aneurysm were aged 70 years or older. These patients aged 70-91 years (mean age, 74 years) were treated by coil embolization for RIAs. Among them, seven had a Hunt and Hess (HH) grade of I or II, 42 had an HH grade of III or IV, and 2 had an HH grade of V. Endovascular treatment resulted in 32 complete occlusions (62.7%), 15 neck remnants (22%), and 4 body fillings (7.9%). Procedural complications occurred in five patients (9.8%). The outcomes were good or excellent in 17 patients (33.3%). Three patients (5.8%) who died had an HH grade of IV or V. Rebleeding occurred during follow-up in one patient (1.9%). Conclusions: Coil embolization of intracranial aneurysms is safe and effective in the elderly. However, the morbidity and mortality rates are higher in patients with high HH grades. This finding suggests that the timing of treatment should be based on the patient's initial clinical status. PMID:25101199

  12. [Some disorder features of blood circulation in lungs in older age influenza patients].

    PubMed

    Roganova, I V

    2011-01-01

    Patients aged 51-65 years with influenza develop circulatory disorders of the lung. Tone of the arteries of small and medium-caliber and venular vessels of the vascular bed of the lungs persistently reduced during the illness and a month after its start. The flow of venous blood from the vessels of the lungs disturbs: it is slow, difficult and becomes unstable. Such circulatory disorders in the lungs of influenza patients of older age groups appear during the illness and persist for a long time in the recovery period, which is a risk factor associated with complications of the respiratory system, not only during the illness, but after the disease.

  13. Characteristics of middle-aged and older patients with temporomandibular disorders and burning mouth syndrome.

    PubMed

    Honda, Mika; Iida, Takashi; Komiyama, Osamu; Masuda, Manabu; Uchida, Takashi; Nishimura, Hitoshi; Okubo, Masakazu; Shimosaka, Michiharu; Narita, Noriyuki; Niwa, Hideo; Kubo, Hideyuki; De Laat, Antoon; Kawara, Misao; Makiyama, Yasuhide

    2015-01-01

    The aim of this study was to evaluate the relationship between pain intensities and psychosocial characteristics in middle-aged and older patients with temporomandibular disorders (TMDs) and burning mouth syndrome (BMS). Subjects were selected according to the Research Diagnostic Criteria for TMD (n = 705) and International Association for the Study of Pain criteria for BMS (n = 175). Patients were then divided into two age groups: 45-64 years (middle-aged, Group A) and 65-84 years (older, Group B). Pain intensity and depression and somatization scores were evaluated in both groups. In BMS patients, present and worst pain intensities were significantly higher in Group B than in Group A {4.6 [95% confidence interval (CI) = 4.0-5.2] vs. 3.5 [95% CI = 3.1-3.9] and 5.9 [95% CI = 5.2-6.4] vs. 5.0 [95% CI = 4.5-5.6], respectively; P < 0.05}, with no difference observed in TMD patients. The depression and somatization scores were significantly higher in Group A than in Group B among BMS patients [0.57 (95% CI = 0.45-0.69) vs. 0.46 (95% CI = 0.34-0.59) and 0.537 (95% CI = 0.45-0.63) vs. 0.45 (95% CI = 0.34-0.55); P < 0.05], with no difference observed in TMD patients. The results of the present study indicate that pain intensities and psychosocial characteristics in BMS appear to differ between middle-aged and older patients. PMID:26666859

  14. Outcomes and Tolerability of Chemoradiation Therapy for Pancreatic Cancer Patients Aged 75 Years or Older

    SciTech Connect

    Miyamoto, David T.; Mamon, Harvey J.

    2010-07-15

    Purpose: To review the outcomes and tolerability of full-dose chemoradiation in elderly patients aged 75 years or older with localized pancreatic cancer. Methods and Materials: We retrospectively reviewed patients aged 75 years or older with nonmetastatic pancreatic cancer treated with chemoradiation therapy at two institutions from 2002 to 2007. Patients were analyzed for treatment toxicity, local recurrences, distant metastases, and survival. Results: A total of 42 patients with a median age of 78 years (range, 75-90 years) who received chemoradiation therapy for pancreatic cancer were identified. Of the patients, 24 had locally advanced disease treated with definitive chemoradiation, and 18 had disease treated with surgery and chemoradiation. Before chemoradiotherapy, the mean Eastern Cooperative Oncology Group performance status was 1.0 {+-} 0.8, and the mean 6-month weight loss was 5.3 {+-} 3.8 kg. The mean radiation dose delivered was 48.1 {+-} 9.2 Gy. All patients received fluoropyrimidine-based chemotherapy concurrently with radiotherapy. In all, 8 patients (19%) were hospitalized, 7 (17%) had an emergency room visit, 15 (36%) required a radiation treatment break, 3 (7%) required a chemotherapy break, 9 (21%) did not complete therapy, and 22 (49%) had at least one of these adverse events. The most common toxicities were nausea, pain, and failure to thrive. Median overall survival was 8.6 months (95% confidence interval, 7.2-13.1) in patients who received definitive chemoradiation therapy and 20.6 months (95% confidence interval, 9.5-{infinity}) in patients who underwent resection and chemoradiation therapy. Conclusions: In this dataset of very elderly patients with pancreatic cancer and good Eastern Cooperative Oncology Group performance status, outcomes after chemoradiotherapy were similar to those among historic controls for patients with locally advanced and resected pancreatic cancer, although many patients experienced substantial treatment

  15. Elective shoulder arthroplasty in patients older than ninety years of age.

    PubMed

    Churchill, R Sean

    2008-01-01

    This study examined the outcome of elective shoulder arthroplasty for glenohumeral osteoarthritis or rotator cuff arthropathy in patients aged older than 90 years. The study included 7 shoulders in 6 patients with an average age of 93 years 5 months, (range, 91 years 0 months to 97 years 4 months). Average follow-up was 2.2 years, (range, 1-4 years). Preoperative range of motion, Simple Shoulder Test (SST) scores, and Medical Outcomes Study Short-Form 36-Item Health Survey (SF-36) scores were obtained and compared with postoperative values at 3 and 6 months and yearly thereafter. Average forward elevation improved from 87 degrees to 137 degrees (P < .00001), and external rotation to the side improved from 0 degrees to 50 degrees (P < .0001). The SST scores improved from a preoperative average of 2.0 to 6.1 at 3 months (P < .0001), 6.9 at 6 months (P < .0001), 8.0 at 1 year (P < .00001), and 7.4 at 2 years (P < .0001). Significant improvements occurred in 6 of 8 SF-36 domains: Mental Health (P < .05), Vitality (P < .01), Role limitations due to emotional problems (P < .05), Social Function (P < .001), Role limitations due to physical health (P < .001), and Comfort (P < .00001). No patient had worse pain or function postoperatively. These data suggest that elective shoulder arthroplasty can be performed in patients 90 years of age and older, providing excellent pain relief, improved functional outcome, and enhanced general health status.

  16. Eribulin Monotherapy in Patients Aged 70 Years and Older With Metastatic Breast Cancer

    PubMed Central

    Cortes, Javier; Vahdat, Linda T.; Cardoso, Fatima; Twelves, Chris; Wanders, Jantien; Dutcus, Corina E.; Yang, Jay; Seegobin, Seth; O’Shaughnessy, Joyce

    2014-01-01

    Purpose. Following the demonstrated efficacy and safety of eribulin mesylate in heavily pretreated patients with metastatic breast cancer, an exploratory analysis was performed to investigate the effect of age in these patients. Methods. Data were pooled from two single-arm phase II studies and one open-label randomized phase III study in which patients received eribulin mesylate at 1.4 mg/m2 as 2- to 5-minute intravenous infusions on days 1 and 8 of a 21-day cycle. The effect of age on median overall survival (OS), progression-free survival (PFS), overall response rate (ORR), clinical benefit rate (CBR), and incidence of adverse events (AEs) was calculated for four age groups (<50 years, 50–59 years, 60–69 years, ≥70 years). Results. Overall, 827 patients were included in the analysis (<50 years, n = 253; 50–59 years, n = 289; 60–69 years, n = 206; ≥70 years, n = 79). Age had no significant impact on OS (11.8 months, 12.3 months, 11.7 months, and 12.5 months, respectively; p = .82), PFS (3.5 months, 2.9 months, 3.8 months, and 4.0 months, respectively; p = .42), ORR (12.7%, 12.5%, 6.3%, and 10.1%, respectively), or CBR (20.2%, 20.8%, 20.4%, and 21.5%, respectively). Although some AEs had higher incidence in either the youngest or the oldest subgroup, there was no overall effect of age on the incidence of AEs (including neuropathy, neutropenia, and leukopenia). Conclusion. Eribulin monotherapy in these selected older patients with good baseline performance status led to OS, PFS, ORR, CBR, and tolerability similar to those of younger patients with metastatic breast cancer. The benefits and risks of eribulin appear to be similar across age groups. PMID:24682463

  17. Tolerability of Combined Modality Therapy for Rectal Cancer in Elderly Patients Aged 75 Years and Older

    SciTech Connect

    Margalit, Danielle N.; Mamon, Harvey J.; Ryan, David P.; Blaszkowsky, Lawrence S.; Clark, Jeffrey; Willett, Christopher G.; Hong, Theodore S.

    2011-12-01

    Purpose: To determine the rate of treatment deviations during combined modality therapy for rectal cancer in elderly patients aged 75 years and older. Methods and Materials: We reviewed the records of consecutively treated patients with rectal cancer aged 75 years and older treated with combined modality therapy at Massachusetts General Hospital and Brigham and Women's Hospital from 2002 to 2007. The primary endpoint was the rate of treatment deviation, defined as a treatment break, dose reduction, early discontinuation of therapy, or hospitalization during combined modality therapy. Patient comorbidity was rated using the validated Adult Comorbidity Evaluation 27 Test (ACE-27) comorbidity index. Fisher's exact test and the Mantel-Haenszel trend test were used to identify predictors of treatment tolerability. Results: Thirty-six eligible patients had a median age of 79.0 years (range, 75-87 years); 53% (19/36) had no or mild comorbidity and 47% (17/36) had moderate or severe comorbidity. In all, 58% of patients (21/36) were treated with preoperative chemoradiotherapy (CRT) and 33% (12/36) with postoperative CRT. Although 92% patients (33/36) completed the planned radiotherapy (RT) dose, 25% (9/36) required an RT-treatment break, 11% (4/36) were hospitalized, and 33% (12/36) had a dose reduction, break, or discontinuation of concurrent chemotherapy. In all, 39% of patients (14/36) completed {>=}4 months of adjuvant chemotherapy, and 17% (6/36) completed therapy without a treatment deviation. More patients with no to mild comorbidity completed treatment than did patients with moderate to severe comorbidity (21% vs. 12%, p = 0.66). The rate of deviation did not differ between patients who had preoperative or postoperative CRT (19% vs. 17%, p = 1.0). Conclusions: The majority of elderly patients with rectal cancer in this series required early termination of treatment, treatment interruptions, or dose reductions. These data suggest that further intensification of

  18. Acceptance Factors of Mobile Apps for Diabetes by Patients Aged 50 or Older: A Qualitative Study

    PubMed Central

    Reichelt, Julius; Bellmann, Maike; Kirch, Wilhelm

    2015-01-01

    Background Mobile apps for people with diabetes offer great potential to support therapy management, increase therapy adherence, and reduce the probability of the occurrence of accompanying and secondary diseases. However, they are rarely used by elderly patients due to a lack of acceptance. Objective We investigated the question “Which factors influence the acceptance of diabetes apps among patients aged 50 or older?” Particular emphasis was placed on the current use of mobile devices/apps, acceptance-promoting/-inhibiting factors, features of a helpful diabetes app, and contact persons for technical questions. This qualitative study was the third of three substudies investigating factors influencing acceptance of diabetes apps among patients aged 50 or older. Methods Guided interviews were chosen in order to get a comprehensive insight into the subjective perspective of elderly diabetes patients. At the end of each interview, the patients tested two existing diabetes apps to reveal obstacles in (first) use. Results Altogether, 32 patients with diabetes were interviewed. The mean age was 68.8 years (SD 8.2). Of 32 participants, 15 (47%) knew apps, however only 2 (6%) had already used a diabetes app within their therapy. The reasons reported for being against the use of apps were a lack of additional benefits (4/8, 50%) compared to current therapy management, a lack of interoperability with other devices/apps (1/8, 12%), and no joy of use (1/8, 12%). The app test revealed the following main difficulties in use: nonintuitive understanding of the functionality of the apps (26/29, 90%), nonintuitive understanding of the menu navigation/labeling (19/29, 66%), font sizes and representations that were too small (14/29, 48%), and difficulties in recognizing and pressing touch-sensitive areas (14/29, 48%). Furthermore, the patients felt the apps lacked individually important functions (11/29, 38%), or felt the functions that were offered were unnecessary for their own

  19. Older Age and Steroid Use Are Associated with Increasing Polypharmacy and Potential Medication Interactions Among Patients with Inflammatory Bowel Disease

    PubMed Central

    Parian, Alyssa

    2015-01-01

    Background: Comorbidity and polypharmacy, more prevalent among older persons, may impact the treatment of patients with inflammatory bowel disease (IBD). The aims of this study were to assess the frequency of polypharmacy and medication interactions within a cohort of older patients with IBD and describe IBD treatment patterns. Methods: Cohort study of 190 patients with IBD 65 years or older followed at a tertiary IBD referral center from 2006 to 2012. Data collected included demographics, IBD-specific characteristics including disease activity, and comorbidity. Medication histories were extracted from medical records, and data were used to classify polypharmacy, frequency, and severity of potential medication interactions and inappropriate medication use. Results: Older patients with IBD were prescribed an average of 9 routine medications. Severe polypharmacy (≥10 routine medications) was present in 43.2% of studied patients and associated with increasing age, greater comorbidity, and steroid use. Overall, 73.7% of patients had at least 1 potential medication interaction, including 40% of patients with potential IBD medication-associated interactions. Chronic steroids were prescribed to 40% of the older patients including 24% who were in remission or with mild disease activity. Only 39.5% of patients were on immunomodulators and 21.1% on biologics. Approximately, 35% of patients were given at least 1 Beers inappropriate medication and almost 10% were receiving chronic narcotics. Conclusions: Older patients with IBD are at increased risk for severe polypharmacy and potential major medication interactions especially with increasing comorbidity and chronic steroid use. Steroid-maintenance therapies are prevalent among the older patients with IBD with lower utilization of steroid-sparing regimens. PMID:25856768

  20. Hospital mortality of patients aged 80 and older after surgical repair for type A acute aortic dissection in Japan

    PubMed Central

    Ohnuma, Tetsu; Shinjo, Daisuke; Fushimi, Kiyohide

    2016-01-01

    Abstract To evaluate whether patients aged 80 and older have higher risk of hospital mortality after repair of type A acute aortic dissection (TAAAD). Emergency surgery for TAAAD in patients aged 80 and older remains a controversial issue because of its high surgical risk. Data from patients who underwent surgical repair of TAAAD between April 2011 and March 2013 were retrospectively extracted from the Japanese Diagnosis Procedure Combination database. The effect of age on hospital mortality was evaluated using multivariate logistic regression analysis. A total of 5175 patients were enrolled. The mean age of patients was 67.1 ± 13.0 years, and the male:female ratio was 51:49. Patients aged 80 and older more frequently received tracheostomy than their younger counterparts (9.5% vs 5.4%, P <0.001). Intensive care unit and hospital stays were significantly longer in the elderly cohort versus the younger cohort (7.6 vs 6.7 days, P <0.001, and 42.2 vs 35.8 days, P <0.001, respectively). Logistic regression analysis showed that age ≥80 years was significantly associated with a higher risk of hospital mortality (adjusted odds ratio, 1.62; 95% confidence interval, 1.28–2.06; P <0.001). In linear regression analysis, age ≥80 years was also significantly associated with longer hospital stay (P = 0.007). In a large, nationwide, Japanese database, patients aged 80 and older were at increased risk of hospital mortality and length of hospital stay. PMID:27495057

  1. Hospital mortality of patients aged 80 and older after surgical repair for type A acute aortic dissection in Japan.

    PubMed

    Ohnuma, Tetsu; Shinjo, Daisuke; Fushimi, Kiyohide

    2016-08-01

    To evaluate whether patients aged 80 and older have higher risk of hospital mortality after repair of type A acute aortic dissection (TAAAD).Emergency surgery for TAAAD in patients aged 80 and older remains a controversial issue because of its high surgical risk.Data from patients who underwent surgical repair of TAAAD between April 2011 and March 2013 were retrospectively extracted from the Japanese Diagnosis Procedure Combination database. The effect of age on hospital mortality was evaluated using multivariate logistic regression analysis.A total of 5175 patients were enrolled. The mean age of patients was 67.1 ± 13.0 years, and the male:female ratio was 51:49. Patients aged 80 and older more frequently received tracheostomy than their younger counterparts (9.5% vs 5.4%, P <0.001). Intensive care unit and hospital stays were significantly longer in the elderly cohort versus the younger cohort (7.6 vs 6.7 days, P <0.001, and 42.2 vs 35.8 days, P <0.001, respectively). Logistic regression analysis showed that age ≥80 years was significantly associated with a higher risk of hospital mortality (adjusted odds ratio, 1.62; 95% confidence interval, 1.28-2.06; P <0.001). In linear regression analysis, age ≥80 years was also significantly associated with longer hospital stay (P = 0.007).In a large, nationwide, Japanese database, patients aged 80 and older were at increased risk of hospital mortality and length of hospital stay. PMID:27495057

  2. Old age, high risk medication, polypharmacy: a ‘trilogy’ of risks in older patients with atrial fibrillation

    PubMed Central

    2015-01-01

    Background: The safety of pharmacotherapy in atrial fibrillation (AF) is compounded by a trilogy of risks old age, high-risk medications (e.g., antithrombotics, antiarrhythmics), polypharmacy due to multiple patient comorbidities. However, to date, scarce study has investigated the use of polypharmacy (including potentially inappropriate medication (PIM)) in AF patients, and how this may contribute to their overall risk of medication misadventure. Objectives: To review the extent of polypharmacy and PIM use in older patients (65 years or older) with AF. Methods: Information was extracted from a database characterising a cohort of older AF patients treated in general practice in New South Wales, Australia. Patient characteristics, number and types of drugs, the degree of PIM use were recorded. The predictors for the use of polypharmacy in older AF patients were identified. Results: Overall, 367 patients (mean age 77.8 years) were reviewed, among which 94.8% used 5 medications or more and over half used 10 medications or more. Cardiovascular agents were most commonly used (98.9%), followed by antithrombotics (90.7%). Among agents deemed PIMs, digoxin (30.2%) was the most frequently used, followed by benzodiazepines (19.6%), and sotalol (9.8%). AF patients using polypharmacy were more likely to have low bleeding risk (OR=10.97), representing those patients in whom high-risk antithrombotics are mostly indicated. Patients with major-polypharmacy (5-9 medications) are more likely to have obstructive pulmonary diseases (OR=2.32), upper gastrointestinal diseases (OR=2.02) and poor physical function (OR=1.04), but less likely to have cognitive impairment (OR=0.27). Conclusion: Polypharmacy affects oldest AF patients, comprising medications that are indicated for AF, yet regarded as PIMs. Patients with lower risk of bleeding, obstructive pulmonary diseases, upper gastrointestinal diseases and poor physical function are also at higher risk of using higher number of

  3. Geriatric Trauma: A Radiologist's Guide to Imaging Trauma Patients Aged 65 Years and Older.

    PubMed

    Sadro, Claudia T; Sandstrom, Claire K; Verma, Nupur; Gunn, Martin L

    2015-01-01

    Radiologists play an important role in evaluation of geriatric trauma patients. Geriatric patients have injury patterns that differ markedly from those seen in younger adults and are susceptible to serious injury from minor trauma. The spectrum of trauma in geriatric patients includes head and spine injury, chest and rib trauma, blunt abdominal injury, pelvic fractures, and extremity fractures. Clinical evaluation of geriatric trauma patients is difficult because of overall frailty, comorbid illness, and medication effects. Specific attention should be focused on the effects of medications in this population, including anticoagulants, steroids, and bisphosphonates. Radiologists should use age-appropriate algorithms for radiography, computed tomography (CT), and magnetic resonance imaging of geriatric trauma patients and follow guidelines for intravenous contrast agent administration in elderly patients with impaired renal function. Because there is less concern about risk for cancer with use of ionizing radiation in this age group, CT is the primary imaging modality used in the setting of geriatric trauma. Clinical examples are provided from the authors' experience at a trauma center where geriatric patients who have sustained major and minor injuries are treated daily. PMID:26065932

  4. Faith-based and secular pathways to hope and optimism subconstructs in middle-aged and older cardiac patients.

    PubMed

    Ai, Amy L; Peterson, Christopher; Tice, Terrence N; Bolling, Steven F; Koenig, Harold G

    2004-05-01

    This study was designed to fill gaps in the new field of positive psychology. Using data from two sequential interviews, this study examined the effect of faith-based and secular pathways to hope and optimism among 226 middle-aged and older patients facing a major medical crisis-cardiac surgery. Structural equation modeling demonstrated that religious faith factors contributed to the agency component of hope and dispositional optimism indirectly through the use of prayer as a coping strategy. Other sociodemographically resourcable factors affected both the agency and pathway components of hope as well as dispositional optimism and dispositional pessimism directly or indirectly through their effects on emotional distress.

  5. Phase 2 study of frontline brentuximab vedotin monotherapy in Hodgkin lymphoma patients aged 60 years and older

    PubMed Central

    Holkova, Beata; Goldschmidt, Jerome; Chen, Robert; Olsen, Gregg; Boccia, Ralph V.; Bordoni, Rodolfo E.; Friedberg, Jonathan W.; Sharman, Jeff P.; Palanca-Wessels, Maria Corinna; Wang, Yinghui; Yasenchak, Christopher A.

    2015-01-01

    Outcomes in older patients with Hodgkin lymphoma (HL) tend to be poor following conventional chemotherapy regimens. Treatment-related toxicity is significant and comorbidities often limit therapeutic options. This phase 2, open-label study evaluated the efficacy and safety of brentuximab vedotin, a CD30-directed antibody-drug conjugate, as frontline therapy in 27 HL patients aged ≥60 years. The objective response rate (ORR) was 92%, with 73% achieving complete remission. All patients achieved stable disease or better, and had decreased tumor volume following treatment. At the time of this analysis, the median duration of objective response for efficacy-evaluable patients (N = 26) was 9.1 months (range, 2.8 to 20.9+ months), median progression-free survival was 10.5 months (range, 2.6+ to 22.3+ months), and median overall survival had not been reached (range, 4.6+ to 24.9+ months). The observed adverse events (AEs) were generally consistent with the known safety profile of brentuximab vedotin. The most common AEs were peripheral sensory neuropathy (78%), fatigue (44%), and nausea (44%), and were ≤ grade 2 for most patients. The incidence of grade 3 peripheral neuropathy events was relatively high (30% overall), particularly among patients with the known risk factors of diabetes and/or hypothyroidism (46% vs 14% for those without). However, these risk factors were not associated with delayed time to resolution/improvement of peripheral neuropathy. Preliminary data showed no substantial age-related changes in brentuximab vedotin pharmacokinetics. Brentuximab vedotin monotherapy may provide a frontline treatment option for older patients who cannot tolerate conventional combination chemotherapy. This trial was registered at www.clinicaltrials.gov as #NCT01716806. PMID:26377597

  6. Discharging older patients.

    PubMed

    2016-09-01

    Significant numbers of older people with dementia use general hospital services, and ensuring the safe and appropriate discharge home of patients with poor cognition, impaired judgement, misperception or reduced risk awareness is complex and challenging for many healthcare professionals. PMID:27615354

  7. Age differences in postoperative pain are scale dependent: a comparison of measures of pain intensity and quality in younger and older surgical patients.

    PubMed

    Gagliese, Lucia; Katz, Joel

    2003-05-01

    As the population ages, research into the assessment of postoperative pain in older patients is urgently needed. The reliability and validity of most pain scales for the assessment of acute postoperative pain in the elderly remain to be demonstrated. The present study reports the analysis of age-related patterns on three pain scales (McGill Pain Questionnaire, MPQ; Present Pain Intensity, PPI; and Visual Analog Scale, VAS) completed by younger (n=95, mean age=56.4+/-5.8 years) and older (n=105; mean age=66.8+/-2.7 years) men following radical prostatectomy. All patients received intravenous morphine via patient-controlled analgesia (PCA) throughout the study. On the first 2 postoperative days (POD), patients completed the pain scales and PCA opioid intake was recorded. An interaction was found between amount of opioid self-administered and POD. In both groups, less opioid was administered on POD 2 than POD 1, but the decrease over time was greater in younger than older men. On both PODs, older men self-administered less opioid than younger men. Age differences in pain were dependent on the pain scale used. Older men had significantly lower scores than younger men on the MPQ and PPI but there were no differences on the VAS. Several age differences in the psychometric properties of the scales were evident. On both PODs, the correlation between VAS and MPQ scores was significantly lower in the older than younger group. POD effect sizes did not differ between the scales or age groups suggesting that all three scales have comparable sensitivity within an age group. However, the different results between the scales for the effect of age suggests that the VAS is not sufficiently sensitive to detect age differences. Therefore, age differences in postoperative pain are better captured by verbal descriptions of pain qualities than non-verbal measures of intensity.

  8. The impact of adjuvant chemotherapy in older breast cancer patients on clinical and biological aging parameters

    PubMed Central

    Brouwers, Barbara; Hatse, Sigrid; Lago, Lissandra Dal; Neven, Patrick; Vuylsteke, Peter; Dalmasso, Bruna; Debrock, Guy; Van Den Bulck, Heidi; Smeets, Ann; Bechter, Oliver; Bailur, Jithendra Kini; Kenis, Cindy; Laenen, Annouschka; Schöffski, Patrick; Pawelec, Graham; Journe, Fabrice; Ghanem, Ghanem-Elias; Wildiers, Hans

    2016-01-01

    Purpose This prospective observational study aimed to evaluate the impact of adjuvant chemotherapy on biological and clinical markers of aging and frailty. Methods Women ≥ 70 years old with early breast cancer were enrolled after surgery and assigned to a chemotherapy (Docetaxel and Cyclophosphamide) group (CTG, n=57) or control group (CG, n=52) depending on their planned adjuvant treatment. Full geriatric assessment (GA) and Quality of Life (QoL) were evaluated at inclusion (T0), after 3 months (T1) and at 1 year (T2). Blood samples were collected to measure leukocyte telomere length (LTL), levels of interleukin-6 (IL-6) and other circulating markers potentially informative for aging and frailty: Interleukin-10 (IL-10), Tumor Necrosis Factor Alpha (TNF-α), Insulin-like Growth Factor 1 (IGF-1), Monocyte Chemotactic Protein 1 (MCP-1) and Regulated on Activation, Normal T cell Expressed and Secreted (RANTES). Results LTL decreased significantly but comparably in both groups, whereas IL-6 was unchanged at T2. However, IL-10, TNF-α, IGF-1 and MCP-1 suggested a minor biological aging effect of chemotherapy. Clinical frailty and QoL decreased at T1 in the CTG, but recovered at T2, while remaining stable in the CG. Conclusion Chemotherapy (TC) is unlikely to amplify clinical aging or induce frailty at 1 year. Accordingly, there is no impact on the most established aging biomarkers (LTL, IL-6). PMID:27102154

  9. Long-term safety and tolerability of saxagliptin add-on therapy in older patients (aged ≥65 years) with type 2 diabetes

    PubMed Central

    Iqbal, Nayyar; Allen, Elsie; Öhman, Peter

    2014-01-01

    Background Treatment decisions for older patients with type 2 diabetes mellitus must balance glycemic control and adverse event risk. The objective of this study was to evaluate the long-term safety and tolerability of saxagliptin 5 mg as add-on therapy to common antihyperglycemic drugs in patients aged ≥65 years and <65 years. Methods Pooled adverse event data from three placebo-controlled trials of 76–206 weeks’ duration in older (≥65 years) and younger (<65 years) patients receiving saxagliptin 5 mg or matching placebo added to metformin, glyburide, or a thiazolidinedione were analyzed. Measurements were calculated from day of first dose to specified event or last dose and included time at risk for adverse events, treatment-related adverse events, serious adverse events, adverse events leading to discontinuation, and events of special interest. Weighted incidence rates (number of events/total time) and incidence rate ratios (saxagliptin/placebo) with 95% confidence intervals were calculated (Mantel-Haenszel test). Results A total of 205 older (mean age 69 years; saxagliptin, n=99; placebo, n=106) and 1,055 younger (mean age 52 years; saxagliptin, n=531; placebo, n=524) patients were assessed. Regardless of age category, the adverse event incidence rates were generally similar between treatments, with confidence intervals for incidence rate ratios bridging 1. Treatment-related adverse events occurred in 36 older patients receiving saxagliptin versus 32 receiving placebo (incidence rate 34.1 versus 27.1 per 100 person-years) and in 150 younger patients in both treatment groups (incidence rate 24.0 versus 27.8 per 100 person-years). With saxagliptin versus placebo, serious adverse events occurred in eight versus 14 older (incidence rate 5.7 versus 9.9 per 100 person-years) and 49 versus 44 younger patients (incidence rate 6.5 versus 6.6 per 100 person-years). There were two deaths (one patient ≥65 years) with saxagliptin and six (none aged ≥65 years

  10. Cancer Screening in Older Patients.

    PubMed

    Salzman, Brooke; Beldowski, Kathryn; de la Paz, Amanda

    2016-04-15

    Although cancer is the second leading cause of death among persons 65 years and older, there is a paucity of clinical trial data about the effectiveness and harms of cancer screening in this population. Given the heterogeneous nature of the older population, cancer screening in these patients should not be based on age alone. Studies suggest that a life expectancy of at least 10 years is necessary to derive a survival benefit from screening for breast and colorectal cancers; therefore, screening for these cancers is not recommended in those with a life expectancy of less than 10 years. Prostate cancer screening, if performed at all, should not be performed after 69 years of age. Cervical cancer screening may be stopped after 65 years of age if the patient has an adequate history of negative screening results. An individualized approach to cancer screening decisions involves estimating life expectancy, determining the potential benefits and harms of screenings, and weighing those benefits and harms in relation to the patient's values and preferences.

  11. Various distinctive cytogenetic abnormalities in patients with acute myeloid leukaemia aged 60 years and older express adverse prognostic value: results from a prospective clinical trial.

    PubMed

    van der Holt, Bronno; Breems, Dimitri A; Berna Beverloo, H; van den Berg, Eva; Burnett, Alan K; Sonneveld, Pieter; Löwenberg, Bob

    2007-01-01

    Diagnostic cytogenetic abnormalities are considered important prognostic factors in patients with acute myeloid leukaemia (AML). However, the prognostic assessments have mainly been derived from patients with AML aged <60 years. Two recent studies of AML patients of 60 years and older proposed prognostic classifications with distinct discrepancies. To further study the prognostic value of cytogenetic abnormalities in this patient population, we have evaluated cytogenetic abnormalities in a series of 293 untreated patients with AML aged 60 years and older, included in a randomised phase 3 trial, also in relation to patient characteristics and clinical outcome. The most frequently observed cytogenetic abnormality was trisomy 8 (+8), in 31 (11%) patients. Abnormalities, such as -5, 5q-, abn(17p) and abn(17q), were almost exclusively present in complex karyotypes. A relatively favourable outcome was only observed in five patients with core-binding factor abnormalities t(8;21) and inv(16)/del(16)/t(16;16). However, most of the other evaluated cytogenetic abnormalities, such as 5q-, -7, +8, abn(17p), abn(17q), and complex aberrations expressed a more adverse prognosis when compared with patients with AML aged 60 years and older with a normal karyotype. Large studies to confirm the prognosis of individual cytogenetic aberrations are warranted.

  12. Symptomatology and Coping Resources Predict Self-Care Behaviors in Middle to Older Age Patients with Heart Failure

    PubMed Central

    Graven, Lucinda J.; Grant, Joan S.; Gordon, Glenna

    2015-01-01

    Background. Symptoms of heart failure (HF) and coping resources, such as social support and social problem-solving, may influence self-care behaviors. Research regarding the influence of HF symptomatology characteristics and components of social support and social problem-solving on self-care is limited. Objective. To identify predictors of HF self-care behaviors using characteristics of HF symptomatology, components of social support and social problem-solving, and demographic and clinical factors. Methods. Using a cross-sectional, correlational predictive design, a convenience sample (N = 201) of outpatients with HF answered self-report surveys. Multiple linear regression with stepwise variable selection was conducted. Results. Six predictors of HF self-care were identified: race, symptom frequency, symptom-related interference with enjoyment of life, New York Heart Association Class HF, rational problem-solving style, and social network (β = 34.265, R2 = 0.19, P = 0.001). Conclusions. Assessing the influence of race on self-care behaviors in middle to older age patients with HF is important. Clinical assessment that focuses on symptom frequency, symptom-related interference with enjoyment of life, and HF Class might also impact self-care behaviors in this population. Rational problem-solving skills used and evaluation of the size of and satisfaction with one's social network may be appropriate when assessing self-care. PMID:26618000

  13. Symptomatology and Coping Resources Predict Self-Care Behaviors in Middle to Older Age Patients with Heart Failure.

    PubMed

    Graven, Lucinda J; Grant, Joan S; Gordon, Glenna

    2015-01-01

    Background. Symptoms of heart failure (HF) and coping resources, such as social support and social problem-solving, may influence self-care behaviors. Research regarding the influence of HF symptomatology characteristics and components of social support and social problem-solving on self-care is limited. Objective. To identify predictors of HF self-care behaviors using characteristics of HF symptomatology, components of social support and social problem-solving, and demographic and clinical factors. Methods. Using a cross-sectional, correlational predictive design, a convenience sample (N = 201) of outpatients with HF answered self-report surveys. Multiple linear regression with stepwise variable selection was conducted. Results. Six predictors of HF self-care were identified: race, symptom frequency, symptom-related interference with enjoyment of life, New York Heart Association Class HF, rational problem-solving style, and social network (β = 34.265, R (2) = 0.19, P = 0.001). Conclusions. Assessing the influence of race on self-care behaviors in middle to older age patients with HF is important. Clinical assessment that focuses on symptom frequency, symptom-related interference with enjoyment of life, and HF Class might also impact self-care behaviors in this population. Rational problem-solving skills used and evaluation of the size of and satisfaction with one's social network may be appropriate when assessing self-care.

  14. Diagnostic challenges in the older patient

    PubMed Central

    2012-01-01

    Older patients often present with a long, complex history and a clinical picture that frequently includes co-morbidities. It is essential that health professionals caring for older patients become familiar with common age-related changes, and the specific clinical factors that complicate the diagnostic process. A case-based approach is taken in this article to explore the diagnostic challenges in caring for older patients. Three areas of focus are used: a) polypharmacy, b) cognitive issues such as delirium, dementia and depression, and c) increased odds of pathologies and chronic illnesses. PMID:22950718

  15. Medication for older patients.

    PubMed

    2016-09-01

    A growing body of literature documents multiple morbidities and multiple medication use among older people with intellectual disabilities. In Ireland in 2012, 8.6% of all medication-related adverse events were reported from the disability sector. PMID:27581916

  16. Is cancer vaccination feasible at older age?

    PubMed Central

    Gravekamp, Claudia; Jahangir, Arthee

    2014-01-01

    Age-related defects of the immune system are responsible for T cell unresponsiveness to cancer vaccination at older age. Major immune defects at older age are lack of naïve T cells, impaired activation pathways of T cells and antigen-presenting cells (APC), and age-related changes in the tumor microenvironment (TME). This raises the question whether cancer vaccination is feasible at older age. We compared various cancer vaccine studies at young and old age, thereby focusing on the importance of both innate and adaptive immune responses for cancer immunotherapy. These analyses suggest that creating an immune-stimulating environment with help of the innate immune system may improve T cell responses in cancer vaccination at older age. PMID:24509231

  17. Thyroid Disease in the Older Patient

    MedlinePlus

    ... these patients, without treatment unless they are symptomatic. HYPOTHYROIDISM IN THE OLDER PATIENT Hypothyroidism is very common ... is given. TREATMENT OF THE OLDER PATIENT WITH HYPOTHYROIDISM As with the younger patient, pure synthetic thyroxine ( ...

  18. Treatment of Muscle-Invasive Bladder Cancer in Older Patients.

    PubMed

    Skinner, Eila C

    2016-01-01

    Treatment of muscle-invasive bladder cancer in older patients is challenging. Definitive therapy of localized disease requires either surgery or radiation therapy, ideally combined with systemic chemotherapy. However, current population data suggest that less than half of patients older than age 70 are offered such treatments. We will review tools available to assess the fitness of older patients for surgery, alternatives, and tips for perioperative patient treatment.

  19. Prospective trial of radiotherapy for patients 80 years of age or older with squamous cell carcinoma of the thoracic esophagus

    SciTech Connect

    Kawashima, Mitsuhiko . E-mail: mkawashi@east.ncc.go.jp; Kagami, Yoshikazu; Toita, Takafumi; Uno, Takashi; Sugiyama, Masato; Tamura, Yoichirio; Hirota, Saeko; Fuwa, Nobukazu; Hashimoto, Mitsumasa; Yoshida, Hiroshi; Shikama, Naoto; Kataoka, Masaaki; Akuta, Keizo; Sasaki, Kinro; Tamamoto, Tetsuro; Nemoto, Kenji; Ito, Hisao; Kato, Hoichi; Yamada, Shogo; Ikeda, Hiroshi

    2006-03-15

    Purpose: To assess the safety and efficacy of external beam radiotherapy for elderly patients with esophageal cancer. Methods and Materials: A trial testing external beam radiotherapy (66 Gy within 6.5 weeks) as a single-modality treatment was performed for biopsy-proven squamous cell carcinoma of the thoracic esophagus clinically staged as Stage I and II A (Tz1-Taman, International Union Against Cancer, 1987) in patients aged {>=}80 years. Results: From January 1999 through December 2002, 51 evaluable patients (35 men and 16 women) with a median age of 83 years (range, 80-91 years) were enrolled from 22 institutions. Of the 51 patients, 18 (35%) had Stage Tz1 and 33 (65%) had Stage Tz2-T disease. Radiotherapy could be completed in 47 patients (92%) within 43-58 days (median, 49). The actuarial incidence of Grade 3 or worse cardiopulmonary complications at 3 years was 26%, with 3 early deaths, and correlated significantly with the size of the anteroposterior radiotherapy portals. The median survival time and overall survival rate at 3 years was 30 months and 39% (95% confidence interval, 25-52%), respectively. Conclusion: The results of high-dose radiotherapy in octogenarians are comparable to those in younger patients, but meticulous treatment planning and quality control is required.

  20. Recall in Older Cancer Patients: Measuring Memory for Medical Information

    ERIC Educational Resources Information Center

    Jansen, Jesse; van Weert, Julia; van der Meulen, Nienke; van Dulmen, Sandra; Heeren, Thea; Bensing, Jozien

    2008-01-01

    Purpose: Remembering medical treatment information may be particularly taxing for older cancer patients, but to our knowledge this ability has never been assessed in this specific age group only. Our purpose in this study was to investigate older cancer patients' recall of information after patient education preceding chemotherapy. Design and…

  1. Age-related appearance of muscle trauma in primary total hip arthroplasty and the benefit of a minimally invasive approach for patients older than 70 years

    PubMed Central

    Tohtz, Stephan; Dewey, Marc; Springer, Ivonne; Perka, Carsten

    2010-01-01

    Old age is frequently associated with a poorer functional outcome after THA. This might be based upon muscular damage resulting from surgical trauma. Minimally invasive approaches have been widely promoted on the basis of the muscle sparing effect. The aim of the study was to evaluate of the functional outcome and the grade of fatty muscle atrophy of the gluteus medius muscle by magnetic-resonance-imaging (MRI) in patients undergoing minimally invasive or traditional THA. Forty patients (21 female, 19 male) underwent THA either via a modified direct lateral (mDL) or a minimally invasive anterolateral (ALMI) approach. Patients were evaluated clinically and by MRI in terms of age (< or ≥70 y) preoperatively and at three and 12 months postoperatively. The Harris hip score and Trendelenburg’s sign were recorded and a survey of a pain (using a numeric rating scale of 0–10) and satisfaction score (using a numeric rating scale of 1–6) was performed. Fatty atrophy (FA) of gluteus medius muscle was rated by means of a five-point rating scale (0 indicates no fat and 4 implies more fat than muscle). Younger patients reached a significantly higher Harris hip score, lower pain score and lower rate of positive Trendelenburg’s sign accompanied by a significantly lower rate of postoperative FA (P = 0.03; young: FA (MW) = (preop. / 3 / 12 months), 0.15 / 0.7 / 0.7; old: FA (MW) = 0.18 / 1.3 / 1.36). Older patients with an mDL-approach had the significantly lowest clinical scores, the highest rate of positive Trendelenburg’s sign and also the highest rate of fatty atrophy (P = 0.03; FA (old) mDL: 1.8; ALMI: 0.7). Interestingly, no influence of the approach could be detected within the younger group. Patients older than 70 years had a poorer functional outcome and a higher postoperative extent of FA when compared to younger patients, which must be based upon a higher vulnerability and a reduced regenerative capacity of their skeletal muscle. Through a

  2. [Frequency of cancer at older ages].

    PubMed

    Hill, Catherine; Doyon, Françoise

    2008-05-28

    The dependency between the risk of death and age is analysed, and the contribution of cancer to the overall risk of death is evaluated as a function of age. The frequency of the different cancer sites is described in different age groups. Lastly cancer mortality trends are presented by age. The risk of death from cancer increases markedly with age, but the risk of a death from a cardiovascular disease increases even more rapidly, consequently the importance of cancer as a cause of death decreases with age. In the male population, lung and head and neck cancers are the most frequent cancers before age 65, whereas prostate and colorectal cancers are more frequent at older ages. In the female population, breast and colorectal cancers are the most frequent cancers except for mortality before age 65 where lung cancer is the second killer after breast cancer. The risk of cancer death decreases in recent years for all age groups.

  3. Early and Long-Term Outcomes in Japanese Patients Aged 80 Years or Older Undergoing Conventional Aortic Valve Replacement

    PubMed Central

    Osaka, Shunji; Yaoita, Hiroko; Ishii, Yusuke; Arimoto, Munehito; Hata, Hiroaki; Shiono, Motomi

    2015-01-01

    In this study, we investigated the early and long-term results of conventional aortic valve replacement (AVR) in very old patients. Methods: Seventy-five patients with aortic stenosis underwent conventional AVR for patients aged 80 years.We examined early death and major adverse cardiovascular and cerebrovascular event (MACCE). Results: The operative mortality was 0% for isolated AVR and 19.2% for concomitant surgery. The postoperative survival rate and MACCE free-rate were no significant differences between the isolated AVR and the concomitant surgery. Univariate analysis confirmed that cardiac dysfunction, severe chronic kidney disease (CKD), hemodialysis, + coronary artery bypass grafting, and norepinephrine use were risk factor of early death. Univariate analysis confirmed that severe CKD, BNP >1000 pg/ml, aortic cross clamping time (ACCT) >180 min, and non-use carperitide and multivariate analysis confirmed that ACCT >180 min, and non-use carperitide were risk factor of MACCE. Conclusions: This study showed that the results of conventional AVR in very old patients were not satisfactory. However, the results obtained with isolated AVR were favorable with no operative deaths. The present study demonstrated that preoperative cardiac function, preoperative renal function, and operative factors have an important impact on early mortality and MACCE. PMID:26004118

  4. Depression and religiosity in older age.

    PubMed

    Pokorski, M; Warzecha, A

    2011-09-12

    We investigated the hypothesis that religious commitment could help counter general affective distress, accompanying depressive symptoms, in older age. A total of 34 older adults, all catholic believers, completed self-reported questionnaires on the presence of depressive symptoms, religiosity, health, worry, and the style of coping with stress. The depressive and non-depressive subgroups were then created. The prevalence of depressive symptoms was 50%, with the substantial predominance of females. Regression analyses indicate that health expectations and worry significantly worsen with increasing intensity of depressive symptoms. The results further show that religious engagement was not different between the depressive and non-depressive subgroups. Religiosity failed to influence the intensity of depressive symptoms or the strategy of coping with stress in either subgroup, although a trend was noted for better health expectations with increasing religious engagement in depressive subjects. We conclude that religiosity is unlikely to significantly ameliorate dysphoric distress accompanying older age.

  5. Chemotherapy-related cognitive impairment in older patients with cancer

    PubMed Central

    Loh, Kah Poh; Janelsins, Michelle C.; Mohile, Supriya G.; Holmes, Holly M.; Hsu, Tina; Inouye, Sharon K.; Karuturi, Meghan S.; Kimmick, Gretchen G.; Lichtman, Stuart M.; Magnuson, Allison; Whitehead, Mary I.; Wong, Melisa L.; Ahles, Tim A.

    2016-01-01

    Chemotherapy-related cognitive impairment (CRCI) can occur during or after chemotherapy and represents a concern for many patients with cancer. Among older patients with cancer, in whom there is little clinical trial evidence examining side effects like CRCI, many unanswered questions remain regarding risk for and resulting adverse outcomes from CRCI. Given the rising incidence of cancer with age, CRCI is of particular concern for older patients with cancer who receive treatment. Therefore, research related to CRCI in older patients with cancers is a high priority. In this manuscript, we discuss current gaps in research highlighting the lack of clinical studies of CRCI in older adults, the complex mechanisms of CRCI, and the challenges in measuring cognitive impairment in older patients with cancer. Although we focus on CRCI, we also discuss cognitive impairment related to cancer itself and other treatment modalities. We highlight several research priorities to improve the study of CRCI in older patients with cancer. PMID:27197918

  6. Age is not a limiting factor for brachytherapy for carcinoma of the node negative oral tongue in patients aged eighty or older

    PubMed Central

    2010-01-01

    Background To examine the role of brachytherapy for aged patients 80 or more in the trend of rapidly increasing number. Methods We examined the outcomes for elderly patients with node negative oral tongue cancer (T1-3N0M0) treated with brachytherapy. The 21 patients (2 T1, 14 T2, and 5 T3 cases) ranged in age from 80 to 89 years (median 81), and their cancer was pathologically confirmed. All patients underwent definitive radiation therapy, with low dose rate (LDR) Ra-226 brachytherapy (n = 4; median 70Gy), with Ir-192 (n = 12; 70Gy), with Au-198 (n = 1) or with high dose rate (HDR) Ir-192 brachytherapy (n = 4; 60 Gy). Eight patients also underwent external radiotherapy (median 30 Gy). The period of observation ranged from 13 months to 14 years (median 2.5 years). We selected 226 population matched younger counterpart from our medical chart. Results Definitive radiation therapy was completed for all 21 patients (100%), and acute grade 2-3 mucositis related to the therapy was tolerable. Local control (initial complete response) was attained in 19 of 21 patients (90%). The 2-year and 5-year local control rates were 91%, (100% for T1, 83% for T2 and 80% for T3 tumors after 2 years). These figures was not inferior to that of younger counterpart (82% at 5-year, n.s.). The cause-specific survival rate was 83% and the regional control rate 84% at the 2-years follow-up. However, 12 patients died because of intercurrent diseases or senility, resulting in overall survival rates of 55% at 2 years and 34% at 5 years. Conclusion Age is not a limiting factor for brachytherapy for appropriately selected elderly patients, and brachytherapy achieved good local control with acceptable morbidity. PMID:21143904

  7. Long-Term Outcome of Prosthetic Valve Replacement in Japanese Patients Aged 65 Years or Older: Are Guidelines for Prosthetic Valve Selection Based on Overseas Data Appropriate for Japanese Patients?

    PubMed Central

    Osaka, Shunji; Yaoita, Hiroko; Ishii, Yusuke; Arimoto, Munehito; Hata, Hiroaki; Shiono, Motomi

    2015-01-01

    Background: Based on the revised AHA/ACC guidelines, it might be necessary to take into consideration the average life expectancy of Japanese people and revise the Japanese guidelines accordingly. Accordingly, we performed the present study to compare the long-term outcome in patients aged 65 years or older who underwent prosthetic valve replacement at our hospital using mechanical valves or biological valves. Methods: We have performed valve replacement in 416 patients aged 65 years or older (mechanical: 157; biological: 244). Results: There was no significant difference between the mechanical and biological valve for the actuarial survival rate. As for the valve-related complication free rate, in the mechanical valve group, the rates were significantly higher for all patients, aortic valve replacement (AVR) patients, and mitral valve replacement (MVR) patients. Conclusions: Following revision of the AHA/ACC guidelines for selection of prosthetic valves, it is necessary to investigate whether patients aged 60–70 represent the gray zone for selecting valves as in US and European guidelines, or whether a higher age is more appropriate in view of the longer average life expectancy in Japan. Accordingly, further evaluation of the long-term outcome for mechanical and biological valves in Japanese patients is needed to obtain evidence for preparation of original Japanese guidelines on prosthetic valve selection. PMID:26004117

  8. Preparing for a healthier older age.

    PubMed

    Jefferson, Angie

    2006-01-01

    People are living longer and if they are to enjoy a healthier old age it is important that they start preparing themselves for this during middle age. Many diseases are at least partly preventable by diet and exercise, so understanding the practicalities of good nutrition and the need to achieve and maintain a healthy weight is vital. Health professionals should use every opportunity to get this message across in their contacts with middle aged and older people. This article explains the key nutritional and physiological points and includes specific practical tips for burning off calories and reducing calorie intake. PMID:16550807

  9. Comparison between continuous ambulatory arterial blood pressure monitoring and standard blood pressure measurements among patients of younger and older age group.

    PubMed

    Babić, Betty Korljan; Bagatin, Jugoslav; Kokić, Slaven; Ostojić, Sanja Barsić; Carević, Vedran; Berović, Nina

    2009-03-01

    The purpose of the study was to evaluate whether there is a difference between blood pressure measured in a physician's office and the average 24 hr continuous blood pressure monitored by hypertensive patients at home. If there is a difference between these two situations then is it possibly the result of a blood pressure response by the patient to the physician which is known as "white coat effect" or "white coat hypertension". We studied 80 hypertensive outpatients which were divided into two groups of 40 patients each--a younger patient group, with a mean age of 22.8 +/- 1.8 years, and an older patient group with a mean age of 50.3 +/- 5.7 years. They were selected because they had been diagnosed as essentially hypertension grade 1, according to 2007 ESH/ESC Guidelines, or the USA Joint National Committee Guidelines (JNC 7) (i.e., arterial blood pressure > 140/90 mm Hg and < 160/100 mmHg) and 35 were not having any antihypertensive treatment. All participants in the study went through a two-week "wash-out" period without medication. At the beginning of the study blood pressure was measured using the Riva-Rocci-Korotkoff method (mercury sphygmomanometer) after 5 minutes of rest and with the patient in the sitting position. The average of the two last measurements by sphygmomanometer was used in the analysis. The subsequent measurement was made by continuous ambulatory blood pressure monitoring (SpaceLabs 90207 device). Continuous ambulatory blood pressure monitoring revealed that 17 patients of the younger age group (42.5%) who were diagnosed hypertonic, according to mercury sphygmomanometeric measurement, were in fact normotonic. In the older age group only 7 (17.5%) of participants were normotonic during 24 hr blood pressure monitoring. The proportion of miss-diagnosed normotonic younger patients was directly related to elevated clinic blood pressure, which could be referred to as office hypertension or isolated clinic hypertension (white coat hypertension

  10. How I treat glioblastoma in older patients.

    PubMed

    Mohile, Nimish A

    2016-01-01

    Glioblastoma, a WHO grade IV astrocytoma, is the most common primary malignant brain tumor in adults. It is characterized by molecular heterogeneity and aggressive behavior. Glioblastoma is almost always incurable and most older patients survive less than 6 months. Supportive care with steroids and anti-epileptic drugs is critical to improving and maintain quality of life. Young age, good performance status and methylation of the methyl guanyl methyl transferase promoter are important positive prognostic factors. Several recent clinical trials suggest that there is a subset of the elderly with prolonged survival that is comparable to younger patients. Treatment of glioblastoma in older patients includes maximal safe resection followed by either radiation, chemotherapy or combined modality therapy. Recent advances suggest that some patients can avoid radiation entirely and be treated with chemotherapy alone. Decisions about therapy are individual and based on a patient's performance status, family support and molecular features. Future work needs to better determine the role for comprehensive geriatric assessments in this patient population to better identify patients who may most benefit from aggressive therapies. PMID:26725536

  11. Aging on the Street: Homeless Older Adults in America.

    PubMed

    Sorrell, Jeanne M

    2016-09-01

    Older adults are at greater risk for homelessness today than at any time in recent history. Approximately one half of homeless individuals in America are older than 50, which has created serious challenges for how cities, governments, and health care providers care for homeless populations. Systems established in the 1980s to help care for homeless individuals were not designed to address problems of aging. It is critical that nurses and all health professionals have a better understanding of the unique needs and concerns of homeless older adults. Nurses can be an important part of the solution, not only through direct patient care but by advocating for improvements in care for this vulnerable population. [Journal of Psychosocial Nursing and Mental Health Services, 54(9), 25-29.]. PMID:27576225

  12. Healthy Aging in Community for Older Lesbians

    PubMed Central

    Putney, Jennifer M.; Shepard, Bonnie L.; Sass, Samantha E.; Rudicel, Sally; Ladd, Holly

    2016-01-01

    Abstract Purpose: In Boston and Outer Cape, Massachusetts, we explored the expectations of lesbians 60 years and older regarding healthy aging and community importance. Methods: Focus groups were conducted with participants after completing an anonymous demographic questionnaire. Thematic analysis was used to generate themes and identify how they varied by urban versus rural settings. Results: Group discussions focused on community, finances, housing, and healthcare. Primary concerns included continued access to supportive and lesbian communities as a source of resilience during aging. Conclusion: Concerns about discrimination and isolation mirror themes found in national research. The study findings suggest a need for more research into the housing and transportation needs of lesbians approaching later life, with a focus on how those needs relate to affordability, accessibility, and proximity to social support and healthcare. These findings also suggest the need for substantial investments in strengthening the LGBT-related cultural competence of providers of services for the elderly. PMID:27046541

  13. Mobile Applications for Diabetics: A Systematic Review and Expert-Based Usability Evaluation Considering the Special Requirements of Diabetes Patients Age 50 Years or Older

    PubMed Central

    Quade, Mandy; Kirch, Wilhelm

    2014-01-01

    Background A multitude of mhealth (mobile health) apps have been developed in recent years to support effective self-management of patients with diabetes mellitus type 1 or 2. Objective We carried out a systematic review of all currently available diabetes apps for the operating systems iOS and Android. We considered the number of newly released diabetes apps, range of functions, target user groups, languages, acquisition costs, user ratings, available interfaces, and the connection between acquisition costs and user ratings. Additionally, we examined whether the available applications serve the special needs of diabetes patients aged 50 or older by performing an expert-based usability evaluation. Methods We identified relevant keywords, comparative categories, and their specifications. Subsequently, we performed the app review based on the information given in the Google Play Store, the Apple App Store, and the apps themselves. In addition, we carried out an expert-based usability evaluation based on a representative 10% sample of diabetes apps. Results In total, we analyzed 656 apps finding that 355 (54.1%) offered just one function and 348 (53.0%) provided a documentation function. The dominating app language was English (85.4%, 560/656), patients represented the main user group (96.0%, 630/656), and the analysis of the costs revealed a trend toward free apps (53.7%, 352/656). The median price of paid apps was €1.90. The average user rating was 3.6 stars (maximum 5). Our analyses indicated no clear differences in the user rating between free and paid apps. Only 30 (4.6%) of the 656 available diabetes apps offered an interface to a measurement device. We evaluated 66 apps within the usability evaluation. On average, apps were rated best regarding the criterion “comprehensibility” (4.0 out of 5.0), while showing a lack of “fault tolerance” (2.8 out of 5.0). Of the 66 apps, 48 (72.7%) offered the ability to read the screen content aloud. The number of

  14. The older female patient with a complex chronic dissociative disorder.

    PubMed

    Kluft, Richard P

    2007-01-01

    Dissociative disorders are rarely considered in the diagnostic assessment of older women, despite the fact that the existence, appearance and characteristics of certain dissociative disorders in older populations has been known and described since the 1980s. This communication reviews the core phenomena of Dissociative Identity Disorder and related forms of Dissociative Disorder Not Otherwise Specified, the natural history of their phenomena from youth to old age, and describes common presentations of Dissociative Disorders in older women. It also reviews the treatment of complex chronic dissociative disorders and discusses alternative approaches to their psychotherapy in the older female patient. It is crucial to recognize and respect the importance of appreciating individual differences among older dissociative patients and to individualize their treatments accordingly.

  15. 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…

  16. Employment Hardship Among Older Workers: Does Residential and Gender Inequality Extend Into Older Age?

    PubMed Central

    Slack, Tim; Jensen, Leif

    2008-01-01

    Objectives. The realities of a rapidly aging society make the employment circumstances of older workers an increasingly important social issue. We examine the prevalence and correlates of underemployment among older Americans, with a special focus on residence and gender, to provide an assessment of the labor market challenges facing older workers. Methods. We analyzed data from the March Current Population Surveys for the years 2003, 2004, and 2005. We used descriptive statistics to explore the prevalence of underemployment among older workers and developed multivariate models to assess the impact of age, residence, and gender on the likelihood of underemployment, net of other predictors. Results. We found clear disadvantages for older workers relative to their middle-aged counterparts, and particular disadvantages for older rural residents and women. Multivariate models showed that the disadvantages of older age held net of other predictors. The results also indicated that much of the disadvantage faced by older rural workers and women was explained by factors other than age, particularly education. Discussion. In an aging society, underemployment among older workers comes at an increasing social cost. Policies aimed at supporting older workers and alleviating employment hardship among them are increasingly in the public interest. PMID:18332197

  17. Medical students' and doctors' attitudes towards older patients and their care in hospital settings: a conceptualisation

    PubMed Central

    Samra, Rajvinder; Griffiths, Amanda; Cox, Tom; Conroy, Simon; Gordon, Adam; Gladman, John R. F.

    2015-01-01

    Background: despite assertions in reports from governmental and charitable bodies that negative staff attitudes towards older patients may contribute to inequitable healthcare provision for older patients when compared with younger patients (those aged under 65 years), the research literature does not describe these attitudes in any detail. Objective: this study explored and conceptualised attitudes towards older patients using in-depth interviews. Methods: twenty-five semi-structured interviews with medical students and hospital-based doctors in a UK acute teaching hospital were conducted. Participants were asked about their beliefs, emotions and behavioural tendencies towards older patients, in line with the psychological literature on the definition of attitudes (affective, cognitive and behavioural information). Data were analysed thematically. Results: attitudes towards older patients and their care could be conceptualised under the headings: (i) beliefs about older patients; (ii) older patients' unique needs and the skills required to care for them and (iii) emotions and satisfaction with caring for older patients. Conclusions: our findings outlined common beliefs and stereotypes specific to older patients, as opposed to older people in general. Older patients had unique needs concerning their healthcare. Participants typically described negative emotions about caring for older patients, but the sources of dissatisfaction largely related to the organisational setting and system in which the care is delivered to these patients. This study marks one of the first in-depth attempts to explore attitudes towards older patients in UK hospital settings. PMID:26185282

  18. Coming of Age: Considerations in the Prescription of Exercise for Older Adults

    PubMed Central

    Zaleski, Amanda L.; Taylor, Beth A.; Panza, Gregory A.; Wu, Yin; Pescatello, Linda S.; Thompson, Paul D.; Fernandez, Antonio B.

    2016-01-01

    Older adults represent the fastest-growing age demographic of the population. Physiological changes associated with primary aging and concurrent chronic disease adversely impact functional capacity, health outcomes, and quality of life. For these reasons, there is a national emphasis for healthcare providers to improve the health, function, and quality of life of older adults to preserve independent living and psychological well-being. The benefits of regular physical activity or exercise with regard to aging and disease are indisputable, yet many clinicians do not prescribe exercise to older adults. This reluctance may be attributable to a lack of knowledge regarding appropriate exercise prescription for older adults in light of the potential risks and benefits of various doses and types of exercise. In addition, clinicians and patients may have concerns about potential health considerations relevant to older adults such as comprehensive pre-exercise screening and exercise-drug interactions. In light of this, the following review presents (1) guidelines for exercise prescription in older adults and modification of these guidelines for patients with the most common age-associated comorbidities; (2) recommendations for pre-exercise screening prior to initiating an exercise program in older adults; (3) considerations for older adults on one or more medications; and (4) common barriers to adopting and maintaining exercise in an older population. Our goal is to provide a framework that clinicians can follow when prescribing exercise in older adults while considering the unique characteristics and concerns present in this population. PMID:27486492

  19. Coming of Age: Considerations in the Prescription of Exercise for Older Adults.

    PubMed

    Zaleski, Amanda L; Taylor, Beth A; Panza, Gregory A; Wu, Yin; Pescatello, Linda S; Thompson, Paul D; Fernandez, Antonio B

    2016-01-01

    Older adults represent the fastest-growing age demographic of the population. Physiological changes associated with primary aging and concurrent chronic disease adversely impact functional capacity, health outcomes, and quality of life. For these reasons, there is a national emphasis for healthcare providers to improve the health, function, and quality of life of older adults to preserve independent living and psychological well-being. The benefits of regular physical activity or exercise with regard to aging and disease are indisputable, yet many clinicians do not prescribe exercise to older adults. This reluctance may be attributable to a lack of knowledge regarding appropriate exercise prescription for older adults in light of the potential risks and benefits of various doses and types of exercise. In addition, clinicians and patients may have concerns about potential health considerations relevant to older adults such as comprehensive pre-exercise screening and exercise-drug interactions. In light of this, the following review presents (1) guidelines for exercise prescription in older adults and modification of these guidelines for patients with the most common age-associated comorbidities; (2) recommendations for pre-exercise screening prior to initiating an exercise program in older adults; (3) considerations for older adults on one or more medications; and (4) common barriers to adopting and maintaining exercise in an older population. Our goal is to provide a framework that clinicians can follow when prescribing exercise in older adults while considering the unique characteristics and concerns present in this population. PMID:27486492

  20. Osteoporosis and sarcopenia in older age.

    PubMed

    Edwards, M H; Dennison, E M; Aihie Sayer, A; Fielding, R; Cooper, C

    2015-11-01

    Osteoporosis and sarcopenia are common in older age and associated with significant morbidity and mortality. Consequently, they are both attended by a considerable socioeconomic burden. Osteoporosis was defined by the World Health Organisation (WHO) in 1994 as a bone mineral density of less than 2.5 standard deviations below the sex-specific young adult mean and this characterisation has been adopted globally. Subsequently, a further step forward was taken when bone mineral density was incorporated into fracture risk prediction algorithms, such as the Fracture Risk Assessment Tool (FRAX®) also developed by the WHO. In contrast, for sarcopenia there have been several diagnostic criteria suggested, initially relating to low muscle mass alone and more recently low muscle mass and muscle function. However, none of these have been universally accepted. This has led to difficulties in accurately delineating the burden of disease, exploring geographic differences, and recruiting appropriate subjects to clinical trials. There is also uncertainty about how improvement in sarcopenia should be measured in pharmaceutical trials. Reasons for these difficulties include the number of facets of muscle health available, e.g. mass, strength, function, and performance, and the various clinical outcomes to which sarcopenia can be related such as falls, fracture, disability and premature mortality. It is imperative that a universal definition of sarcopenia is reached soon to facilitate greater progress in research into this debilitating condition. This article is part of a Special Issue entitled "Muscle Bone Interactions".

  1. Learning Choices, Older Australians and Active Ageing

    ERIC Educational Resources Information Center

    Boulton-Lewis, Gillian M.; Buys, Laurie

    2015-01-01

    This paper reports on the findings of qualitative, semistructured interviews conducted with 40 older Australian participants who either did or did not engage in organized learning. Phenomenology was used to guide the interviews and analysis to explore the lived learning experiences and perspectives of these older people. Their experiences of…

  2. Older Patient, Physician and Pharmacist Perspectives about Community Pharmacists’ Roles

    PubMed Central

    Paterniti, Debora A.; Wenger, Neil S.; Williams, Bradley R.; Chewning, Betty A.

    2012-01-01

    Objectives To investigate older patient, physician and pharmacist perspectives about the pharmacists’ role in pharmacist-patient interactions. Methods Design Eight focus group discussions. Settings Senior centers, community pharmacies, primary care physician offices. Participants Forty-two patients aged 63 and older, 17 primary care physicians, and 13 community pharmacists. Measurements Qualitative analysis of focus group discussions. Results Participants in all focus groups indicated that pharmacists are a good resource for basic information about medications. Physicians appreciated pharmacists’ ability to identify drug interactions, yet did not comment on other specific aspects related to patient education and care. Physicians noted that pharmacists often were hindered by time constraints that impede patient counseling. Both patient and pharmacist participants indicated that patients often asked pharmacists to expand upon, reinforce, and explain physician-patient conversations about medications, as well as to evaluate medication appropriateness and physician treatment plans. These groups also noted that patients confided in pharmacists about medication-related problems before contacting physicians. Pharmacists identified several barriers to patient counseling, including lack of knowledge about medication indications and physician treatment plans. Conclusions Community-based pharmacists may often be presented with opportunities to address questions that can affect patient medication use. Older patients, physicians and pharmacists all value greater pharmacist participation in patient care. Suboptimal information flow between physicians and pharmacists may hinder pharmacist interactions with patients and detract from patient medication management. Interventions to integrate pharmacists into the patient healthcare team could improve patient medication management. PMID:22953767

  3. Treatment of older patients with colorectal cancer: a perspective review

    PubMed Central

    Kordatou, Z.; Kountourakis, P.

    2014-01-01

    In a continuously aging population, the burden of colorectal cancer (CRC) is rising among older patients. Despite the fact that almost half of the cases occur in patients over 75 years, this age group is subjected to disparities regarding diagnostic and therapeutic options. So far, exclusion of older patients from randomized clinical trials has resulted in a lack of evidence-based guidelines. Nevertheless, newer data from studies specifically targeting older patients and subgroup analyses indicate that proper treatment planning and specific medical and geriatric assessment can achieve a safe and beneficial treatment result in older patients, often with similar outcomes to their younger counterparts. Resection of the primary tumour, if feasible, should be the primary goal of surgery aiming for cure, although it should be avoided under emergency conditions. Chronological age per se should not be an exclusion criterion for adjuvant or palliative chemotherapy, or targeted therapies. Careful patient selection, dose adjustments, close monitoring and early intervention in the event of side effects are essential. The benefits of treatment must be balanced with potential effects of treatment and patients’ wishes. PMID:24790652

  4. Low-Dose Interleukin-2 Immunotherapy Does Not Improve Outcome of Patients Age 60 Years and Older With Acute Myeloid Leukemia in First Complete Remission: Cancer and Leukemia Group B Study 9720

    PubMed Central

    Baer, Maria R.; George, Stephen L.; Caligiuri, Michael A.; Sanford, Ben L.; Bothun, Sandra M.; Mrózek, Krzysztof; Kolitz, Jonathan E.; Powell, Bayard L.; Moore, Joseph O.; Stone, Richard M.; Anastasi, John; Bloomfield, Clara D.; Larson, Richard A.

    2008-01-01

    Purpose Cancer and Leukemia Group B (CALGB) 9720 evaluated subcutaneous low-dose recombinant interleukin-2 (rIL-2) maintenance immunotherapy as a strategy for prolonging remission in older patients with acute myeloid leukemia (AML). Patients and Methods AML patients age 60 years and older in first complete remission after induction and consolidation chemotherapy were randomly assigned to no further therapy or a 90-day regimen of 14-day cycles of low-dose rIL-2, aimed at expanding natural killer (NK) cells, followed by 3-day higher doses aimed at activating cytotoxicity of expanded NK cells to lyse residual AML cells. All randomly assigned patients were included in an intention-to-treat analysis. Results A total of 163 (64%) of 254 patients who completed induction and consolidation chemotherapy on CALGB 9720 were randomly assigned to rIL-2 (n = 81) or no further therapy (n = 82); the most common reasons for lack of random assignment were patient refusal and relapse. Fifteen patients randomly assigned to rIL-2 never initiated it because of refusal, intercurrent medical problems, or relapse, and 24 patients initiated rIL-2 but stopped early because of toxicity or relapse. Grade 4 toxicities during rIL-2 therapy included thrombocytopenia (65%) and neutropenia (64%), and grade 3 toxicities included anemia (33%), infection (24%) and malaise/fatigue (14%). Forty-two patients (52%) randomly assigned to rIL-2 completed the full 90-day course. Patients in both arms had similar distributions of both disease-free (combined median = 6.1 months; P = .47) and overall survival (combined median = 14.7 months; P = .61) after random assignment. Moreover, the 42 patients who completed all planned therapy did not show prolongation of disease-free or overall survival. Conclusion Low-dose rIL-2 maintenance immunotherapy is not a successful strategy in older AML patients. PMID:18591543

  5. Health screening - men age 65 and older

    MedlinePlus

    Health maintenance visit - men - over age 65; Physical exam - men - over age 65; Yearly exam - men - over age 65; Checkup - men - over age 65; Men's health - over age 65; Preventive care exam - men - over ...

  6. Pretreatment cytogenetics add to other prognostic factors predicting complete remission and long-term outcome in patients 60 years of age or older with acute myeloid leukemia: results from Cancer and Leukemia Group B 8461

    PubMed Central

    Farag, Sherif S.; Archer, Kellie J.; Mrózek, Krzysztof; Ruppert, Amy S.; Carroll, Andrew J.; Vardiman, James W.; Pettenati, Mark J.; Baer, Maria R.; Qumsiyeh, Mazin B.; Koduru, Prasad R.; Ning, Yi; Mayer, Robert J.; Stone, Richard M.; Larson, Richard A.; Bloomfield, Clara D.

    2006-01-01

    We investigated the relative prognostic significance of cytogenetics in 635 adult acute myeloid leukemia (AML) patients 60 years of age or older treated on front-line protocols. Classification trees and tree-structured survival analysis (TSSA) were used to identify important cytogenetic groups, and their prognostic significance was then assessed in multivariable analysis (MVA). Overall, 48.5% achieved complete remission (CR); 6.6% survived at 5 years. Complex karyotypes with at least 3 abnormalities (complex ≥ 3) and a group including “rare aberrations” predicted lower CR rates (25% and 30%) versus other patients (56%). Compared with complex ≥ 3, the odds of CR were significantly higher for noncomplex karyotypes without rare aberrations on MVA. Cytogenetically, complex ≥ 5 predicted inferior disease-free survival on TSSA, remaining significant on MVA together with white blood cell count (WBC), sex, and age. For survival, complex ≥ 5, rare aberrations, and core-binding factor (CBF) abnormalities were prognostic (P < .001), with 5-year survivals of 0%, 0%, and 19.4%, respectively, and 7.5% for remaining patients. Together with WBC, marrow blasts, sex, and age, the cytogenetic groups remained significant on MVA. In conclusion, pretreatment cytogenetics adds to other prognostic factors in older AML patients. Patients with complex ≥ 5 appear to benefit minimally from current treatment and are better suited for investigational therapy or supportive care. (Blood. 2006;108:63-73) PMID:16522815

  7. Anterior cruciate ligament reconstruction in patients older than 35 years.

    PubMed

    El-Sallakh, Sameh; Pastides, Philip; Thomas, Panos

    2014-12-01

    Anterior cruciate ligament (ACL) reconstruction is an increasingly established method even in patients older than 35 years. Our hypothesis is that functional outcome after ACL reconstruction is comparable in patients younger and older than 35 years. A total of 28 patients (5 women and 23 men) with average age of 41.5 years (36-68) were retrospectively evaluated. The average follow-up period was 33 months. All of them were treated operatively with arthroscopic single-bundle four-strand hamstring tendon autograft. The functional outcome was determined by clinical scores (Tegner activity scale and Lysholm knee score). The median values for the Lysholm knee score were preoperatively 77 and postoperatively 96 points (range, 90-100) with significant improvement (p < 0.05) and that for the Tegner activity scale were preoperatively 4.6 points (range, 3-6), which is the same pre- and postoperatively with an overall return to baseline for all patients. No significant correlation between functional outcome and patients' age was present and no reported significant complications. The good results and a high level of patient satisfaction show that ACL reconstruction is justified even in patients (older than 35 years) with symptomatic anterior knee instability. We commonly propose surgical treatment in symptomatic patients who express the need to restore their preinjury activity levels, regardless of their age.

  8. Formerly homeless, older women's experiences with health, housing, and aging.

    PubMed

    Waldbrook, Natalie

    2013-01-01

    The perspectives of formerly homeless, older women are absent in the academic literature on aging and homelessness. In this study, a group of formerly homeless women, aged 45 years and older were surveyed (N = 15) and interviewed (n = 11) about their experiences with health, housing, and aging. The qualitative themes to be explored include the women's perceptions of their current health, coping with low incomes, dealing with addictions to alcohol and drugs, and the importance of supportive housing and other community services. The female participants' views on adapting to home, planning for their elderly years, and views on growing older are also explored.

  9. Does Work Contribute to Successful Aging Outcomes in Older Workers?

    ERIC Educational Resources Information Center

    Sanders, Martha J.; McCready, Jack W.

    2010-01-01

    Older workers are the fastest growing segment of the labor force, yet little is known about designing jobs for older workers that optimize their experiences relative to aging successfully. This study examined the contribution of workplace job design (opportunities for decision-making, skill variety, coworker support, supervisor support) to…

  10. Active Ageing Level of Older Persons: Regional Comparison in Thailand.

    PubMed

    Haque, Md Nuruzzaman

    2016-01-01

    Active ageing level and its discrepancy in different regions (Bangkok, Central, North, Northeast, and South) of Thailand have been examined for prioritizing the policy agenda to be implemented. Attempt has been made to test preliminary active ageing models for Thai older persons and hence active ageing index (AAI, ranges from 0 to 1) has been estimated. Using nationally representative data and confirmatory factor analysis approach, this study justified active ageing models for female and male older persons in Thailand. Results revealed that active ageing level of Thai older persons is not high (mean AAIs for female and male older persons are 0.64 and 0.61, resp., and those are significantly different (p < 0.001)). Mean AAI in Central region is lower than North, Northeast, and South regions but there is no significant difference in the latter three regions of Thailand. Special emphasis should be given to Central region and policy should be undertaken for increasing active ageing level. Implementation of an Integrated Active Ageing Package (IAAP), containing policies for older persons to improve their health and economic security, to promote participation in social groups and longer working lives, and to arrange learning programs, would be helpful for increasing older persons' active ageing level in Thailand. PMID:27375903

  11. Active Ageing Level of Older Persons: Regional Comparison in Thailand.

    PubMed

    Haque, Md Nuruzzaman

    2016-01-01

    Active ageing level and its discrepancy in different regions (Bangkok, Central, North, Northeast, and South) of Thailand have been examined for prioritizing the policy agenda to be implemented. Attempt has been made to test preliminary active ageing models for Thai older persons and hence active ageing index (AAI, ranges from 0 to 1) has been estimated. Using nationally representative data and confirmatory factor analysis approach, this study justified active ageing models for female and male older persons in Thailand. Results revealed that active ageing level of Thai older persons is not high (mean AAIs for female and male older persons are 0.64 and 0.61, resp., and those are significantly different (p < 0.001)). Mean AAI in Central region is lower than North, Northeast, and South regions but there is no significant difference in the latter three regions of Thailand. Special emphasis should be given to Central region and policy should be undertaken for increasing active ageing level. Implementation of an Integrated Active Ageing Package (IAAP), containing policies for older persons to improve their health and economic security, to promote participation in social groups and longer working lives, and to arrange learning programs, would be helpful for increasing older persons' active ageing level in Thailand.

  12. Epidemiology of Falls in Older Age

    ERIC Educational Resources Information Center

    Peel, Nancye May

    2011-01-01

    Worldwide, falls among older people are a public health concern because of their frequency and adverse consequences in terms of morbidity, mortality, and quality of life, as well as their impact on health system services and costs. This epidemiological review outlines the public health burden of falls and fall-related injuries and the impact of…

  13. So You Think You Look Young? Matching Older Adults' Subjective Ages with Age Estimations Provided by Younger, Middle-Aged, and Older Adults

    ERIC Educational Resources Information Center

    Kotter-Gruhn, Dana; Hess, Thomas M.

    2012-01-01

    Perceived age plays an important role in the context of age identity and social interactions. To examine how accurate individuals are in estimating how old they look and how old others are, younger, middle-aged, and older adults rated photographs of older target persons (for whom we had information about objective and subjective age) in terms of…

  14. [The rationale for the conservative treatment of chronic tonsillitis in the patients of the older age groups by the «soft» therapy methods].

    PubMed

    Lavrenova, G V; Nesterova, K I; Yaremenko, K V; Nesterova, A A

    2016-01-01

    The objective of the present study was to develop an efficient system for the treatment of chronic tonsillitis in the patients of advanced and middle age based on the application of polyvalent bacteriophages in the combination with the physical factors and herbal medicines. The study involved 65 patients (39 women and 276 men) at the age from 65 to 73 years presenting with chronic tonsillitis. The treatment included washing the tonsillar lacunae with herbal infusion consisting of a tetterwort (Choledoniummajus) extract. This procedure was followed by phonophoresiswith the use of the combined polyvalent bacteriophage preparation in the non-liquid formulation during 7-10 days. The effectiveness of such treatment was evaluated based on the results of clinical examination and the analysis of the subjective feelings reported by the patients. In addition, the rosette-forming function of lymphocytes was estimated and palatine tonsil microbiotas in different patients were compared. The effectiveness of therapy was estimated at 89.2%. The positive outcome of the proposed treatment was documented in 78.6% of the cases within 6 months after the onset of therapy. It is concluded that the treatment of chronic tonsillitis with bacteriophagal preparations and herbal infusions in combination with thetraditionallow-frequency ultrasound treatment is highly efficacious (favourable outcome in 78.6% of the patients of middle and advanced age) without the use of antibiotic medications. PMID:27500573

  15. [The rationale for the conservative treatment of chronic tonsillitis in the patients of the older age groups by the «soft» therapy methods].

    PubMed

    Lavrenova, G V; Nesterova, K I; Yaremenko, K V; Nesterova, A A

    2016-01-01

    The objective of the present study was to develop an efficient system for the treatment of chronic tonsillitis in the patients of advanced and middle age based on the application of polyvalent bacteriophages in the combination with the physical factors and herbal medicines. The study involved 65 patients (39 women and 276 men) at the age from 65 to 73 years presenting with chronic tonsillitis. The treatment included washing the tonsillar lacunae with herbal infusion consisting of a tetterwort (Choledoniummajus) extract. This procedure was followed by phonophoresiswith the use of the combined polyvalent bacteriophage preparation in the non-liquid formulation during 7-10 days. The effectiveness of such treatment was evaluated based on the results of clinical examination and the analysis of the subjective feelings reported by the patients. In addition, the rosette-forming function of lymphocytes was estimated and palatine tonsil microbiotas in different patients were compared. The effectiveness of therapy was estimated at 89.2%. The positive outcome of the proposed treatment was documented in 78.6% of the cases within 6 months after the onset of therapy. It is concluded that the treatment of chronic tonsillitis with bacteriophagal preparations and herbal infusions in combination with thetraditionallow-frequency ultrasound treatment is highly efficacious (favourable outcome in 78.6% of the patients of middle and advanced age) without the use of antibiotic medications.

  16. Measuring Successful Aging in Southern Black Older Adults

    ERIC Educational Resources Information Center

    Troutman, Meredith; Nies, Mary A.; Bentley, Monica

    2011-01-01

    With the growing size of the population of aging Black individuals, it is important to understand successful aging in this group. This study, therefore, piloted the Successful Aging Inventory (SAI) with a convenience sample of Black older adults. Participants completed a demographic form, the SAI, Purpose in Life Test, Life Satisfaction…

  17. Older Adults in Lifelong Learning: Participation and Successful Aging

    ERIC Educational Resources Information Center

    Sloane-Seale, Atlanta; Kops, Bill

    2008-01-01

    This article examines the relationship between the participation of older adult learners in educational activities and successful aging. In partnership with seniors' organizations, focus-group interviews were conducted on seniors' involvement in learning and their perceptions of its influence on successful aging. Successful aging is defined in…

  18. Prevalence of unrecognized benign paroxysmal positional vertigo in older patients.

    PubMed

    van der Zaag-Loonen, H J; van Leeuwen, R B; Bruintjes, Tj D; van Munster, B C

    2015-06-01

    Dizziness is a relatively common complaint which occurs more often with increasing age. Benign paroxysmal positional vertigo (BPPV) is an important cause which can easily be treated but is frequently not recognized by professionals. The aim of this study was to assess the prevalence of unrecognized BPPV in older patients. Patients ≥70 years of age (n = 989) indicated whether they experienced dizziness, and if so whether the symptoms were typical for BPPV. If affirmed, a diagnostic maneuver was performed. Positive patients were treated at once. All suspected patients completed quality of life questionnaires and were followed for 3 and 6 months. Positive BPPV patients were compared with negative (but suspected) patients. Almost one quarter of the patients (226 patients, 23 %) suffered from dizziness, among whom 101 were suspected of BPPV. Less than half (n = 45) underwent the diagnostic maneuver, of whom 13 (29 %) were positive for BPPV. At follow-up, one patient developed BPPV, leading to a total of 14 positive patients (overall prevalence 1.4 %). BPPV positive patients did not differ from BPPV negative patients. Among a large group of older patients, one quarter experiences dizziness, and 1.4 % has definite BPPV.

  19. Multimorbidities and Overprescription of Proton Pump Inhibitors in Older Patients

    PubMed Central

    Delcher, Anne; Hily, Sylvie; Boureau, Anne Sophie; Chapelet, Guillaume; Berrut, Gilles; de Decker, Laure

    2015-01-01

    Objectives To determine whether there is an association between overprescription of proton pump inhibitors (PPIs) and multimorbidities in older patients. Design Multicenter prospective study. Setting Acute geriatric medicine at the University Hospital of Nantes and the Hospital of Saint-Nazaire. Participants Older patients aged 75 and over hospitalized in acute geriatric medicine. Measurements Older patients in acute geriatric medicine who received proton pump inhibitors. Variables studied were individual multimorbidities, the burden of multimorbidity evaluated by the Cumulative Illness Rating Scale, age, sex, type of residence (living in nursing home or not), functional abilities (Lawton and Katz scales), nutritional status (Body Mass Index), and the type of concomitant medications (antiaggregant, corticosteroids’, or anticoagulants). Results Overprescription of proton pump inhibitors was found in 73.9% older patients. In the full model, cardiac diseases (odds ratio [OR] = 4.17, p = 0.010), metabolic diseases (OR = 2.14, p = 0.042) and corticosteroids (OR = 5.39, p = 0.028) were significantly associated with overprescription of proton pump inhibitors. Esogastric diseases (OR = 0.49, p = 0.033) were negatively associated with overprescription of proton pump inhibitors. Conclusion Cardiac diseases and metabolic diseases were significantly associated with overprescription of proton pump inhibitors. PMID:26535585

  20. [Treatment of older patients with dyslipidemia].

    PubMed

    González, David Fierro

    2014-05-01

    Elderly persons represent a growing percentage of the total population, and this tendency will become stronger in the coming years. To date, the little evidence available on primary and secondary prevention indicates that this population has high cholesterol levels, that few are under treatment, and that the degree of control requires improvement. Current guidelines recommend that treatment targets in older persons should be the same as those in younger patients. Nevertheless, it is important to remember certain characteristics in older persons, such as biological and metabolic changes or the higher incidence of atherogenic dyslipidemia, which will affect them. Moreover, quality of life and maintaining independence rather than mere survival are especially important in older individuals, as demonstrated by various surveys. Consequently, pravastatin -the most widely studied statin- seems to be the statin of choice for the control of triglycerides and residual risk, although fenofibrate is also useful.

  1. [Treatment of older patients with dyslipidemia].

    PubMed

    González, David Fierro

    2014-05-01

    Elderly persons represent a growing percentage of the total population, and this tendency will become stronger in the coming years. To date, the little evidence available on primary and secondary prevention indicates that this population has high cholesterol levels, that few are under treatment, and that the degree of control requires improvement. Current guidelines recommend that treatment targets in older persons should be the same as those in younger patients. Nevertheless, it is important to remember certain characteristics in older persons, such as biological and metabolic changes or the higher incidence of atherogenic dyslipidemia, which will affect them. Moreover, quality of life and maintaining independence rather than mere survival are especially important in older individuals, as demonstrated by various surveys. Consequently, pravastatin -the most widely studied statin- seems to be the statin of choice for the control of triglycerides and residual risk, although fenofibrate is also useful. PMID:25263639

  2. Improving Care in Older Patients with Diabetes: A Focus on Glycemic Control.

    PubMed

    Lee, Eric A; Gibbs, Nancy E; Martin, John; Ziel, Fred; Polzin, Jennifer K; Palmer-Toy, Darryl

    2016-01-01

    Diabetes affects more than 25% of Americans older than age 65 years. The medical care of older patients must differ from the care of their younger counterparts. Older patients are at high risk of drug toxicity. A hemoglobin A1c (HbA1c) level less than 7.0% has historically been the goal of all patients with diabetes, regardless of age. Recent research has demonstrated that using medications to achieve such tight glycemic control is not necessary and is often not safe.This article discusses the seminal research findings that strongly suggest that HbA1c goals should be relaxed in older patients. The authors then recommend an age-specific and functionally appropriate HbA1c reference range for patients receiving medications to improve glycemic control. Other interventions are suggested that should make diabetes care safer in older patients receiving hypoglycemic medications. PMID:27352408

  3. Improving Care in Older Patients with Diabetes: A Focus on Glycemic Control

    PubMed Central

    Lee, Eric A; Gibbs, Nancy E; Martin, John; Ziel, Fred; Polzin, Jennifer K; Palmer-Toy, Darryl

    2016-01-01

    Diabetes affects more than 25% of Americans older than age 65 years. The medical care of older patients must differ from the care of their younger counterparts. Older patients are at high risk of drug toxicity. A hemoglobin A1c (HbA1c) level less than 7.0% has historically been the goal of all patients with diabetes, regardless of age. Recent research has demonstrated that using medications to achieve such tight glycemic control is not necessary and is often not safe. This article discusses the seminal research findings that strongly suggest that HbA1c goals should be relaxed in older patients. The authors then recommend an age-specific and functionally appropriate HbA1c reference range for patients receiving medications to improve glycemic control. Other interventions are suggested that should make diabetes care safer in older patients receiving hypoglycemic medications. PMID:27352408

  4. Labor-Force Dynamics at Older Ages

    PubMed Central

    Zissimopoulos, Julie M.; Karoly, Lynn A.

    2012-01-01

    Labor-market transitions toward the latter parts of workers’ careers can be complex, with movement between jobs and classes of work and in and out of retirement. The authors analyzed factors associated with the labor-market transitions of older workers to self-employment from unemployment or disability, retirement, or wage and salary work using rich panel data from seven waves of the Health and Retirement Study (HRS). They found evidence that (prior) job characteristics and liquidity constraints are important predictors of movements to self-employment for workers and nonworkers, while risk aversion is a significant predictor only for workers. PMID:23049149

  5. The prognosis in cases of hepatocellular carcinoma after hepatectomy: young patients versus older patients

    PubMed Central

    Lee, Ji Soo; Lee, Seunghwan; Choi, Jin-Yong; Cho, Wontae; Choi, Gyu-Seoung; Park, Jae Berm; Kwon, Choon Hyuck David; Kim, Sung Joo; Joh, Jae-Won

    2015-01-01

    Backgrounds/Aims Hepatocellular carcinoma (HCC) is uncommon in young adults and the prognosis of these patients is still unclear. In this retrospective study, we compared the clinicopathological characteristics and outcomes of young patients with HCC with those of older patients with HCC. Methods We retrospectively reviewed the clinicopathological characteristics of a total of 1,124 patients with HCC who underwent hepatectomy at our institution between 2006 and 2010. Patients ≤40 years of age at the time of HCC diagnosis were classified in the younger group. Results One hundred and three patients (9.2%) were classified in the younger group. whereas, 1021 patients were classified in the older group. The incidences of hepatitis B virus infection, alpha-fetoprotein (AFP) levels, and indocyanine green retention test were all higher in younger patients than in older patients (p<0.05). Disease-free survival and overall survival were longer in older patients than in younger patients, without statistical significance. In younger patients, increased levels of protein induced by vitamin K antagonist-II (PIVKA-II) and alkaline phosphatase, portal vein tumor thrombosis, and intrahepatic metastasis were all predisposing factors for tumor recurrence after hepatectomy. Conclusions Although the AFP levels were higher in younger patients with HCC than in older patients with HCC, disease-free survival and overall survival after liver resection were not significantly different between the two groups. PMID:26693234

  6. Representation of older patients in clinical trials for drug approval in Japan.

    PubMed

    Asahina, Y; Sugano, H; Sugiyama, E; Uyama, Y

    2014-05-01

    To examine how target patients seen in clinical practice are represented in clinical trials for approved drugs in Japan, we compared the age distribution of older patients enrolled in confirmatory clinical trials for regulatory approval with that of the estimated actual patient population. Drugs for 6 chronic conditions common among older patients (diabetes mellitus, hypertension, rheumatoid arthritis, non-small cell lung cancer, depression and Alzheimer's disease) launched by 2012 in Japan were selected. The disparity in age distribution between patients in trials and patients seen in clinical practice varied depending on the disease, but older patients, especially those aged 75 or older, were generally underrepresented in clinical trials for regulatory approval in Japan. Under-representation of older patients in hypertension trials was particularly marked compared to other conditions, despite the similarity in age distribution of patients seen in clinical practice. One factor causing this disparity may be an upper age limit in clinical trial protocols. More effort is needed to properly characterize the benefits and risks of drugs for older patients. This should include the active enrollment of older patients in clinical trials, the establishment of better assessment tools such as pharmacometric approaches, and the appropriate planning and conducting of post-marketing surveys and studies.

  7. Treatment Outcome in Older Patients with Childhood Acute Myeloid Leukemia

    PubMed Central

    Rubnitz, Jeffrey E.; Pounds, Stanley; Cao, Xueyuan; Jenkins, Laura; Dahl, Gary; Bowman, W. Paul; Taub, Jeffrey W; Pui, Ching-Hon; Ribeiro, Raul C.; Campana, Dario; Inaba, Hiroto

    2013-01-01

    Background Older age has historically been an adverse prognostic factor in pediatric acute myeloid leukemia (AML). The impact of age relative to that of other prognostic factors on the outcome of patients treated in recent trials is unknown. Methods Clinical outcome and causes of treatment failure of 351 patients enrolled on three consecutive protocols for childhood AML between 1991 and 2008 were analyzed according to age and protocol. Results The more recent protocol (AML02) produced improved outcomes for 10- to 21-year-old patients compared to 2 earlier studies (AML91 and 97), with 3-year rates of event-free survival (EFS), overall survival (OS) and cumulative incidence of refractory leukemia or relapse (CIR) for this group similar to those of 0- to 9-year old patients: EFS, 58.3% ± 5.4% vs. 66.6% ± 4.9%, P=.20; OS, 68.9% ± 5.1% vs. 75.1% ± 4.5%, P=.36; cumulative incidence of refractory leukemia or relapse, 21.9% ± 4.4%; vs. 25.3% ± 4.1%, P=.59. EFS and OS estimates for 10–15-year-old patients overlapped those for 16–21-year-old patients. However, the cumulative incidence of toxic death was significantly higher for 10- to 21-year-old patients compared to younger patients (13.2% ± 3.6 vs. 4.5% ± 2.0%, P=.028). Conclusion The survival rate for older children with AML has improved on our recent trial and is now similar to that of younger patients. However, deaths from toxicity remain a significant problem in the older age group. Future trials should focus on improving supportive care while striving to develop more effective antileukemic therapy. PMID:22674050

  8. Do family physicians treat older patients with mental disorders differently from younger patients?

    PubMed Central

    Mackenzie, C. S.; Gekoski, W. L.; Knox, V. J.

    1999-01-01

    OBJECTIVE: To determine whether there are differences between family physicians' beliefs and treatment intentions regarding older patients with mental disorders and younger patients with similar disorders. Such differences might contribute to older adults' lower rates of mental health service use. DESIGN: Mailed survey. SETTING: Primary care practices in and around Kingston, Ont. PARTICIPANTS: Questionnaires were mailed to 294 general practitioners listed in the 42nd Annual Canadian Medical Directory. Of the 285 eligible physicians, 115 (40%) completed and returned questionnaires. MAIN OUTCOME MEASURES: Physicians' ratings of preparedness to identify and treat, likelihood of treating, likelihood of using each of five different treatment methods, likelihood of referral, preferences for six referral options, and treatment effectiveness with respect to hypothetical older and younger patients with panic disorder or dysthymia. RESULTS: Physicians reported being less prepared to identify and treat older patients than younger patients. In addition, physicians reported being significantly less likely to treat and to refer older patients than younger patients. Finally, physicians reported that both psychotherapy alone, and in combination with pharmacotherapy, were less effective for older patients than for younger patients. CONCLUSIONS: In addition to other possible reasons for older adults' low rates of mental health service use, this study suggests that family physicians' beliefs and treatment intentions could be contributing factors. Changes in medical education aimed at replacing inaccurate beliefs with accurate information regarding older patients might be one way to increase rates of use in this underserved age group, because family physicians play a key role in the mental health care of older adults. PMID:10349066

  9. 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

  10. College Students' Perceptions about Older People and Aging

    ERIC Educational Resources Information Center

    Kimuna, Sitawa R.; Knox, David; Zusman, Marty

    2005-01-01

    This study assessed the perceptions of college students at a large southeastern university about aging and older people. Participants were 441 students from age 17 to 49 years with a median age of 19 years. There were 118 males (26.8%) and 323 females (73.2%). The results indicated that students believed a person is "old" at the age of 60 years.…

  11. Older Surgery Patients Should Be Screened for Frailty

    MedlinePlus

    ... html Older Surgery Patients Should Be Screened for Frailty: Study Warning signs such as exhaustion increase the ... 2016 (HealthDay News) -- Screening older surgery patients for frailty could improve their outcomes and chances for survival, ...

  12. Communicating with older ethnic minority patients.

    PubMed

    Likupe, Gloria

    2014-06-10

    In a time of increasing cultural diversity, it is essential that healthcare professionals respond by providing culturally competent care. Healthcare professionals must recognise the diverse needs of people from ethnic minority communities to ensure that they receive equal standards of care. This is particularly pertinent when providing care for older ethnic minority patients who may not be fluent in English. This article focuses on the need to communicate effectively with this group of patients to meet their health and social care needs, with the ultimate aim of improving patient outcomes. PMID:24894254

  13. Correlates of Root Caries Experience in Middle-Aged and Older Adults within the Northwest PRECEDENT

    PubMed Central

    Chi, Donald L.; Berg, Joel H.; Kim, Amy S.; Scott, JoAnna

    2014-01-01

    STRUCTURED ABSTRACT Background We examined the correlates of root caries experience for middle-aged (ages 45–64 years) and older adults (ages 65+ years) to test the hypothesis that the factors related to root caries are different for middle-aged versus older adults. Methods This observational cross-sectional study focused on adult patients ages 45–97 years recruited from the Northwest PRECEDENT (N=775 adults). The outcome variable was any root caries experience (no/yes). Sociodemographic, intraoral, and behavioral factors were hypothesized as potential root caries correlates. We used Poisson regression models to generate overall and age-stratified prevalence ratios (PR) of root caries and Generalized Estimating Equations to account for practice-level clustering of participants. Results About 20% of adults had any root caries. Dentists’ assessment that the patient was at high risk for any caries was associated with greater prevalence of root caries experience in both middle-aged adults (PR=2.70, 95% CI: 1.63,4.46) and older adults (PR=1.87, 95% CI: 1.19,2.95). The following factors were significantly associated with increased root caries prevalence, but only for middle-aged adults: male sex (P=.02), self-reported dry mouth (P<.0001), exposed roots (P=.03), and increased frequency of eating or drinking between meals (P=.03). No other covariates were related to root caries experience for older adults. Conclusions Within a practice-based research network, the factors associated with root caries experience were different for middle-aged and older adults. Future work should identify relevant root caries correlates for adults ages 65+ years. Clinical Implications Interventions aimed at preventing root caries are likely to be different for middle-aged and older adults. Root caries prevention programs should address the appropriate aged-based risk factors. PMID:23633699

  14. Characteristics of Older Adults and the Aging: Some Comments.

    ERIC Educational Resources Information Center

    Kowalski, Cash J.; Cangemi, Joseph P.

    1978-01-01

    Asserting that both humanistic and manpower considerations dictate that we address the aging process, this article describes the characteristics of older adults and illustrates the way in which they may be allowed to remain productive. Maslow's "Need Hierarchy" and Thorndike's "Theory of Developmental Tasks" are applied to the aging process. (JC)

  15. Active Ageing and Universities: Engaging Older Learners. Research Report

    ERIC Educational Resources Information Center

    Phillipson, Chris; Ogg, Jim

    2010-01-01

    This report reviews the engagement of older learners (defined as those aged 50 and over) in education and training with particular reference to their involvement in higher education. The ageing of populations was one of the most important trends in the 20th century and will raise major challenges in this century. Appended are: (1) Selected UK…

  16. Eye Conditions in Older Adults: Age-Related Macular Degeneration.

    PubMed

    Iroku-Malize, Tochi; Kirsch, Scott

    2016-06-01

    Age-related macular degeneration (AMD) causes a progressive loss of photoreceptors in the macula. It is the most common cause of legal blindness in the United States, and some form of AMD is thought to affect more than 9 million individuals. Risk factors include older age, smoking, dyslipidemia, obesity, white race, female sex, and a family history of AMD. There are two types of advanced AMD: nonexudative (dry or geographic atrophy) and exudative (wet or neovascular). Both cause progressive central vision loss with intact peripheral vision. Nonexudative AMD accounts for 80% to 90% of all advanced cases, and more than 90% of patients with severe vision loss have exudative AMD. On ophthalmoscopic examination, early findings include drusen (ie, yellow deposits in the retina). Prominent choroidal vessels, subretinal edema, and/or hemorrhage are seen in wet AMD. Regular eye examinations, visual field testing, fluorescein angiography, and optical coherence tomography are used for diagnosis and to guide management. There is no specific therapy for dry AMD, but antioxidant supplementation may be helpful. Intravitreal injection of a vascular endothelial growth factor inhibitor is the treatment of choice for wet AMD. Optical aids and devices can help to maximize function for patients with AMD. PMID:27348529

  17. Eye Conditions in Older Adults: Age-Related Macular Degeneration.

    PubMed

    Iroku-Malize, Tochi; Kirsch, Scott

    2016-06-01

    Age-related macular degeneration (AMD) causes a progressive loss of photoreceptors in the macula. It is the most common cause of legal blindness in the United States, and some form of AMD is thought to affect more than 9 million individuals. Risk factors include older age, smoking, dyslipidemia, obesity, white race, female sex, and a family history of AMD. There are two types of advanced AMD: nonexudative (dry or geographic atrophy) and exudative (wet or neovascular). Both cause progressive central vision loss with intact peripheral vision. Nonexudative AMD accounts for 80% to 90% of all advanced cases, and more than 90% of patients with severe vision loss have exudative AMD. On ophthalmoscopic examination, early findings include drusen (ie, yellow deposits in the retina). Prominent choroidal vessels, subretinal edema, and/or hemorrhage are seen in wet AMD. Regular eye examinations, visual field testing, fluorescein angiography, and optical coherence tomography are used for diagnosis and to guide management. There is no specific therapy for dry AMD, but antioxidant supplementation may be helpful. Intravitreal injection of a vascular endothelial growth factor inhibitor is the treatment of choice for wet AMD. Optical aids and devices can help to maximize function for patients with AMD.

  18. Approach to skin ulcers in older patients.

    PubMed Central

    Frank, Christopher

    2004-01-01

    OBJECTIVE: To provide family physicians with an approach to managing skin ulcers in older patients. SOURCES OF INFORMATION: Clinical practice guidelines and best practice guidelines were summarized to describe an evidence-based approach. MAIN MESSAGE; Preventing ulcers is important in frail older patients. Using guidelines can help prevent ulcers in institutions. Clarifying the cause and contributing factors is the first step in management. Pressure and venous ulcers are common in elderly people. Poor nutrition, edema, arterial insufficiency, and anemia often impair wound healing. Adequate debridement is important to decrease risk of infection and to promote healing. There are guidelines for cleaning ulcers. Choice of dressings depends on the circumstances of each wound, but dressings should provide a moist environment. Options for dressings are summarized. CONCLUSION: Family physicians can manage skin ulcers effectively by applying basic principles and using readily available guidelines. PMID:15648380

  19. Differential Impacts of Age of Acquisition on Letter and Semantic Fluency in Alzheimer’s Disease Patients and Healthy Older Adults

    PubMed Central

    Sailor, Kevin M.; Zimmerman, Molly E.; Sanders, Amy E.

    2013-01-01

    The degree to which the typical age of acquisition (AoA) of words and word frequency have separable influences on verbal production tasks has been strongly debated. To examine the overlap between these factors in verbal fluency tasks, the performance of Alzheimer’s disease (AD) patients (N=34) and normal elderly controls (N=36) was compared on semantic (e.g., vegetables) and letter (e.g. words that begin with F) fluency tasks. These comparisons revealed that words generated for the semantic fluency task had an earlier AoA while words generated for the letter fluency task had a higher word frequency.. Differences in AoA between AD patients and controls were larger for semantic than letter fluency. These results suggest that AoA has an effect on verbal production that is independent of word frequency and that AoA has a semantic locus. PMID:21851152

  20. Automated bone age assessment of older children using the radius

    NASA Astrophysics Data System (ADS)

    Tsao, Sinchai; Gertych, Arkadiusz; Zhang, Aifeng; Liu, Brent J.; Huang, Han K.

    2008-03-01

    The Digital Hand Atlas in Assessment of Skeletal Development is a large-scale Computer Aided Diagnosis (CAD) project for automating the process of grading Skeletal Development of children from 0-18 years of age. It includes a complete collection of 1,400 normal hand X-rays of children between the ages of 0-18 years of age. Bone Age Assessment is used as an index of skeletal development for detection of growth pathologies that can be related to endocrine, malnutrition and other disease types. Previous work at the Image Processing and Informatics Lab (IPILab) allowed the bone age CAD algorithm to accurately assess bone age of children from 1 to 16 (male) or 14 (female) years of age using the Phalanges as well as the Carpal Bones. At the older ages (16(male) or 14(female) -19 years of age) the Phalanges as well as the Carpal Bones are fully developed and do not provide well-defined features for accurate bone age assessment. Therefore integration of the Radius Bone as a region of interest (ROI) is greatly needed and will significantly improve the ability to accurately assess the bone age of older children. Preliminary studies show that an integrated Bone Age CAD that utilizes the Phalanges, Carpal Bones and Radius forms a robust method for automatic bone age assessment throughout the entire age range (1-19 years of age).

  1. Nitrogen Balance and Protein Requirements for Critically Ill Older Patients

    PubMed Central

    Dickerson, Roland N.

    2016-01-01

    Critically ill older patients with sarcopenia experience greater morbidity and mortality than younger patients. It is anticipated that unabated protein catabolism would be detrimental for the critically ill older patient. Healthy older subjects experience a diminished response to protein supplementation when compared to their younger counterparts, but this anabolic resistance can be overcome by increasing protein intake. Preliminary evidence suggests that older patients may respond differently to protein intake than younger patients during critical illness as well. If sufficient protein intake is given, older patients can achieve a similar nitrogen accretion response as younger patients even during critical illness. However, there is concern among some clinicians that increasing protein intake in older patients during critical illness may lead to azotemia due to decreased renal functional reserve which may augment the propensity towards worsened renal function and worsened clinical outcomes. Current evidence regarding protein requirements, nitrogen balance, ureagenesis, and clinical outcomes during nutritional therapy for critically ill older patients is reviewed. PMID:27096868

  2. Does cancer survival differ for older patients?

    PubMed

    Kant, A K; Glover, C; Horm, J; Schatzkin, A; Harris, T B

    1992-12-01

    The relation of age to 5-year relative survival rates was examined for leading sites of cancer resulting in death among 127,554 patients; data from 1978 to 1982 were studied for four areas of the Surveillance, Epidemiology and End Results program of the National Cancer Institute. Overall and stage-stratified relative survival rates declined with advancing patient age for cancer of the lung, prostate, pancreas, bladder, oral cavity, uterus, cervix, ovary, and large bowel (women only). In men, this trend was not explained by age differences in stage of diagnosis, whereas, among women, age was associated with more advanced disease for most sites examined. Although overall survival rates were lower in black patients compared with white patients, the age-survival and age-stage trends were similar in the two racial groups.

  3. Older Workers' Perspectives on Training and Retention of Older Workers: Victorian Aged Care Workers Survey. Support Document

    ERIC Educational Resources Information Center

    Lundberg, David; Marshallsay, Zariah

    2007-01-01

    Older workers' perspectives are examined in a national survey of the finance sector and case studies of aged care and construction workers. The majority of older workers intend to work beyond retirement age, to achieve a better lifestyle. With training, older workers could mentor younger workers. This support document includes a national survey of…

  4. Older Workers' Perspectives on Training and Retention of Older Workers: South Australian Aged Care Workers Study. Support Document

    ERIC Educational Resources Information Center

    Lundberg, David; Marshallsay, Zariah

    2007-01-01

    Older workers' perspectives are examined in a national survey of the finance sector and case studies of aged care and construction workers. The majority of older workers intend to work beyond retirement age, to achieve a better lifestyle. With training, older workers could mentor younger workers. This support document includes a national survey of…

  5. Attitudes about Aging and Gender among Young, Middle Age, and Older College-Based Students

    ERIC Educational Resources Information Center

    Laditka, Sarah B.; Fischer, Mary; Laditka, James N.; Segal, David R.

    2004-01-01

    Using an updated version of the Aging Semantic Differential, 534 younger, middle age, and older participants from a college community rated female and male targets categorized as ages 21-34 and 75-85. Participants also provided views about their own aging. Repeated measures of analysis of variance examined attitudinal differences by age and gender…

  6. Autologous stem cell transplantation for patients aged 60 years or older with refractory or relapsed classical Hodgkin's lymphoma: a retrospective analysis from the French Society of Bone Marrow Transplantation and Cell Therapies (SFGM-TC).

    PubMed

    Stamatoullas, A; Brice, P; Gueye, M S; Mareschal, S; Chevallier, P; Bouabdallah, R; Nguyenquoc, S; Francois, S; Turlure, P; Ceballos, P; Monjanel, H; Bourhis, J-H; Guillerm, G; Mohty, M; Biron, P; Cornillon, J; Belhadj, K; Bonmati, C; Dilhuydy, M-S; Huynh, A; Bernard, M; Chrétien, M-L; Peffault de Latour, R; Tilly, H

    2016-07-01

    This report retrospectively analyzed the outcome of 91 patients aged 60 years or older with refractory/relapsed (R/R) classical Hodgkin's lymphoma (cHL) who underwent autologous stem cell transplantation (ASCT) between 1992 and 2013 and were reported to the French Society of Bone Marrow Transplantation and Cell Therapies registry. The median age at transplant was 63 years. The majority of patients exhibited disease chemosensitivity to salvage treatment (57 complete responses, 30 partial responses, 1 progressive disease and 3 unknown). The most frequent conditioning regimen consisted of BCNU, cytarabine, etoposide, melphalan (BEAM) chemotherapy (93%). With a median follow-up of 54 months, 5-year estimates of overall survival (OS) and progression free survival (PFS) for the entire group were 67 and 54%, respectively. Despite the missing data, in univariate analysis, the number of salvage chemotherapy lines (1-2 versus ⩾3) significantly influenced the OS, unlike the other prognostic factors (stage III-IV at relapse, disease status before ASCT and negative positron emission tomography (PET) scan) encountered in younger patients. In spite of its limitations, this retrospective study with a long-term follow-up suggests that ASCT is a valid treatment option for chemosensitive R/R cHL in selected elderly patients, with an acceptable rate of toxicity.

  7. Autologous stem cell transplantation for patients aged 60 years or older with refractory or relapsed classical Hodgkin's lymphoma: a retrospective analysis from the French Society of Bone Marrow Transplantation and Cell Therapies (SFGM-TC).

    PubMed

    Stamatoullas, A; Brice, P; Gueye, M S; Mareschal, S; Chevallier, P; Bouabdallah, R; Nguyenquoc, S; Francois, S; Turlure, P; Ceballos, P; Monjanel, H; Bourhis, J-H; Guillerm, G; Mohty, M; Biron, P; Cornillon, J; Belhadj, K; Bonmati, C; Dilhuydy, M-S; Huynh, A; Bernard, M; Chrétien, M-L; Peffault de Latour, R; Tilly, H

    2016-07-01

    This report retrospectively analyzed the outcome of 91 patients aged 60 years or older with refractory/relapsed (R/R) classical Hodgkin's lymphoma (cHL) who underwent autologous stem cell transplantation (ASCT) between 1992 and 2013 and were reported to the French Society of Bone Marrow Transplantation and Cell Therapies registry. The median age at transplant was 63 years. The majority of patients exhibited disease chemosensitivity to salvage treatment (57 complete responses, 30 partial responses, 1 progressive disease and 3 unknown). The most frequent conditioning regimen consisted of BCNU, cytarabine, etoposide, melphalan (BEAM) chemotherapy (93%). With a median follow-up of 54 months, 5-year estimates of overall survival (OS) and progression free survival (PFS) for the entire group were 67 and 54%, respectively. Despite the missing data, in univariate analysis, the number of salvage chemotherapy lines (1-2 versus ⩾3) significantly influenced the OS, unlike the other prognostic factors (stage III-IV at relapse, disease status before ASCT and negative positron emission tomography (PET) scan) encountered in younger patients. In spite of its limitations, this retrospective study with a long-term follow-up suggests that ASCT is a valid treatment option for chemosensitive R/R cHL in selected elderly patients, with an acceptable rate of toxicity. PMID:27042842

  8. Impact of Training on Attitudes of Older Paraprofessionals Toward Aging.

    ERIC Educational Resources Information Center

    Guttman, Rosalie A.

    With the increased use of paraprofessionals as service providers to the elderly, and indication in current literature that negative attitudes toward the aged are reflected in treatment received, the need for specialized training in geriatrics is apparent. A true-false 54-item questionnaire concerning older people's social, economic, physical and…

  9. Perspective Taking in Older Age Revisited: A Motivational Perspective

    ERIC Educational Resources Information Center

    Zhang, Xin; Fung, Helene H.; Stanley, Jennifer T.; Isaacowitz, Derek M.; Ho, Man Yee

    2013-01-01

    How perspective-taking ability changes with age (i.e., whether older adults are better at understanding others' behaviors and intentions and show greater empathy to others or not) is not clear, with prior empirical findings on this phenomenon yielding mixed results. In a series of experiments, we investigated the phenomenon from a…

  10. Keeping It Safe: Aging in Place among Rural Older Adults

    ERIC Educational Resources Information Center

    Peek, Gina G.; Bishop, Alex J.

    2016-01-01

    The purpose of the study addressed in this article was to identify ways to reduce risk and improve safe aging in place among rural older adults. Resident and Extension faculty and county educators visited study participants at home to assess functional capacity and the home environment. Extension professionals may be uniquely positioned to provide…

  11. Middle-Aged and Older Women in Print Advertisements.

    ERIC Educational Resources Information Center

    Hollenshead, Carol; Ingersoll, Berit

    1982-01-01

    Examined images of aging women depicted in periodical advertising over a 10-year period. Analyzed content for frequency, products involved, setting, value orientation, and change over time. Found older women in less than 1% of the advertisements, and no significant changes from 1967-1977. (Author/JAC)

  12. ANXIETY AND ITS CORRELATES AMONG OLDER ADULTS ACCESSING AGING SERVICES

    PubMed Central

    Richardson, Thomas M.; Simning, Adam; He, Hua; Conwell, Yeates

    2010-01-01

    Objectives To assess the characteristics of anxiety in aging services network (ASN) clients. Methods Interviews were conducted as part of an academic-community partnership for studying the mental health needs of community-dwelling older adults. Participants consisted of ASN clients in Monroe County, NY, that were aged 60 years and older and received an in-home assessment for care management services. The Goldberg Anxiety Scale screened for anxiety symptoms, and instruments covering the domains of associated mental health, physical health and disability, social support, negative life events, and other areas relevant to delivery of aging services were administered. Results Of 378 subjects enrolled, 27% had clinically significant levels of anxiety. In bivariate analyses anxiety was associated with having a current major depressive episode (MDE), five or more medical conditions, pain, younger age, less income, and negative life events. After controlling for MDE in multivariate analyses, medical conditions, pain, negative life events, and younger age were significant correlates of anxiety in ASN clients. Conclusions Anxiety was common among ASN clients who received in-home care management services. These anxious clients suffered from a combination of mental, medical, and social issues that suggests the need for multidisciplinary care. Because aging services providers work with their clients to ameliorate conditions that are highly correlated with anxiety, the ASN represents a promising venue for detecting, managing, and preventing anxiety among older adults. PMID:20066684

  13. [Inappropriate prescription in older patients: the STOPP/START criteria].

    PubMed

    Delgado Silveira, Eva; Muñoz García, María; Montero Errasquin, Beatriz; Sánchez Castellano, Carmen; Gallagher, Paul F; Cruz-Jentoft, Alfonso J

    2009-01-01

    Older people are a heterogeneous group of patients, often with multiple comorbidities for which they are prescribed a large number of drugs, leading to an increased risk of adverse drug reactions (ADR) and drug interactions. This risk is compounded by physiological age-related changes in physiology, changes in drug pharmacokinetics and pharmacodynamics, as well as by disease-related, functional and social issues. Inappropriate prescription of drugs is common in the older individuals and contributes to the increased risk of ADR. Several tools have been developed to detect potentially inappropriate prescription, the most frequently used in Spain being Beers' criteria. However, the value of these criteria is limited, especially as they were developed in a different healthcare system. In this article, the Spanish version of a new tool to detect potentially inappropriate prescriptions-STOPP (Screening Tool of Older Person's Prescriptions) and START (Screening Tool to Alert doctors to Right i.e. appropriate, indicated Treatment) criteria-is presented. The creation, development, reliability, and use of these criteria in routine practice is described and discussed. These criteria have shown better sensitivity than Beers' criteria in detecting prescription problems and have the added value of being able to detect not only inappropriate prescription of some drugs, but also the omission of well indicated drugs. The STOPP/START criteria could become a useful screening tool to improve prescription in older people. PMID:19540624

  14. Treating the older adult dental patient: what are the issues of concern?

    PubMed

    Mulligan, Roseann; Vanderlinde, Michele Alexis

    2009-11-01

    Just as aging successfully requires a multifaceted approach that includes full engagement in life, maintenance of high physical and cognitive function, and avoidance of disease and related disability, so does the care of adult patients. This geriatric treatment model suggests that understanding the psychosocial, behavioral, and medical presentation of the older patient may prove to be the key to the ultimate success of the dental/oral treatment arrived at collaboratively by the dentist and the older patient.

  15. Age Differences in Prefrontal Surface Area and Thickness in Middle Aged to Older Adults

    PubMed Central

    Dotson, Vonetta M.; Szymkowicz, Sarah M.; Sozda, Christopher N.; Kirton, Joshua W.; Green, Mackenzie L.; O’Shea, Andrew; McLaren, Molly E.; Anton, Stephen D.; Manini, Todd M.; Woods, Adam J.

    2016-01-01

    Age is associated with reductions in surface area and cortical thickness, particularly in prefrontal regions. There is also evidence of greater thickness in some regions at older ages. Non-linear age effects in some studies suggest that age may continue to impact brain structure in later decades of life, but relatively few studies have examined the impact of age on brain structure within middle-aged to older adults. We investigated age differences in prefrontal surface area and cortical thickness in healthy adults between the ages of 51 and 81 years. Participants received a structural 3-Tesla magnetic resonance imaging scan. Based on a priori hypotheses, primary analyses focused on surface area and cortical thickness in the dorsolateral prefrontal cortex, anterior cingulate cortex, and orbitofrontal cortex. We also performed exploratory vertex-wise analyses of surface area and cortical thickness across the entire cortex. We found that older age was associated with smaller surface area in the dorsolateral prefrontal and orbitofrontal cortices but greater cortical thickness in the dorsolateral prefrontal and anterior cingulate cortices. Vertex-wise analyses revealed smaller surface area in primarily frontal regions at older ages, but no age effects were found for cortical thickness. Results suggest age is associated with reduced surface area but greater cortical thickness in prefrontal regions during later decades of life, and highlight the differential effects age has on regional surface area and cortical thickness. PMID:26834623

  16. Age Differences in Prefrontal Surface Area and Thickness in Middle Aged to Older Adults.

    PubMed

    Dotson, Vonetta M; Szymkowicz, Sarah M; Sozda, Christopher N; Kirton, Joshua W; Green, Mackenzie L; O'Shea, Andrew; McLaren, Molly E; Anton, Stephen D; Manini, Todd M; Woods, Adam J

    2015-01-01

    Age is associated with reductions in surface area and cortical thickness, particularly in prefrontal regions. There is also evidence of greater thickness in some regions at older ages. Non-linear age effects in some studies suggest that age may continue to impact brain structure in later decades of life, but relatively few studies have examined the impact of age on brain structure within middle-aged to older adults. We investigated age differences in prefrontal surface area and cortical thickness in healthy adults between the ages of 51 and 81 years. Participants received a structural 3-Tesla magnetic resonance imaging scan. Based on a priori hypotheses, primary analyses focused on surface area and cortical thickness in the dorsolateral prefrontal cortex, anterior cingulate cortex, and orbitofrontal cortex. We also performed exploratory vertex-wise analyses of surface area and cortical thickness across the entire cortex. We found that older age was associated with smaller surface area in the dorsolateral prefrontal and orbitofrontal cortices but greater cortical thickness in the dorsolateral prefrontal and anterior cingulate cortices. Vertex-wise analyses revealed smaller surface area in primarily frontal regions at older ages, but no age effects were found for cortical thickness. Results suggest age is associated with reduced surface area but greater cortical thickness in prefrontal regions during later decades of life, and highlight the differential effects age has on regional surface area and cortical thickness.

  17. Long-term Toxicity of Cancer Treatment in Older Patients.

    PubMed

    Shahrokni, Armin; Wu, Abraham J; Carter, Jeanne; Lichtman, Stuart M

    2016-02-01

    With earlier cancer diagnosis among older patients with cancer, the possibility of curing cancer increases. However, cancer treatment may have a long-lasting impact on older cancer survivors. It is vital to screen, diagnose, and properly manage the long-term toxicities of cancer treatment in order to maintain the quality of life of older cancer survivors. PMID:26614861

  18. Amisulpride for older patients with long-standing schizophrenia.

    PubMed

    Pridan, Shani; Baruch, Yehuda; Swartz, Marnina; Barak, Yoram

    2014-12-01

    A large and growing number of older people across the world experience schizophrenia. Recommendations for their treatment are largely based on data extrapolated from studies of the use of antipsychotic medications in younger populations. The present study was designed to evaluate the efficacy and safety of amisulpride monotherapy in a diagnostically homogeneous group of elderly patients without cognitive impairment experiencing schizophrenia (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria for schizophrenia). Mortality and rehospitalization for a 5-year period were the predefined outcome measures. We conducted a retrospective chart review of all elderly (60 years and older) schizophrenia patients treated in a large tertiary care center. Of the 527 elderly schizophrenia patients for a 5-year period (2007-2013), 30 patients, mean (SD) age of 67.5 (5.8) years, were treated with amisulpride monotherapy. There were 19 women and 11 men in the analyzed group. Mean duration of disease was 34.4 years. All had been exposed to at least 3 first- and second-generation antipsychotics before amisulpride treatment. Amisulpride was very well tolerated by the patients, and mortality rate (10% vs 19%) was significantly lower than that of other first- and second-generation antipsychotics (P < 0.02). Rehospitalization rates with amisulpride were significantly lower than those with other second-generation antipsychotics (P < 0.001). We tentatively conclude that our preliminary results demonstrate that amisulpride is an efficacious and safe atypical antipsychotic for the treatment for elderly schizophrenia patients.

  19. Older Adults' Level of Knowledge about Old Age Using the Facts of Aging Quiz.

    ERIC Educational Resources Information Center

    Atkins, Arleen J.

    The Facts on Aging Quiz (FAQ) has been used in different studies to assess the level of knowledge about old age. It contains 25 factual statements concerning basic physical, mental, and social facts and the most common misconceptions about aging. One purpose of this study was to identify the most frequent misconceptions in a group of older adults…

  20. Work, Health, and Family at Older Ages in Japan.

    PubMed

    Raymo, James M; Liang, Jersey; Kobayashi, Erika; Sugihara, Yoko; Fukaya, Taro

    2009-03-01

    In this paper, we investigate ways in which the relationship between health and labor force exit at older ages is moderated by family characteristics. Using two waves of data from a national sample of older Japanese men collected 1999 and 2002, we estimate logistic regression models for labor force exit beyond age 63 as a function of health change, family characteristics, and their interactions. We confirm that poor health is strongly associated with labor force exit and find evidence that moderating influences of family context depend upon the level of health. However, results are only partially consistent with hypotheses that the relationship between health and the likelihood of labor force exit should be stronger for (a) those with good health and family incentives to exit the labor force and (b) those with poor health and family incentives to remain in the labor force.

  1. 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.

  2. The Healthy Ageing Model: health behaviour change for older adults.

    PubMed

    Potempa, Kathleen M; Butterworth, Susan W; Flaherty-Robb, Marna K; Gaynor, William L

    2010-01-01

    Proposed is a model of primary care for older adults with chronic health conditions that focuses on active engagement in health care. The Healthy Ageing Model is anchored in established theory on motivation and health behaviour change. The model draws on empirical and applied clinical underpinnings in such diverse areas as health promotion and education, treatment of addictions or obesity, management of chronic diseases, goal-setting, and coaching techniques. The conceptual foundation for the Healthy Ageing Model is described first, followed by a brief description of the key characteristics of the model. In conclusion, suggestions are offered for the clinical application and for further developing the model.

  3. Experience, Knowledge and Attitudes: Are Paramedic Students Prepared to Care for Older Patients?

    ERIC Educational Resources Information Center

    Ross, Linda; Jennings, Paul; Williams, Brett

    2016-01-01

    As the population ages, so does the number of older patients encountered by paramedics. It is vital that paramedics are adequately prepared to meet the unique and growing needs of these patients. Experience and education play key roles in the formation of attitudes that impact behavior, and ultimately patient care. The aim of this study was to…

  4. Age Preferences: How Old Is "Too Old" for Selected Service Providers among Young, Middle-Aged, and Older Adults?

    ERIC Educational Resources Information Center

    Farney, Lori; Aday, Ronald H.; Breault, Kevin D.

    2006-01-01

    This study investigated age preferences for 11 different service providers and the age at which workers in these occupational roles were considered to be "too old" by three age groups: young (18-24), middle-aged (35-55), and older adults (65+). Results indicate that in comparison to middle-aged and older adults, young adults continue to have…

  5. Physical activity in older age: perspectives for healthy ageing and frailty.

    PubMed

    McPhee, Jamie S; French, David P; Jackson, Dean; Nazroo, James; Pendleton, Neil; Degens, Hans

    2016-06-01

    Regular physical activity helps to improve physical and mental functions as well as reverse some effects of chronic disease to keep older people mobile and independent. Despite the highly publicised benefits of physical activity, the overwhelming majority of older people in the United Kingdom do not meet the minimum physical activity levels needed to maintain health. The sedentary lifestyles that predominate in older age results in premature onset of ill health, disease and frailty. Local authorities have a responsibility to promote physical activity amongst older people, but knowing how to stimulate regular activity at the population-level is challenging. The physiological rationale for physical activity, risks of adverse events, societal and psychological factors are discussed with a view to inform public health initiatives for the relatively healthy older person as well as those with physical frailty. The evidence shows that regular physical activity is safe for healthy and for frail older people and the risks of developing major cardiovascular and metabolic diseases, obesity, falls, cognitive impairments, osteoporosis and muscular weakness are decreased by regularly completing activities ranging from low intensity walking through to more vigorous sports and resistance exercises. Yet, participation in physical activities remains low amongst older adults, particularly those living in less affluent areas. Older people may be encouraged to increase their activities if influenced by clinicians, family or friends, keeping costs low and enjoyment high, facilitating group-based activities and raising self-efficacy for exercise. PMID:26936444

  6. Physical activity in older age: perspectives for healthy ageing and frailty.

    PubMed

    McPhee, Jamie S; French, David P; Jackson, Dean; Nazroo, James; Pendleton, Neil; Degens, Hans

    2016-06-01

    Regular physical activity helps to improve physical and mental functions as well as reverse some effects of chronic disease to keep older people mobile and independent. Despite the highly publicised benefits of physical activity, the overwhelming majority of older people in the United Kingdom do not meet the minimum physical activity levels needed to maintain health. The sedentary lifestyles that predominate in older age results in premature onset of ill health, disease and frailty. Local authorities have a responsibility to promote physical activity amongst older people, but knowing how to stimulate regular activity at the population-level is challenging. The physiological rationale for physical activity, risks of adverse events, societal and psychological factors are discussed with a view to inform public health initiatives for the relatively healthy older person as well as those with physical frailty. The evidence shows that regular physical activity is safe for healthy and for frail older people and the risks of developing major cardiovascular and metabolic diseases, obesity, falls, cognitive impairments, osteoporosis and muscular weakness are decreased by regularly completing activities ranging from low intensity walking through to more vigorous sports and resistance exercises. Yet, participation in physical activities remains low amongst older adults, particularly those living in less affluent areas. Older people may be encouraged to increase their activities if influenced by clinicians, family or friends, keeping costs low and enjoyment high, facilitating group-based activities and raising self-efficacy for exercise.

  7. Falls risk assessment in older patients in hospital.

    PubMed

    Matarese, Maria; Ivziku, Dhurata

    2016-07-27

    Falls are the most frequent adverse event reported in hospitals, usually affecting older patients. All hospitals in NHS organisations develop risk prevention policies that include falls risk assessment. Falls risk assessment involves the use of risk screening tools, aimed at identifying patients at increased risk of falls, and risk assessment tools, which identify a patient's risk factors for falls. Various risk screening tools have been used in clinical practice, but no single tool is able to identify all patients at risk of falls or to accurately exclude all those who are not at risk of falls. Guidelines recommend that patients aged 65 years and over who are admitted to hospital should be considered at high risk of falls and that a multifactorial falls risk assessment should be performed. Therefore, falls risk assessment tools should be used to identify the risk factors for each inpatient aged 65 years or over, in order to determine the most appropriate care plan for falls prevention and to maximise patient mobility and independence. PMID:27461329

  8. Protective factors in patients aged over 65 with stroke treated by physiotherapy, showing cognitive impairment, in the Valencia Community. Protection Study in Older People (EPACV)

    PubMed Central

    2012-01-01

    Background Family function may have an influence on the mental health deterioration of the caregivers of dependent family members and it could have a varying importance on the care of dependents. Little attention has been paid to the preparation of minor stroke survivors for the recovery trajectory or the spouse for the caregiving role. Therefore, this study protocol intends to analyze the influence of family function on the protection of patients with stroke sequels needing physiotherapy in the family environment. Methods/Design This is an analytical observational design, prospective cohort study and using a qualitative methodology by means of data collected in the “interviews of life”. The study will be carried out by the Rehabilitation Service at Hospital of Elda in the Valencia Community. All patients that have been diagnosed with stroke and need physiotherapy treatment, having a dependency grade assigned and consent to participate in the study, will undergo a monitoring of one year in order to assess the predictive factors depending on the dependence of the people affected. Discussion Our research aims to analyze the perception of caregivers, their difficulties to work, and the influence of family function. Moreover, it aims to register the perception of the patients with stroke sequel over the care received and whether they feel protected in their family environment. PMID:23039063

  9. Telemedicine for recently discharged older patients.

    PubMed

    Cardozo, Lavoisier; Steinberg, Joel

    2010-01-01

    Congestive heart failure, chronic obstructive pulmonary disease, diabetes, and hypertension are common causes of hospitalization in the elderly. Short-term postdischarge clinical outcomes regarding compliance, symptom control, readmission, functional status, and mortality rates are in need of improvement. This observational study documents the results of a home-based case-managed telemedicine (CMTM) program delivered over a 2-month period postdischarge. A population of 851, predominantly elderly (over age 60), recently discharged patients were enrolled in the program. They received a nurse visit up to 3 times/week and home telemedicine monitoring (weight, blood pressure, pulse rate, blood glucose, and oximeter recordings) on a daily basis. Patient education was provided by the nurse and reinforced through telemedicine. Compliance rates, quality of life parameters, patient satisfaction with telemedicine, and data regarding nine quality of care measures (QCM), hospital readmission, and mortality rates were documented. Patient demographics and outcomes of care were analyzed. There were 68% females and 56% African Americans. The readmission rate was 13% and mortality 2%. Treatment goals were met in 67%, patient compliance rate was 77%, and the average improvement in the nine QCM indicators was 66%. A majority of patients showed improved quality of health perception, better disease understanding, and high satisfaction rates with telemedicine. This is one of the larger observational studies in a predominantly elderly patient population enrolled in a CMTM program, to date. This model of care was well accepted by the elderly and produced excellent short-term clinical outcomes. PMID:20064067

  10. Does age at onset have clinical significance in older adults with bipolar disorder?

    PubMed Central

    Chu, David; Gildengers, Ariel G.; Houck, Patricia R.; Anderson, Stewart J.; Mulsant, Benoit H.; Reynolds, Charles F.; Kupfer, David J.

    2011-01-01

    Objective While age at onset may be useful in explaining some of the heterogeneity of bipolar disorder (BD) in large, mixed age groups, investigations to date have found few meaningful clinical differences between early versus late age at onset in older adults with BD. Methods Data were collected from sixty-one subjects aged 60 years and older, mean (SD) age 67.6 (7.0), with BD I (75%) and II (25%). Subjects were grouped by early (<40 years; n=43) versus late (≥40 years; n=18) age at onset. Early versus late onset groups were compared on psychiatric comorbidity, medical burden, and percentage of days well during study participation. Results Except for family history of major psychiatric illnesses, there were no differences between the groups on demographic or clinical variables. Patients with early and late onset experienced similar percentages of days well; however, those with early onset had slightly more percentage of days depressed than those with late onset (22% versus 13%) Conclusion Distinguishing older adults with BD by early or late age at onset has limited clinical usefulness. PMID:20082348

  11. A Different Approach of Dizziness in Older Patients: Away from the Diagnostic Dance between Patient and Physician

    PubMed Central

    Maarsingh, Otto R.; Stam, Hanneke; van der Horst, Henriëtte E.

    2014-01-01

    Although the etiology of dizziness in older patients differs significantly from that of younger patients, most guidelines on dizziness advocate the same diagnosis-oriented approach for all patients regardless of their age. However, this diagnosis-oriented approach may be insufficient for older patients presenting with dizziness in general practice, because (1) general practitioners are often not able to identify an underlying cause of dizziness, (2) general practitioners regularly identify causes of dizziness that cannot be treated, and (3) general practitioners may identify causes of dizziness for which treatment is available but not desirable. In this article, the authors present a simultaneous diagnosis- and prognosis-oriented approach for older dizzy patients. This approach may enable general practitioners to improve their care for a voluminous group of impaired older patients, even if a diagnosis is not available (yet). PMID:25593923

  12. Experimental identification of potential falls in older adult hospital patients.

    PubMed

    Cloutier, Aimee; Yang, James; Pati, Debajyoti; Valipoor, Shabboo

    2016-05-01

    Patient falls within hospitals have been identified as serious but largely preventable incidents, particularly among older adult patients. Previous literature has explored intrinsic factors associated with patient falls, but literature identifying possible extrinsic or situational factors related to falls is lacking. This study seeks to identify patient motions and activities along with associated environmental design factors in a patient bathroom and clinician zone setting that may lead to falls. A motion capture experiment was conducted in a laboratory setting on 27 subjects over the age of seventy using scripted tasks and mockups of the bathroom and clinician zone of a patient room. Data were post-processed using Cortex and Visual3D software. A potential fall was characterized by a set of criteria based on the jerk of the upper body׳s center of mass (COM). Results suggest that only motion-related factors, particularly turning, pushing, pulling, and grabbing, contribute most significantly to potential falls in the patient bathroom, whereas only pushing and pulling contribute significantly in the clinician zone. Future work includes identifying and changing precise environmental design factors associated with these motions for an updated patient room and performing motion capture experiments using the new setup. PMID:26920507

  13. [Life expectancy at older ages and alternative approach to aging measurement (the case of St. Petersburg)].

    PubMed

    Kozlov, L V; Safarova, G L; Lisenenkov, F I; Mikhaĭlova, O N

    2009-01-01

    St. Petersburg Institute of Bioregulation and Gerontology, NWB of RAMS, 3 pr. Dinamo, St. Petersburg 197110; For St. Petersburg, aging issues are of great importance as values of many aging indicators for St. Petersburg are higher than for Russia as a whole. Taper aims at analyzing the dynamics of life expectancy at older ages and comparing traditional (proportion of the elderly, average age, median age) and new (proportion of population with a remaining life expectancy 15 years or less, population average remaining years of life) aging indicators for St. Petersburg in 1990-2006.

  14. Osteoporosis management in older patients who experienced a fracture

    PubMed Central

    Oertel, Mark J; Graves, Leland; Al-Hihi, Eyad; Leonardo, Vincent; Hopkins, Christina; DeSouza, Kristin; Bhattacharya, Rajib K

    2016-01-01

    Background Fractures in older patients are common, morbid, and associated with increased risk of subsequent fractures. Inpatient and outpatient management and treatment of fractures can be costly. With more emphasis placed on quality care for Medicare beneficiaries, we studied if patients were receiving proper screening for osteoporosis and treatment after diagnosis of fracture. This study aims to determine if adequate screening and treatment for osteoporosis occurs in the postfracture period. Methods A retrospective analysis of Medicare beneficiaries aged 67 years or older was gathered from a single institution in both inpatient and outpatient visits. Based on International Classification of Diseases ninth revision codes, primary diagnosis of fractures of neck and trunk, upper limb, and lower limb were obtained in addition to current procedural terminology codes for fracture procedures. We studied patients who had been screened for osteoporosis with a bone mineral study or received osteoporosis treatment after their fracture. Results Medicare beneficiaries totaling 1,375 patients were determined to have an inclusion fracture between June 1, 2013 and November 30, 2014. At the time of our analysis on December 1, 2014, 1,219 patients were living and included in the analysis. Of these patients, 256 (21.0%) either received osteoporosis testing with bone mineral density or received treatment for osteoporosis. On sex breakdown, 208/820 (25.4%) females received proper evaluation or treatment of osteoporosis in comparison to 48/399 (12.0%) males. This is in comparison to the Centers for Medicare and Medicaid Services’ national average of 19.1% for osteoporosis management in females. Conclusion A minority of studied patients received evaluation or treatment for osteoporosis after their fracture. Postfracture investigation and treatment for osteoporosis in Medicare beneficiaries is inadequate. If improved, Medicare costs could be reduced by prevention of future fractures

  15. Older patients with breast cancer: is there bias in the treatment they receive?

    PubMed Central

    van de Water, Willemien

    2012-01-01

    Breast cancer is the most frequent malignant tumor in women worldwide and as breast cancer incidence increases with increasing age, over 40% of new cases are diagnosed in women older than 65 years of age. However, older patients are not treated to the same extent as younger patients and increasing age at diagnosis predicts deviation from guidelines for all treatment modalities. Evidence-based medicine in older patients is lacking as they are usually excluded from clinical trials often because of existing comorbidities and limited life expectancy. Accordingly, there is a higher competing risk of death from other causes than breast cancer compared with younger patients and this may have led to the false interpretation that prognosis of breast cancer in older patients is relatively good. However, every treatment modality should be evaluated during treatment decision making. Multimodal therapy should not be routinely withheld as data show that disease-specific mortality increases with age, probably due to undertreatment. Prognostic markers, fitness and comorbidities rather than chronological age should determine optimal, individualized therapy. It is recommended that treatment decisions should be discussed in a multidisciplinary setting, ideally in combination with any form of geriatric assessment, to improve breast cancer outcome in the older population. PMID:23118807

  16. Inflammatory pancreatic diseases in older patients: recognition and management.

    PubMed

    Uomo, Generoso

    2003-01-01

    The aging process influences and modifies the clinical picture and treatment modalities of inflammatory pancreatic diseases in elderly patients. The two major categories of inflammatory exocrine pancreatic diseases seen in the elderly are acute pancreatitis (AP) and chronic pancreatitis (CP). In elderly patients with AP, the presence of concomitant diseases affecting renal, hepatic and cardiopulmonary function make the early clinical assessment of the severity of AP inaccurate at the time of admission to hospital. In addition, the classical multifactorial scoring system routinely utilised in clinical practice to determine the severity of AP may overscore elderly patients because increasing age is associated with more points. Contrast-enhanced computed tomography is particularly useful in assessing the severity of AP and is required in all patients suspected with severe AP. It should be repeated after a certain time period to monitor the disease. The most important aspect of the management of elderly patients with severe AP is the prevention and treatment of systemic and local complications. Treatment of AP should address the removal of aetiological factor(s) and support of organ systems and hydroelectrolytic/caloric balance; specific treatments (antiproteases, antibacterials) should also be administered to patients with severe AP. Surgery is indicated mainly when infection occurs following pancreatic necrosis and/or fluid collection. However, in selected patients with a high anaesthetic risk, alternative, less invasive drainage options (percutaneous, endoscopic) should be considered. CP rarely occurs in older age, and it should be suspected based on clinical findings. The greatest challenge is the differentiation between CP and pancreatic cancer. Treatment of CP in the elderly should be directed at controlling the symptoms, by management of diabetes and exocrine insufficiency because pain and complications are rare in elderly patients with CP. Compliance with

  17. Inflammatory pancreatic diseases in older patients: recognition and management.

    PubMed

    Uomo, Generoso

    2003-01-01

    The aging process influences and modifies the clinical picture and treatment modalities of inflammatory pancreatic diseases in elderly patients. The two major categories of inflammatory exocrine pancreatic diseases seen in the elderly are acute pancreatitis (AP) and chronic pancreatitis (CP). In elderly patients with AP, the presence of concomitant diseases affecting renal, hepatic and cardiopulmonary function make the early clinical assessment of the severity of AP inaccurate at the time of admission to hospital. In addition, the classical multifactorial scoring system routinely utilised in clinical practice to determine the severity of AP may overscore elderly patients because increasing age is associated with more points. Contrast-enhanced computed tomography is particularly useful in assessing the severity of AP and is required in all patients suspected with severe AP. It should be repeated after a certain time period to monitor the disease. The most important aspect of the management of elderly patients with severe AP is the prevention and treatment of systemic and local complications. Treatment of AP should address the removal of aetiological factor(s) and support of organ systems and hydroelectrolytic/caloric balance; specific treatments (antiproteases, antibacterials) should also be administered to patients with severe AP. Surgery is indicated mainly when infection occurs following pancreatic necrosis and/or fluid collection. However, in selected patients with a high anaesthetic risk, alternative, less invasive drainage options (percutaneous, endoscopic) should be considered. CP rarely occurs in older age, and it should be suspected based on clinical findings. The greatest challenge is the differentiation between CP and pancreatic cancer. Treatment of CP in the elderly should be directed at controlling the symptoms, by management of diabetes and exocrine insufficiency because pain and complications are rare in elderly patients with CP. Compliance with

  18. 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…

  19. Viewing Our Aged Selves: Age Progression Simulations Increase Young Adults' Aging Anxiety and Negative Stereotypes of Older Adults.

    PubMed

    Rittenour, Christine E; Cohen, Elizabeth L

    2016-04-01

    This experiment tests the effect of an old-age progression simulation on young adults' (N = 139) reported aging anxiety and perceptions about older adults as a social group. College students were randomly assigned to one of three conditions: self-aged simulation, stranger-aged simulation, or a control group. Compared with the control group, groups exposed to an age progression experienced more negative affect, and individuals in the self-aged condition reported greater aging anxiety. In accordance with stereotype activation theorizing, the self-age simulation group also perceived older adults as less competent and expressed more pity and less envy for older adults. Compared to the stranger-aged group, participants who observed their own age progression were also the more likely to deny the authenticity of their transformed image.These findings highlight potential negative social and psychological consequences of using age simulations to affect positive health outcomes, and they shed light on how virtual experiences can affect stereotyping of older adults. PMID:27076488

  20. Prevalence and Predictors of Adverse Events in Older Surgical Patients: Impact of the Present on Admission Indicator

    ERIC Educational Resources Information Center

    Kim, Hongsoo; Capezuti, Elizabeth; Kovner, Christine; Zhao, Zhonglin; Boockvar, Kenneth

    2010-01-01

    Purpose of the Study: To examine the effects of the present on admission (POA) indicator on the prevalence of and factors associated with postsurgical adverse events in older patients. Design and Methods: This is a secondary data analysis of 82,898 surgical patients aged 65 years or older in 252 acute care hospitals in California in 2004. Four…

  1. The problems of anticholinergic adverse effects in older patients.

    PubMed

    Feinberg, M

    1993-01-01

    The old saying 'red as a beet, dry as a bone, blind as a bat, hot as a hare, mad as a hatter' is often quoted when describing the autonomic effects of drugs that block the muscarinic cholinergic system. These effects may be subtle or dramatic, yet can be overlooked or discounted as a natural consequence of old age. Elderly patients can be particularly sensitive to the anticholinergic action of drugs because of physiological and pathophysiological changes that often accompany the aging process. The use of multiple drugs, a common finding in older patients, may result in pharmacodynamic and pharmacokinetic drug interactions that heighten anticholinergic effects. While the classic anticholinergic problems of decreased secretions, slowed gastrointestinal motility, blurred vision, increased heart rate, heat intolerance, sedation and possibly mild confusion, may be uncomfortable for a younger patient in relatively good health, these effects can be disastrous for older patients. Even the most common peripheral anticholinergic complaint of dry mouth can reduce the ability to communicate, predispose to malnutrition, promote mucosal damage, denture misfit or dental caries, and increase the risk of serious respiratory infection secondary to loss of antimicrobial activity of saliva. Mydriasis and the inability to accommodate will impair near vision and may precipitate narrow angle glaucoma in predisposed patients, but less obviously could lead to an increased risk of accidents, including falls. Somatic complaints of constipation and urinary hesitancy, could, in the presence of anticholinergic challenge, result in faecal impaction or urinary retention. Cardiac effects may be poorly tolerated. Increases in heart rate may precipitate or worsen angina. Finally, thermoregulatory impairment induced by anticholinergics, which block the ability to sweat, may lead to life threatening hyperthermia. Central anticholinergic effects range from sedation, mild confusion and inability to

  2. Body dissatisfaction among middle-aged and older women.

    PubMed

    Marshall, Catherine; Lengyel, Christina; Utioh, Alphonsus

    2012-01-01

    With the growing pervasiveness of mass media, individuals of all ages and both sexes are bombarded with images that glorify youthfulness, messages that tie self-worth to thinness, and products that promise youth and beauty forever. Aging women are vulnerable to these societal messages and experience strong pressures to maintain their youth and thinness. As the physiological changes that accompany normal aging move these women farther from the "ideal" image, body dissatisfaction may increase. These women are confronted with the impossible task of trying to defy the natural process of aging through a variety of means, including fashion, cosmetics, selective surgeries, and personal food choices. The resulting body image issues, weight preoccupation, and eating disturbances can lead to voluntary food restriction, depression, social withdrawal, lower self-esteem, and disordered eating, all of which can have a negative impact on quality of life and nutritional status. In this review we explore existing research on body dissatisfaction among middle-aged (30 to 60) and older (over 60) women, discuss the prevalence of body dissatisfaction, its predisposing risk factors, and the resulting eating and body maintenance behaviours, and examine implications for dietetic practice.

  3. Body dissatisfaction among middle-aged and older women.

    PubMed

    Marshall, Catherine; Lengyel, Christina; Utioh, Alphonsus

    2012-01-01

    With the growing pervasiveness of mass media, individuals of all ages and both sexes are bombarded with images that glorify youthfulness, messages that tie self-worth to thinness, and products that promise youth and beauty forever. Aging women are vulnerable to these societal messages and experience strong pressures to maintain their youth and thinness. As the physiological changes that accompany normal aging move these women farther from the "ideal" image, body dissatisfaction may increase. These women are confronted with the impossible task of trying to defy the natural process of aging through a variety of means, including fashion, cosmetics, selective surgeries, and personal food choices. The resulting body image issues, weight preoccupation, and eating disturbances can lead to voluntary food restriction, depression, social withdrawal, lower self-esteem, and disordered eating, all of which can have a negative impact on quality of life and nutritional status. In this review we explore existing research on body dissatisfaction among middle-aged (30 to 60) and older (over 60) women, discuss the prevalence of body dissatisfaction, its predisposing risk factors, and the resulting eating and body maintenance behaviours, and examine implications for dietetic practice. PMID:22668843

  4. Office management of urinary incontinence among older patients

    PubMed Central

    Frank, Christopher; Szlanta, Agata

    2010-01-01

    OBJECTIVE To provide family physicians with a guide to office management of urinary incontinence (UI) among older patients. SOURCES OF INFORMATION Ovid MEDLINE and the Cochrane database were searched using the terms urinary incontinence, stress incontinence, overactive bladder, urge incontinence, elderly, and geriatrics. MAIN MESSAGE A variety of conditions affecting the nervous system and the lower urinary tract can affect bladder function and UI. Among older patients the effects of decreased cognition and impaired mobility can be substantial, and environmental barriers can play a role. When managing older patients with UI, emphasis on treating concurrent conditions, optimizing medications, and working on lifestyle and behavioural factors is at least as important as pharmacologic treatment. Medications are relevant, but the potential for adverse effects increases among older patients. CONCLUSION Various resources are available to support family physicians in office management of UI, and family physicians can improve symptoms and the quality of patients’ lives by screening for and helping patients to manage incontinence. PMID:21075990

  5. Management and outcomes of localized esophageal and gastroesophageal junction cancer in older patients

    PubMed Central

    Qu, X.; Biagi, J.; Banashkevich, A.; Mercer, C.D.; Tremblay, L.; Mahmud, A.

    2015-01-01

    Background Older patients are commonly excluded from clinical trials in esophageal and gastroesophageal junction (gej) cancer. High-level evidence to guide management in this group is lacking. In the present study, we compared outcomes and described tolerance for curative- and noncurative-intent treatments among patients 70 years of age and older. Methods We retrospectively reviewed all patients 70 years of age and older diagnosed with localized esophageal and gej cancer at our centre between 2005 and 2012. Results The 74 patients identified had a median age of 77 years. Of those patients, 62% received curative-intent treatment, consisting mostly of concomitant chemoradiation therapy (n = 43, 93%). Median overall survival for patients receiving curative-intent treatment was 18.6 months [95% confidence interval (ci): 13.0 to 28.0 months], with 23% being long-term survivors (95% ci: 11.3% to 36.7%). In contrast, patients receiving noncurative-intent treatment had a median overall survival of 8.8 months (95% ci: 6.7 to 11.9 months), with none being long-term survivors (p < 0.0001). Improvement of dysphagia was seen after curative (81%) or palliative radiotherapy (78%) in symptomatic patients, and toxicities were manageable. The odds of not receiving curative treatment was higher by a factor of 8.5 among patients 80 years of age or older compared with those 70–79 years of age (95% ci: 2.5 to 28.7). Conclusions In managing older patients with esophageal and gej cancer, curative-intent treatment (compared with noncurative-intent treatment) leads to a significant survival benefit with a reasonable toxicity profile. Informed counselling of patients and their families about a curative treatment approach and efforts to increase awareness among oncology care providers are suggested. PMID:26715880

  6. Impaired recovery of strength in older patients after major abdominal surgery.

    PubMed Central

    Watters, J M; Clancey, S M; Moulton, S B; Briere, K M; Zhu, J M

    1993-01-01

    OBJECTIVE: This study compared changes in muscle strength after major elective abdominal surgery in young and old patients, and related these changes to body composition and nitrogen balance. SUMMARY BACKGROUND DATA: The breakdown of muscle protein, erosion of lean tissue, and negative nitrogen balance are characteristic metabolic responses to surgical illness. With a substantial loss of muscle mass typical of advancing age, the authors postulated that older patients would be weaker during acute surgical illness and less able to maintain muscle function and meet metabolic demands. METHODS: Active, community-dwelling individuals undergoing major abdominal procedures who were 70 years of age or older or 50 years of age or younger were studied. Total body water (TBW) was determined preoperatively by deuterium oxide dilution. Maximal voluntary handgrip, respiratory muscle strength, and visual analog pain scores were measured preoperatively and on postoperative days 2, 4, and 6. All urine was collected postoperatively for 7 days for determination of total nitrogen, creatinine, and cortisol. RESULTS: The young (age, 36 +/- 9 years [mean +/- standard deviation]; n = 20) and old groups (age, 77 +/- 5 years; n = 20) were similar regarding weight, sex distribution, nutritional status, surgical procedures and anesthesia, and postoperative urine cortisol values. Age group, time after operation, and interaction effects were significant for each strength variable (all p < 0.005 by analysis of variance). Older patients had lower preoperative strength (29% to 41%) and mean 24-hour urine creatinine (27%). Postoperative strength was decreased most markedly on postoperative day 2, with similar proportional changes in the two age groups but lower absolute levels in the older patients. The rate of recovery of strength was substantially less rapid and complete in older patients. Older patients had less postoperative pain and received much less parenteral narcotic than younger patients

  7. Relationship between perceived sleep and polysomnography in older adult patients

    PubMed Central

    dos Santos Silva, Mayra; Bazzana, Caroline Moreira; de Souza, Altay Lino; Ramos, Luiz Roberto; Tufik, Sergio; Lucchesi, Lígia M.; Lopes, Guiomar Silva

    2015-01-01

    Background and aims Aging is a multifactorial process that elicits changes in the duration and quality of sleep. Polysomnography is considered to be the standard examination for the analysis of sleep and consists of the simultaneous recording of selected physiological variables during sleep. Objective The objective of this study was to use polysomnography to compare sleep reported by senior citizens. Methods We selected 40 patients, both male and female, with ages ranging from 64 to 89 years from the Center for the Study of Aging at the Federal University of São Paulo. Patients answered questions about sleep on the Comprehensive Geriatric Assessment and underwent polysomnography. Results The results were compared, and agreement between perceived sleep and polysomnography was found in several areas. There was an association between difficulty sleeping and sleep onset latency (p=0.015), waking up at night with sleep onset latency (p=0.005), total sleep time with daytime sleepiness (0.005) and snoring (0.027), sleep efficiency with sleepiness (0.004), snoring (0.033) and pause in breathing (p=0.024), awakenings with snoring (p=0.012) and sleep apnea with pauses in breathing (p=0.001). Conclusion These results suggest that the older adult population have a good perception of their sleep. The questionnaires aimed at this population should be used as an alternative to polysomnography. PMID:26483948

  8. "The Wisdom of Age": Perspectives on Aging and Growth among Lesbian Older Adults.

    PubMed

    Putney, Jennifer M; Leafmeeker, Rebecca R; Hebert, Nicholas

    2016-04-01

    Older lesbian-identified women are a health disparate yet resilient population about whom knowledge is limited and emerging. Among the areas in need of research are older lesbians' experiences of later life and stress-related growth. This article presents the findings from a qualitative study that investigated older lesbians' experiences of adversity and adaptation as they age. In-depth, exploratory interviews were conducted with 12 lesbian-identified women who were between the ages of 65-80. This study applied grounded theory methodology to identify respondents sources of stress and fear, their strengths and coping strategies and how those relate to each other and to their growth in later life. We advance a model of adaptive change that shows how spirituality, social support, and resistance to cultural norms help older lesbian adults cope with loss, illness, and discrimination and develop wisdom in later life. Knowledgeable practitioners can help older lesbian women identify and maintain sources of social support, explore spirituality, and facilitate continuous growth through the end of life. Social workers can advocate for services that are welcoming and affirmative so as to reduce fears of isolation and dependence associated with health decline. PMID:27267208

  9. "The Wisdom of Age": Perspectives on Aging and Growth among Lesbian Older Adults.

    PubMed

    Putney, Jennifer M; Leafmeeker, Rebecca R; Hebert, Nicholas

    2016-04-01

    Older lesbian-identified women are a health disparate yet resilient population about whom knowledge is limited and emerging. Among the areas in need of research are older lesbians' experiences of later life and stress-related growth. This article presents the findings from a qualitative study that investigated older lesbians' experiences of adversity and adaptation as they age. In-depth, exploratory interviews were conducted with 12 lesbian-identified women who were between the ages of 65-80. This study applied grounded theory methodology to identify respondents sources of stress and fear, their strengths and coping strategies and how those relate to each other and to their growth in later life. We advance a model of adaptive change that shows how spirituality, social support, and resistance to cultural norms help older lesbian adults cope with loss, illness, and discrimination and develop wisdom in later life. Knowledgeable practitioners can help older lesbian women identify and maintain sources of social support, explore spirituality, and facilitate continuous growth through the end of life. Social workers can advocate for services that are welcoming and affirmative so as to reduce fears of isolation and dependence associated with health decline.

  10. Considerations and controversies in the management of older patients with advanced cancer.

    PubMed

    Mohile, Supriya Gupta; Klepin, Heidi D; Rao, Arati V

    2012-01-01

    The incidence of cancer increases with age. Oncologists need to be adept at assessing physiologic and functional capacity in older patients in order to provide safe and efficacious cancer treatment. Assessment of underlying health status is especially important for older patients with advanced cancer, for whom the benefits of treatment may be low and the toxicity of treatment high. The comprehensive geriatric assessment (CGA) is the criterion standard for evaluation of the older patient. The combined data from the CGA can be used to stratify patients into categories to better predict risk for chemotherapy toxicity as well as overall outcomes. The CGA can also be used to identify and follow-up on possible functional consequences from treatment. A variety of screening tools might be useful in the oncology practice setting to identify patients who may benefit from further testing and intervention. In this chapter, we discuss how the principles of geriatrics can help improve the clinical care of older adults with advanced cancer. Specifically, we discuss assessing tolerance for treatment, options for chemotherapy scheduling and dosing for older patients with advanced cancer, and management of under-recognized symptoms in older patients with cancer.

  11. Naturalistic speeding data: Drivers aged 75 years and older.

    PubMed

    Chevalier, Anna; Chevalier, Aran John; Clarke, Elizabeth; Wall, John; Coxon, Kristy; Brown, Julie; Ivers, Rebecca; Keay, Lisa

    2016-09-01

    The data presented in this article are related to the research article entitled "A longitudinal investigation of the predictors of older drivers׳ speeding behavior" (Chevalier et al., 2016) [1], wherein these speed events were used to investigate older drivers speeding behavior and the influence of cognition, vision, functional decline, and self-reported citations and crashes on speeding behavior over a year of driving. Naturalistic speeding behavior data were collected for up to 52 weeks from volunteer drivers aged 75-94 years (median 80 years, 52% male) living in the suburban outskirts of Sydney. Driving data were collected using an in-vehicle monitoring device. Global Positioning System (GPS) data were recorded at each second and determined driving speed through triangulation of satellite collected location data. Driving speed data were linked with mapped speed zone data based on a service-provider database. To measure speeding behavior, speed events were defined as driving 1 km/h or more, with a 3% tolerance, above a single speed limit, averaged over 30 s. The data contains a row per 124,374 speed events. This article contains information about data processing and quality control. PMID:27294182

  12. Naturalistic speeding data: Drivers aged 75 years and older.

    PubMed

    Chevalier, Anna; Chevalier, Aran John; Clarke, Elizabeth; Wall, John; Coxon, Kristy; Brown, Julie; Ivers, Rebecca; Keay, Lisa

    2016-09-01

    The data presented in this article are related to the research article entitled "A longitudinal investigation of the predictors of older drivers׳ speeding behavior" (Chevalier et al., 2016) [1], wherein these speed events were used to investigate older drivers speeding behavior and the influence of cognition, vision, functional decline, and self-reported citations and crashes on speeding behavior over a year of driving. Naturalistic speeding behavior data were collected for up to 52 weeks from volunteer drivers aged 75-94 years (median 80 years, 52% male) living in the suburban outskirts of Sydney. Driving data were collected using an in-vehicle monitoring device. Global Positioning System (GPS) data were recorded at each second and determined driving speed through triangulation of satellite collected location data. Driving speed data were linked with mapped speed zone data based on a service-provider database. To measure speeding behavior, speed events were defined as driving 1 km/h or more, with a 3% tolerance, above a single speed limit, averaged over 30 s. The data contains a row per 124,374 speed events. This article contains information about data processing and quality control.

  13. Self-perceived Age and Attitudes Toward Marketing of Older Consumers in China.

    PubMed

    Ying, Bin; Yao, Rui

    2010-09-01

    Understanding consumer psychological characteristics and their impact on consumer behavior is an important foundation for business marketing strategies. Self-perceived age has a great impact on older consumers' behavior. This article defines the gray market in China, investigates the factors that affect the differences between older consumers' self-perceived age and life age, and analyzes the influence of self-perceived age on older Chinese consumers' behavior. In this study, 1,120 older consumers were randomly selected from six cities in China. Findings show that over half of the respondents feel younger than their actual life age. Related marketing strategies are discussed.

  14. Bone Turnover Does Not Reflect Skeletal Aging in Older Hispanic Men with Type 2 Diabetes

    NASA Technical Reports Server (NTRS)

    Rianon, N.; McCormick, J.; Ambrose, C.; Smith, S. M.; Fisher-Hoch, S.

    2016-01-01

    The paradox of fragility fracture in the presence of non-osteoporotic bone mineral density in older patients with type 2 diabetes mellitus (DM2) makes it difficult to clinically predict fracture in this vulnerable group. Serum osteocalcin (OC), a marker of bone turnover, increases with normal skeletal aging indicating risk of fracture. However, OC has been reported to be lower in patients with DM2. An inverse association between higher glycated hemoglobin levels (HbA1c) and lower serum OC in older DM2 patients triggered discussions encouraging further investigation. A key question to be answered is whether changes in glucose metabolism is responsible for bone metabolic changes, ultimately leading to increased risk of fragility fractures in DM2 patients. While these studies were conducted among Caucasian and Asian populations, this has not been studied in Hispanic populations who suffer from a higher prevalence of DM2. The Cameron County Hispanic Cohort (CCHC) in Texas is a homogeneous Hispanic cohort known to have high prevalence of DM2 (30%). Our preliminary data from this cohort reported OC levels lower than the suggested threshold for fragility fracture in post-menopausal women. We further investigated whether bone turnover in older CCHC adults with DM2 show a normal pattern of skeletal aging. Samples and data were obtained from a nested cohort of 68 (21 men and 47 women) Hispanic older adults (=50 years) who had a diagnosis of DM2. Given high prevalence of uncontrolled DM2 in this cohort, we divided population into two groups: i) poor DM2 control with HbA1c level =8 (48% men and 38% women) and ii) good DM2 control with HbA1c level <8). A crosssectional analysis documented associations between serum OC and age adjusted HbA1c levels. There was no direct association between age and OC concentrations in our study. Higher HbA1c was associated with lower serum OC in men (odds ratio -6.5, 95% confidence interval -12.7 to - 0.3, p < 0.04). No significant associations

  15. Non-random aneuploidy specifies subgroups of pilocytic astrocytoma and correlates with older age

    PubMed Central

    Khuong-Quang, Dong-Anh; Bechet, Denise; Gayden, Tenzin; Kool, Marcel; De Jay, Nicolas; Jacob, Karine; Gerges, Noha; Hutter, Barbara; Şeker-Cin, Huriye; Witt, Hendrik; Montpetit, Alexandre; Brunet, Sébastien; Lepage, Pierre; Bourret, Geneviève; Klekner, Almos; Bognár, László; Hauser, Peter; Garami, Miklós; Farmer, Jean-Pierre; Montes, Jose-Luis; Atkinson, Jeffrey; Lambert, Sally; Kwan, Tony; Korshunov, Andrey; Tabori, Uri; Collins, V. Peter; Albrecht, Steffen; Faury, Damien; Pfister, Stefan M.; Paulus, Werner; Hasselblatt, Martin; Jones, David T.W.; Jabado, Nada

    2015-01-01

    Pilocytic astrocytoma (PA) is the most common brain tumor in children but is rare in adults, and hence poorly studied in this age group. We investigated 222 PA and report increased aneuploidy in older patients. Aneuploid genomes were identified in 45% of adult compared with 17% of pediatric PA. Gains were non-random, favoring chromosomes 5, 7, 6 and 11 in order of frequency, and preferentially affecting non-cerebellar PA and tumors with BRAF V600E mutations and not with KIAA1549-BRAF fusions or FGFR1 mutations. Aneuploid PA differentially expressed genes involved in CNS development, the unfolded protein response, and regulators of genomic stability and the cell cycle (MDM2, PLK2),whose correlated programs were overexpressed specifically in aneuploid PA compared to other glial tumors. Thus, convergence of pathways affecting the cell cycle and genomic stability may favor aneuploidy in PA, possibly representing an additional molecular driver in older patients with this brain tumor. PMID:26378811

  16. Older patient satisfaction with communication during an initial medical encounter.

    PubMed

    Greene, M G; Adelman, R D; Friedmann, E; Charon, R

    1994-05-01

    There has been extensive research on the factors associated with patient satisfaction with communication during medical encounters, however, little attention has been paid to satisfaction among subgroups of patients, including the elderly. It is inappropriate to assume that all patients have the same physician-patient relationship needs, and thus, they will all be satisfied with the same communication approaches during medical visits. In this study, we examine the interactional correlates of older patient satisfaction with an initial visit with a general internist. A multidisciplinary team composed of social scientists and physicians used the Multi-dimensional Interaction Analysis system to code audiotapes. Patients and physicians completed post-visit satisfaction questionnaires. Older patient satisfaction was positively correlated with the following variables: physician questioning and supportiveness on patient-raised topics; patient information-giving on patient-raised topics; the length of the visit; the physician's use of questions worded in the negative; shared laughter between the physician and the patient; and physician satisfaction. These findings suggest that older patients prefer encounters in which: (1) there is physician supportiveness and shared laughter; (2) they are questioned about and given an opportunity to provide information on their own agenda items; and (3) physicians provide some structure for the first meeting through their use of questions worded in the negative. The authors caution that although this sample of older patients appears to be satisfied with a communication style usually considered characteristic of the traditional model of the physician-patient relationship (i.e. a warm interpersonal style and physician-generated structure for the visit), older patients in other settings and future cohorts of elderly patients may prefer other communication approaches. It is also suggested that aspects of communication which provide

  17. Aging and older adults in three Roman Catholic magazines: Successful aging and the Third and Fourth Ages reframed.

    PubMed

    Sawchuk, Dana

    2015-12-01

    This article is a qualitative content analysis of how aging and older adults are represented in the articles of three Roman Catholic magazines in the United States: America, Commonweal, and U.S. Catholic. The findings suggest that, as in mainstream secular magazines, the concept of successful aging is common in portrayals of older adults in the Third Age. Distinctive in Catholic magazine portrayals of successful aging is an emphasis on meaningful activity and on the wisdom that is gained and transmitted in this stage of life. In contrast to the lack of attention to Fourth Age decline in mainstream magazines, in the Catholic publications the difficult features of such deterioration are acknowledged but are also reframed as potential sources of value. The theoretical implications of these more complex faith-based renderings of the Third and Fourth Ages are briefly explored.

  18. Understanding the Experience of Age-Related Vestibular Loss in Older Individuals: A Qualitative Study

    PubMed Central

    Li, Carol; Bridges, John F. P.; Agrawal, Yuri

    2016-01-01

    Background Inner ear balance (or vestibular) function declines with age and is associated with decreased mobility and an increased risk of falls in older individuals. We sought to understand the lived experience of older adults with vestibular loss in order to improve care in this population. Methods Qualitative data were derived from semi-structured interviews of individuals aged 65 years or older presenting to the Balance and Falls Prevention Clinic from February 1, 2014 to March 30, 2015 for evaluation of age-related vestibular loss. Transcripts were analyzed using interpretive phenomenological analysis. We created a taxonomy of overarching superordinate themes based on the World Health Organization's International Classification of Functioning, Disability, and Health (ICF) Framework, and classified key dimensions within each of these themes. Results Sixteen interviews were conducted with individuals (mean age 76.0 years, 75 % female) with age-related vestibular loss. The three superordinate themes and associated key dimensions were (1) body impairment (including depression, fatigue, fear/anxiety, and problems with concentrating and memory); (2) activity limitation and participation restriction (isolation, needing to stop in the middle of activities, reduced participation relative to expectations, reduced ability to drive or travel, and problems with bending/looking up, standing, and walking); and (3) environmental influences (needing help with daily activities). All participants reported difficulty walking. Conclusions Older adults report that vestibular loss impacts their body functioning and restricts their participation in activities. The specific key dimensions uncovered by this qualitative study can be used to evaluate care from the patient's perspective. PMID:26739817

  19. Attitudes toward Younger and Older Adults: The German Aging Semantic Differential

    ERIC Educational Resources Information Center

    Gluth, Sebastian; Ebner, Natalie C.; Schmiedek, Florian

    2010-01-01

    The present study used the German Aging Semantic Differential (ASD) to assess attitudes toward younger and older adults in a heterogeneous sample of n = 151 younger and n = 143 older adults. The questionnaire was administered in two versions, one referring to the evaluation of younger adults, the other to the evaluation of older adults.…

  20. 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…

  1. Crisis Model for Older Adults: Special Considerations for an Aging Population

    ERIC Educational Resources Information Center

    Jungers, Christin M.; Slagel, Leslie

    2009-01-01

    As the U.S. population ages, counselors must begin structuring their interactions to meet the unique needs of older adults, especially in the area of crisis intervention. The purposes of this article are to draw attention to the rapidly growing, often disregarded older population and to introduce the Crisis Model for Older Adults (CM-OA), an…

  2. Retrieval of famous names on a Rebus Riddle task by middle-aged and older subjects.

    PubMed

    Marshall, R C; Morelli, C A; Calise, G E; Phillips, D S

    1997-12-01

    This study compared the performances of 20 middle-aged and 20 older subjects on a Rebus Riddle task that required they retrieve the names of famous persons. Older subjects solved significantly more riddles and responded to prompts designed to aid riddle-solving efforts with significantly greater success than middle-aged subjects. Older subjects also had nonsignificantly faster riddle-solving times than middle-aged subjects. Similar riddles were difficult or easy for both groups. Superior performance of the older group appeared to be related to the age of the subject at the time the persons in the riddles had become famous.

  3. Profiles of successful aging in middle-aged and older adult married couples.

    PubMed

    Ko, Kelly J; Berg, Cynthia A; Butner, Jonathan; Uchino, Bert N; Smith, Timothy W

    2007-12-01

    The study identified coupled profiles of successful aging in middle-aged (n = 139; wives, M = 43.8 years old; husbands, M = 45.6 years old) and older adult married couples (n = 148; wives, M = 62.0 years old; husbands, M = 64.4 years old). Latent profile analysis was applied to variables reflecting the domains of cognition, physical health, personality, and social support. A 2-profile solution and a 4-profile solution were interpreted. Both solutions indicated that a large group of couples scored favorably across domains of successful aging. A small group of largely middle-aged couples who were experiencing extreme marital distress was identified. Unevenness across domains was identified, in that some groups involved a disassociation between marital satisfaction and health outcomes. Spouses were substantially similar in the pattern of their profile of aging. Older adults were not always associated with less favorable profiles. Profiles of successful aging did discriminate on external measures of well-being. The results point to the value of a multidimensional notion of successful aging in couples across the life span.

  4. Obesity, job satisfaction and disability at older ages in Europe.

    PubMed

    Pagan, Ricardo; de Haro, Carmen Ordóñez; Sánchez, Carlos Rivas

    2016-03-01

    This study investigates the interaction between obesity and disability and its impact on the levels of job satisfaction reported by older workers (aged 50-64) in ten European countries (Denmark, Sweden, Austria, Belgium, France, Germany, The Netherlands, Switzerland, Italy and Spain). Using longitudinal data from the Survey of Health, Ageing and Retirement in Europe for the years 2004, 2007 and 2011, we estimate a job satisfaction equation which includes a set of explanatory variables measuring worker's obesity and disability status (non-disabled, non-limited disabled, and limited disabled). The results show that, after controlling for other variables, obese workers are more likely to be satisfied with their jobs as compared to those workers with normal weight (0.066 points). In addition, being limited disabled or having poor health contribute to reducing (by 0.082 and 0.172 points, respectively) this positive effect of being obese on job satisfaction. However, we do not find any differential effect of obesity on job satisfaction by disability status, except for those underweight individuals who are not limited in their daily activities. Overall, these findings support the hypothesis of lower expectations about jobs for obese workers, especially if they also have poor health. PMID:26656204

  5. Obesity, job satisfaction and disability at older ages in Europe.

    PubMed

    Pagan, Ricardo; de Haro, Carmen Ordóñez; Sánchez, Carlos Rivas

    2016-03-01

    This study investigates the interaction between obesity and disability and its impact on the levels of job satisfaction reported by older workers (aged 50-64) in ten European countries (Denmark, Sweden, Austria, Belgium, France, Germany, The Netherlands, Switzerland, Italy and Spain). Using longitudinal data from the Survey of Health, Ageing and Retirement in Europe for the years 2004, 2007 and 2011, we estimate a job satisfaction equation which includes a set of explanatory variables measuring worker's obesity and disability status (non-disabled, non-limited disabled, and limited disabled). The results show that, after controlling for other variables, obese workers are more likely to be satisfied with their jobs as compared to those workers with normal weight (0.066 points). In addition, being limited disabled or having poor health contribute to reducing (by 0.082 and 0.172 points, respectively) this positive effect of being obese on job satisfaction. However, we do not find any differential effect of obesity on job satisfaction by disability status, except for those underweight individuals who are not limited in their daily activities. Overall, these findings support the hypothesis of lower expectations about jobs for obese workers, especially if they also have poor health.

  6. Young Cervical Cancer Patients May Be More Responsive than Older Patients to Neoadjuvant Chemotherapy Followed by Radical Surgery

    PubMed Central

    Huang, Kecheng; Jia, Yao; Tang, Fangxu; Sun, Haiying; Zhang, Yuan; Zhang, Qinghua; Ma, Ding; Li, Shuang

    2016-01-01

    Objective To evaluate the effects of age and the clinical response to neoadjuvant chemotherapy (NACT) in patients with cervical cancer who received neoadjuvant chemotherapy followed by radical surgery. Methods A total of 1,014 patients with advanced cervical cancer who received NACT followed by radical surgery were retrospectively selected. Patients were divided into young (aged ≤35 years, n = 177) and older (aged >35 years, n = 837) groups. We compared the short-term responses and survival rates between the groups. The five-year disease-free survival (DFS) and overall survival (OS) rates were stratified by age, NACT response, and FIGO stage. Results The overall response rate was 86.8% in the young group and 80.9% in the older group. The young patients had an earlier FIGO stage (P<0.001), a higher rate of adenocarcinoma (P = 0.022), and more lymph node metastasis (P = 0.033) than the older patients. The presence of adenocarcinoma as the histological type (P = 0.024) and positive lymph node metastasis (P<0.001) were identified as independent risk factors for survival. When stratified by age and clinical response, young patients with no response to NACT had a worse clinicopathological condition compared with the other subgroups. Compared with non-responders, responders to NACT had a higher five-year DFS rate (80.1% versus 71.8%; P = 0.019) and OS rate (82.6% versus 71.8%; P = 0.003) among the young patients but not among the older patients. Conclusions Responders to NACT aged 35 years or younger benefitted the most from NACT, while the young non-responders benefitted the least. Age might represent an important factor to consider when performing NACT in patients with cervical cancer. PMID:26901776

  7. Psychiatric Co-occurring Symptoms and Disorders in Young, Middle-Aged, and Older Adults with Autism Spectrum Disorder.

    PubMed

    Lever, Anne G; Geurts, Hilde M

    2016-06-01

    Although psychiatric problems are less prevalent in old age within the general population, it is largely unknown whether this extends to individuals with autism spectrum disorders (ASD). We examined psychiatric symptoms and disorders in young, middle-aged, and older adults with and without ASD (Nmax = 344, age 19-79 years, IQ > 80). Albeit comparable to other psychiatric patients, levels of symptoms and psychological distress were high over the adult lifespan; 79 % met criteria for a psychiatric disorder at least once in their lives. Depression and anxiety were most common. However, older adults less often met criteria for any psychiatric diagnosis and, specifically, social phobia than younger adults. Hence, despite marked psychological distress, psychiatric problems are also less prevalent in older aged individuals with ASD.

  8. Minimal intervention dentistry and older patients. Part 1: Risk assessment and caries prevention.

    PubMed

    Hayes, Martina; Allen, Edith; da Mata, Cristiane; McKenna, Gerald; Burke, Francis

    2014-06-01

    Ten million people in the UK today are aged over 65. The latest projections estimate that there will be 5 1/2 million more people aged 65 and older in the next 20 years. This projected pattern of population ageing will have profound consequences for dentistry. Minimal intervention dentistry (MID) is a modern evidence-based approach to caries management in dentate patients that uses the 'medical model' whereby disease is controlled by the 'oral physician'. This approach offers considerable benefits over conventional dentistry for older patients. It encourages patients to be responsible for their oral health through the provision of both knowledge and motivation. MID encompasses risk assessment for dental disease, early detection and control of disease processes, and minimally invasive treatment. Clinical Relevance: Risk assessment tools can aid the general dental practitioner and the patient to develop a suitable caries prevention programme for that individual and reduce the need for future operative intervention.

  9. Polypharmacy in the Aging Patient

    PubMed Central

    Lipska, Kasia J.; Krumholz, Harlan; Soones, Tacara; Lee, Sei J.

    2016-01-01

    IMPORTANCE There is substantial uncertainty about optimal glycemic control in older adults with type 2 diabetes mellitus. OBSERVATIONS Four large randomized clinical trials (RCTs), ranging in size from 1791 to 11440 patients, provide the majority of the evidence used to guide diabetes therapy. Most RCTs of intensive vs standard glycemic control excluded adults older than 80 years, used surrogate end points to evaluate microvascular outcomes and provided limited data on which subgroups are most likely to benefit or be harmed by specific therapies. Available data from randomized clinical trials suggest that intensive glycemic control does not reduce major macrovascular events in older adults for at least 10 years. Furthermore, intensive glycemic control does not lead to improved patient-centered microvascular outcomes for at least 8 years. Data from randomized clinical trials consistently suggest that intensive glycemic control immediately increases the risk of severe hypoglycemia 1.5- to 3-fold. Based on these data and observational studies, for the majority of adults older than 65 years, the harms associated with a hemoglobin A1c (HbA1c) target lower than 7.5% or higher than 9% are likely to outweigh the benefits. However, the optimal target depends on patient factors, medications used to reach the target, life expectancy, and patient preferences about treatment. If only medications with low treatment burden and hypoglycemia risk (such as metformin) are required, a lower HbA1c target may be appropriate. If patients strongly prefer to avoid injections or frequent fingerstick monitoring, a higher HbA1c target that obviates the need for insulin may be appropriate. CONCLUSIONS AND RELEVANCE High-quality evidence about glycemic treatment in older adults is lacking. Optimal decisions need to be made collaboratively with patients, incorporating the likelihood of benefits and harms and patient preferences about treatment and treatment burden. For the majority of older

  10. Health professionals' attitudes toward older people and older patients: a systematic review.

    PubMed

    Liu, Yun-e; While, Alison E; Norman, Ian J; Ye, Wenqin

    2012-09-01

    Attitudes toward older people and older patients among healthcare professionals are of concern throughout the world, but there are no recent systematic reviews which have examined and compared the attitudes across the various healthcare professionals who provide healthcare to older people. A comprehensive literature search (2000-2011) was undertaken on electronic databases (CINAHL, MEDLINE, EMBASE, British Nursing Index, PsycINFO, Chinese Biomedical database, China Medical Academic Conference and China Academic Journal) using a combination of terms. We identified 2179 articles indexed with these terms. Initial screening was undertaken by two researchers and then checked by a third researcher. In total, the reviewers selected 117 articles which, on the basis of their abstracts, appeared to meet the criteria for inclusion. We obtained the full texts and two reviewers assessed each full text paper to further examine whether it met all the criteria. The final review identified 51 studies. Publications over the last 10 years show that attitudes towards older people and older patients range from neutral to positive among healthcare professionals and highlight the need for well-designed studies of both qualified and student healthcare professionals recruiting random samples across multiple sites and utilizing validated instruments consistently to permit comparison over time and across countries. PMID:22780579

  11. Psychometric Evaluation of the Beck Anxiety Inventory with Older Medical Patients.

    ERIC Educational Resources Information Center

    Wetherell, Julie Loebach; Arean, Patricia A.

    1997-01-01

    When 197 disadvantaged older medical patients completed the Beck Anxiety Inventory, the instrument demonstrated high internal consistency and no significant differences by sex or race, suggesting that it is appropriate for use with diverse populations. Total instrument scores correlated negatively with age. (SLD)

  12. Substance Use in Older HIV-Infected Patients

    PubMed Central

    Edelman, E. Jennifer; Tetrault, Jeanette M.; Fiellin, David A.

    2014-01-01

    Purpose of the Review Substance use may persist throughout the life course and has a substantial impact on health outcomes globally. As HIV-infected individuals are disproportionately impacted by substance use and living longer, it is critical that providers and researchers alike understand the impact of substance use on older, HIV-infected patients and potential treatment options. To this end, we conducted a review of the literature focusing on the most commonly used substances to outline the epidemiology, health consequences, treatment options and latest research relevant to older, HIV-infected patients. Recent Findings Substance use impacts older, HIV-infected patients with regards to HIV-related and non-HIV related outcomes. Counseling strategies are available for marijuana and stimulant use disorders. Brief counseling is useful alongside medications for alcohol, tobacco and opioid use disorders. Many medications for alcohol, tobacco, and opioid use disorders are safe in the setting of antiretroviral therapy. Unfortunately, few interventions targeting substance use in older, HIV-infected patients have been developed and evaluated. Summary As older, HIV-infected patients continue to experience substance use and its related health consequences, there will be a growing need for the development of safe and effective interventions which address the complex needs of this population. PMID:24824888

  13. Long-term Outcomes After Anterior Cruciate Ligament Reconstruction in Patients 60 Years and Older

    PubMed Central

    Baker, Champ L.; Jones, Jaclyn C.; Zhang, Jeff

    2014-01-01

    Background: Studies evaluating the benefit of surgical reconstruction of the anterior cruciate ligament (ACL) in middle-aged patients have shown promising results, but study populations were limited primarily to patients who were 40 to 60 years old. Some authors have suggested that surgery may benefit these older patients. Hypothesis: Patients aged ≥60 years with functional instability after ACL injury would benefit from ACL reconstruction. Study Design: Case series; Level of evidence, 4. Methods: Medical records from 1984 through 2010 were searched for patients aged ≥60 years who had undergone primary arthroscopic ACL reconstruction at a single institution. Fifteen patients (15 knees) were identified as meeting the above criteria. All patients were contacted for a telephone interview, and they completed Short Form–36 and modified Cincinnati Knee Score forms. One patient was deceased, and 1 had undergone revision to total knee arthroplasty. Among the remaining 13 patients, the mean age at surgery was 63.5 years (range, 60-73 years), and the mean patient age at the time of follow-up was 73 years (range, 65-85 years). Preoperative radiographs showed no obvious evidence of arthritis in 10 (77%) of the 13 patients; small osteophytes without loss of joint space were seen in 3 (23%) patients. The mean length of follow up was 115.7 months (range, 53-193 months). Results: At their last clinic visits, all 13 patients had regained full range of motion and returned to sports or exercise, such as tennis, golf, gym exercise, and yoga. Twelve patients reported no joint laxity. Conclusion: Patients aged ≥60 years with symptomatic instability from ACL injury can have good to excellent subjective outcomes with surgical reconstruction. Clinical Relevance: Physicians who treat active patients older than 60 years should not exclude ACL reconstruction based on the patient’s age alone. PMID:26535289

  14. Outcomes of Subsyndromal Depression in Older Primary Care Patients

    PubMed Central

    Grabovich, Andrew; Lu, Naiji; Tang, Wan; Tu, Xin; Lyness, Jeffrey M.

    2010-01-01

    Objectives Most older persons in primary care suffering clinically significant depressive symptoms do not meet criteria for major or minor depression. We tested the hypothesis that patients with subsyndromal depression (SSD) would have poorer psychiatric, medical, and functional outcomes at follow-up than non-depressed patients, but not as poor as those with minor or major depression. We also explored the relative outcomes of three definitions of SSD to determine their relative prognostic value. Design Prospective observational cohort study. Setting Primary care practices in Monroe County, NY. Participants 481 primary care patients age ≥65 years who completed research assessments at intake and at least one year of follow-up evaluation. Measurements Depression diagnoses and three definitions of SSD were determined by the Structured Clinical Interview for DSM-IV and the 24-item Hamilton Depression Rating Scale. Other validated measures assessed anxiety, cognition, medical burden, and functional status. Results Patients with SSD had poorer 1-year lagged outcomes than non-depressed subjects in terms of psychiatric symptoms and functional status, often not significantly different than major or minor depression. Two of the SSD definitions identified subjects with poorer psychiatric and functional outcomes than the third SSD definition. Conclusions Clinicians should be vigilant in caring for patients with SSD, monitoring for persistent or worsening depressive symptoms including suicidality, anxiety, cognitive impairment, and functional decline. Researchers may use particular SSD definitions to identify individuals at higher risk of poor outcomes, to better understand the relationships of SSD to functional disability and to test innovative preventive and therapeutic interventions. PMID:20173424

  15. "Older is always better": Age-related differences in vocabulary scores across 16 years.

    PubMed

    Ben-David, Boaz M; Erel, Hadas; Goy, Huiwen; Schneider, Bruce A

    2015-12-01

    Cross-sectional studies of cognitive aging compare age groups at 1 time point. It is unclear from such studies whether age-related cognitive differences remain stable across time. We present a cross-sectional investigation of vocabulary scores of 2,000 younger and older adults collected across 16 years, using the same laboratory and protocol. We found a steady decrease with year of testing and an advantage for older adults. An additive relation between age group and year of testing implied that age-related differences in vocabulary are independent of changes over time, suggesting that younger and older adults are similarly affected by changes in word usage.

  16. [Management of vascular risk factors in patients older than 80].

    PubMed

    Gómez-Huelgas, Ricardo; Martínez-Sellés, Manuel; Formiga, Francesc; Alemán Sánchez, José Juan; Camafort, Miguel; Galve, Enrique; Gil, Pedro; Lobos, José María

    2014-08-01

    The number of patients older than 80 years is steadily increasing and it represents the main basis for increasing population figures in developed countries. Cardiovascular diseases are the leading causes of mortality and disability causes result in a huge burden of disease in elderly people. However, available scientific evidence to support decision-making on cardiovascular prevention in elderly patients is scarce. Currently available risk assessment scales cannot be applied to elderly people. They are focused on cardiovascular mortality risk and do not provide information on factors with a proven prognostic value in the very old (functioning disability, dementia). Elderly people are a highly heterogeneous population, with a variety of co-morbidities, as well as several functional and cognitive impairment degrees. Furthermore, aging-associated physiological changes and common use of multiple drugs result in an increased risk of adverse drug reactions. Thus, drug use should always be based on a risk/benefit assessment in the elderly. Therefore, therapeutic decision-making in the very old must be an individually tailored and based on an appropriate clinical judgement and a comprehensive geriatric assessment. The current consensus report aims to present a proposal for clinical practices in the primary and secondary cardiovascular prevention in the very old and to provide a number of recommendations on lifestyle changes and drug therapy for the management of major cardiovascular risk factors.

  17. [Management of vascular risk factors in patients older than 80].

    PubMed

    Gómez-Huelgas, Ricardo; Martínez-Sellés, Manuel; Formiga, Francesc; Alemán Sánchez, José Juan; Camafort, Miguel; Galve, Enrique; Gil, Pedro; Lobos, José María

    2014-08-01

    The number of patients older than 80 years is steadily increasing and it represents the main basis for increasing population figures in developed countries. Cardiovascular diseases are the leading causes of mortality and disability causes result in a huge burden of disease in elderly people. However, available scientific evidence to support decision-making on cardiovascular prevention in elderly patients is scarce. Currently available risk assessment scales cannot be applied to elderly people. They are focused on cardiovascular mortality risk and do not provide information on factors with a proven prognostic value in the very old (functioning disability, dementia). Elderly people are a highly heterogeneous population, with a variety of co-morbidities, as well as several functional and cognitive impairment degrees. Furthermore, aging-associated physiological changes and common use of multiple drugs result in an increased risk of adverse drug reactions. Thus, drug use should always be based on a risk/benefit assessment in the elderly. Therefore, therapeutic decision-making in the very old must be an individually tailored and based on an appropriate clinical judgement and a comprehensive geriatric assessment. The current consensus report aims to present a proposal for clinical practices in the primary and secondary cardiovascular prevention in the very old and to provide a number of recommendations on lifestyle changes and drug therapy for the management of major cardiovascular risk factors. PMID:24908624

  18. Older farmers' prevalence, capital, health, age-related limitations, and adaptations.

    PubMed

    Cole, Henry P; Donovan, Teresa A

    2008-01-01

    A major reduction in the proportion of older farmers in the farm population has been predicted for nearly 50 years. Not only has the proportion of older farmers increased but the proportion of younger farmers has decreased dramatically. In 2002, principal operators age >or= 65 years of age comprised 26.2% of US farmers. These older farmers and farm landlords combined owned 34% of all farm assets. In addition to their economic capital, older farmers have large stocks of social and cultural capital that contribute to their communities and the nation. A large majority of older people in the US population, and older farmers in particular, remain healthy and active. All older adults experience normal age-related deficits in sensory, motor, and cognitive functioning. However, age-related adaptations of healthy older adults, including their experience and compensatory behavioral and information processing strategies, minimize many age-related deficits. These factors allow perhaps 80% or more of older farmers to continue working safely and productively well past typical retirement age. PMID:19042700

  19. Difficulty in Differentiating Trustworthiness from Untrustworthiness in Older Age

    ERIC Educational Resources Information Center

    Webb, Bianca; Hine, Alison C.; Bailey, Phoebe E.

    2016-01-01

    Older adults report being more trusting than young adults, and this may be particularly evident in close social relationships. This is beneficial for well-being when trust is reciprocated, but detrimental when trust is exploited. In a repeated trust game, young (n = 35) and older adults (n = 33) invested real money over repeated interactions with…

  20. Variation in Prostate-Specific Antigen Screening in Men Aged 80 and Older in Fee-for-Service Medicare

    PubMed Central

    Bynum, Julie; Song, Yunjie; Fisher, Elliott

    2010-01-01

    OBJECTIVES To determine the rate of prostate-specific antigen (PSA) screening in men aged 80 and older in Medicare and to examine geographic variation in screening rates across the U.S. DESIGN Retrospective cohort study of variation across hospital referral regions using administrative data. SETTING National random sample in fee-for-service Medicare. PARTICIPANTS Medicare beneficiaries aged 80 and older in 2003. MEASUREMENTS Percentage of men aged 80 and older screened using the PSA test. RESULTS The national rate of PSA screening in men aged 80 and older was 17.2%, but there was wide variation across regions (<2–38%). Higher PSA screening in a region was positively associated with greater total costs (correlation coefficient (r) = 0.49, P<.001), greater intensive care unit use at the end of life (r = 0.46, P<.001), and greater number of unique physicians seen (r = 0.36, P<.001). PSA screening was negatively associated with proportion of beneficiaries using a primary care physician as opposed to a medical subspecialist for the predominance of ambulatory care (r = −0.38, P<.001). CONCLUSION PSA screening in men aged 80 and older is common practice, although its frequency is highly variable across the United States. Its association with fragmented physician care and aggressive end-of-life care may reflect less reliance on primary care and consequent difficulty informing patients of the potential harms and low likelihood of benefit of this procedure. PMID:20345867

  1. Engaging older patients in cardiovascular research: observational analysis of the ICON-1 study

    PubMed Central

    Sinclair, Hannah; Batty, Jonathan A; Qiu, Weiliang; Kunadian, Vijay

    2016-01-01

    Background As a consequence of population ageing, the number of older patients presenting with acute coronary syndrome (ACS) is increasing. The historical underrepresentation of older patients in many pivotal ACS clinical trials undermines the practice of evidence-based medicine in this high-risk cohort. This study evaluates the feasibility of recruitment of older patients to a longitudinal, clinical study. Methods The study to Improve Cardiovascular Outcomes in high-risk patieNts with ACS (ICON-1) is an observational, prospective cohort study investigating predictors of poor outcome in older patients with ACS. All patients aged ≥75 years, referred to a tertiary cardiovascular centre in the North East of England for coronary angiography with a view to urgent percutaneous coronary intervention, were screened for inclusion. A screening log was prospectively maintained, and a detailed analysis was performed to identify the factors associated with recruitment and non-recruitment to ICON-1. Results Of the 629 patients screened over 34 months, 457 (72.7%) satisfied the a priori-defined study inclusion/exclusion criteria. Of those eligible to participate, 300 (68.5%) provided informed consent and were recruited to the study; 59 (13.5%) were unable to consent due to a lack of capacity or limitations in communication, and 79 patients (18.0%) declined to participate in the study. Those lacking adequate capacity to consent were older than those able to provide informed consent (83.0±4.7 vs 81.0±4.7 years, p=0.002). Women were more likely to decline than men (25.1% vs 10.0%, p<0.001). Conclusions The recruitment of patients was robust, comparing favourably to previous longitudinal studies within this age group. Although enrolling older people to research remains challenging, this cohort is enthusiastic to participate. The contribution of older patients must not be ignored, particularly in the setting of an ever-ageing population, in whom cardiovascular disease burden

  2. Brain white matter damage in aging and cognitive ability in youth and older age.

    PubMed

    Valdés Hernández, Maria Del C; Booth, Tom; Murray, Catherine; Gow, Alan J; Penke, Lars; Morris, Zoe; Maniega, Susana Muñoz; Royle, Natalie A; Aribisala, Benjamin S; Bastin, Mark E; Starr, John M; Deary, Ian J; Wardlaw, Joanna M

    2013-12-01

    Cerebral white matter hyperintensities (WMH) reflect accumulating white matter damage with aging and impair cognition. The role of childhood intelligence is rarely considered in associations between cognitive impairment and WMH. We studied community-dwelling older people all born in 1936, in whom IQ had been assessed at age 11 years. We assessed medical histories, current cognitive ability and quantified WMH on MR imaging. Among 634 participants, mean age 72.7 (SD 0.7), age 11 IQ was the strongest predictor of late life cognitive ability. After accounting for age 11 IQ, greater WMH load was significantly associated with lower late life general cognitive ability (β = -0.14, p < 0.01) and processing speed (β = -0.19, p < 0.001). WMH were also associated independently with lower age 11 IQ (β = -0.08, p < 0.05) and hypertension. In conclusion, having more WMH is significantly associated with lower cognitive ability, after accounting for prior ability, age 11IQ. Early-life IQ also influenced WMH in later life. Determining how lower IQ in youth leads to increasing brain damage with aging is important for future successful cognitive aging.

  3. Understanding HIV-related stigma in older age in rural Malawi.

    PubMed

    Freeman, Emily

    2016-09-01

    The combination of HIV- and age-related stigma exacerbates prevalence of HIV infection and late diagnosis and initiation of anti-retroviral therapy among older populations (Moore, 2012; Richards et al. 2013). Interventions to address these stigmas must be grounded in understanding of situated systems of beliefs about illness and older age. This study analyses constructions of HIV and older age that underpinned the stigmatisation of older adults with HIV in rural Balaka, Malawi. It draws on data from a series of in-depth interviews (N = 135) with adults aged 50-∼90 (N = 43) in 2008-2010. Around 40% (n = 18) of the sample had HIV. Dominant understandings of HIV in Balaka pertained to the sexual transmission of the virus and poor prognosis of those infected. They intersected with understandings of ageing. Narratives about older age and HIV in older age both centred on the importance of having bodily, moral and social power to perform broadly-defined "work". Those who could not work were physically and socially excluded from the social world. This status, labelled as "child-like", was feared by all participants. In participants' narratives, growing old involves a gradual decline in the power required to produce one's membership of the social world through work. HIV infection in old age is understood to accelerate this decline. Understandings of the sexual transmission of HIV, in older age, imply the absence of moral power and in turn, loss of social power. The prognosis of those with HIV, in older age, reflects and causes amplified loss of bodily power. In generating dependency, this loss of bodily power infantilises older care recipients and jeopardises their family's survival, resulting in further loss of social power. This age-and HIV-related loss of power to produce social membership through work is the discrediting attribute at the heart of the stigmatisation of older people with HIV. PMID:27459023

  4. Understanding HIV-related stigma in older age in rural Malawi.

    PubMed

    Freeman, Emily

    2016-09-01

    The combination of HIV- and age-related stigma exacerbates prevalence of HIV infection and late diagnosis and initiation of anti-retroviral therapy among older populations (Moore, 2012; Richards et al. 2013). Interventions to address these stigmas must be grounded in understanding of situated systems of beliefs about illness and older age. This study analyses constructions of HIV and older age that underpinned the stigmatisation of older adults with HIV in rural Balaka, Malawi. It draws on data from a series of in-depth interviews (N = 135) with adults aged 50-∼90 (N = 43) in 2008-2010. Around 40% (n = 18) of the sample had HIV. Dominant understandings of HIV in Balaka pertained to the sexual transmission of the virus and poor prognosis of those infected. They intersected with understandings of ageing. Narratives about older age and HIV in older age both centred on the importance of having bodily, moral and social power to perform broadly-defined "work". Those who could not work were physically and socially excluded from the social world. This status, labelled as "child-like", was feared by all participants. In participants' narratives, growing old involves a gradual decline in the power required to produce one's membership of the social world through work. HIV infection in old age is understood to accelerate this decline. Understandings of the sexual transmission of HIV, in older age, imply the absence of moral power and in turn, loss of social power. The prognosis of those with HIV, in older age, reflects and causes amplified loss of bodily power. In generating dependency, this loss of bodily power infantilises older care recipients and jeopardises their family's survival, resulting in further loss of social power. This age-and HIV-related loss of power to produce social membership through work is the discrediting attribute at the heart of the stigmatisation of older people with HIV.

  5. Social integration of the older thalassaemic patient.

    PubMed Central

    Politis, C; Di Palma, A; Fisfis, M; Giasanti, A; Richardson, S C; Vullo, C; Masera, G

    1990-01-01

    Because social policy favours the fullest possible social integration of chronically ill patients, we have evaluated the facilities that are needed to achieve this for patients with beta thalassaemia major in the light of the therapeutic advances that now permit them to survive into adulthood. We have investigated the social integration of adolescent and young adult thalassaemic patients, 171 from Greece and 112 from Ferrara in Italy. Patients in both areas show a good level of social integration and favourable self image, indicating what may be achieved by providing psychosocial support as part of a comprehensive approach to treatment. PMID:2221972

  6. The practical management of cognitive impairment and psychosis in the older Parkinson's disease patient.

    PubMed

    Hindle, John V

    2013-04-01

    Parkinson's disease (PD) has been described as an age-related disease. Ageing significantly increases the risk of psychosis and dementia. Older patients often have a complex mixture of delirium, psychosis, dementia, gait and balance problems and other comorbidities which can cause significant management problems. There are concerns about the safety and tolerability of the treatments for psychosis and dementia. Delirium is common in older Parkinson's patients and must be assessed and managed carefully. The aetiology of psychosis in Parkinson's is complex and often associated with the development of cognitive impairment. Initial adjustments of Parkinson's drugs should be considered if symptoms are intrusive. Where drug therapy is required, evidence suggests that quetiapine may be a safe initial option. There is no contraindication to the use of clozapine in older patients, with the required blood monitoring. Dementia is almost inevitable with very advanced disease and increasing age, and is associated with a marked cholinergic deficit in the brain. Cholinesterase inhibitors may be more effective in PD than in Alzheimer's disease and appear relatively safe with appropriate monitoring of the pulse. There is much less evidence for the use of memantine. There is no current evidence for the use of specific non-pharmacological therapies in the management of psychosis or dementia in PD. Due to the associated gait and balance problems, older Parkinson's patients benefit from comprehensive multi-disciplinary assessment.

  7. Older Patients with Myeloma Derive Similar Benefit from Autologous Transplantation

    PubMed Central

    Sharma, Manish; Zhang, Mei-Jie; Zhong, Xiaobo; Abidi, Muneer H.; Akpek, Görgün; Bacher, Ulrike; Callander, Natalie S.; Dispenzieri, Angela; Freytes, César O.; Fung, Henry C.; Gale, Robert Peter; Gasparetto, Cristina; Gibson, John; Holmberg, Leona A.; Kindwall-Keller, Tamila L.; Klumpp, Thomas R.; Krishnan, Amrita Y.; Landau, Heather J.; Lazarus, Hillard M.; Lonial, Sagar; Maiolino, Angelo; Marks, David I.; Mehta, Paulette; Med, Joseph R. Mikhael; Nishihori, Taiga; Olsson, Richard; Ramanathan, Muthalagu; Roy, Vivek; Savani, Bipin N.; Schouten, Harry C.; Scott, Emma; Tay, Jason; To, Luen Bik; Vesole, David H.; Vogl, Dan T.; Hari, Parameswaran

    2014-01-01

    Autologous hematopoietic cell transplantation (AHCT) for plasma cell myeloma is performed less often in people >70 years old than in people ≤70 years old. We analyzed 11,430 AHCT recipients for plasma cell myeloma prospectively reported to the Center for International Blood and Marrow Transplant Research between 2008 and 2011, representing the majority of US AHCT activity during this period. Survival (OS) was compared in 3 cohorts: ages 18 to 59 years (n = 5818), 60 to 69 years (n = 4666), and >70 years (n = 946). Median OS was not reached for any cohort. In multivariate analysis, increasing age was associated with mortality (P = .0006). Myeloma-specific mortality was similar among cohorts at 12%, indicating an age-related effect on nonmyeloma mortality. Analyses were performed in a representative subgroup comparing relapse rate, progression-free survival (PFS), and nonrelapse mortality (NRM). One-year NRM was 0% for age >70 years and 2% for other ages (P = not significant). The three-year relapse rate was 56% in age 18 to 59 years, 61% in age 60 to 69 years, and 63% age >70 (P = not significant). Three-year PFS was similar at 42% in age 18 to 59 years, 38% in age 60 to 69 years, and 33% in age >70 years (P = not significant). Postrelapse survival was significantly worse for the older cohort (P = .03). Older subjects selected for AHCT derived similar antimyeloma benefit without worse NRM, relapse rate, or PFS. PMID:25046833

  8. Loss of olfactory function and nutritional status in vital older adults and geriatric patients.

    PubMed

    Toussaint, Nicole; de Roon, Margot; van Campen, Jos P C M; Kremer, Stefanie; Boesveldt, Sanne

    2015-03-01

    The aim of this cross-sectional study was to assess the association of olfactory function and nutritional status in vital older adults and geriatric patients. Three hundred forty-five vital (mean age 67.1 years) and 138 geriatric older adults (mean age 80.9 years) were included. Nutritional status was assessed using the mini nutritional assessment-short form. The Sniffin' Sticks was used to measure olfactory function. Eleven percentage of the vital older adults were at risk of malnutrition, whereas 60% of the geriatric participants were malnourished or at risk. Only 2% of the vital older adults were anosmic, compared with 46% of the geriatric participants. Linear regression demonstrated a significant association (P = 0.015) between olfactory function and nutritional status in the geriatric subjects. However, this association became insignificant after adjustment for confounders. Both crude and adjusted analysis in the vital older adults did not show a significant association. The results indicate that, in both groups of elderly, there is no direct relation between olfactory function and nutritional status. We suggest that a decline in olfactory function may still be considered as one of the risk-factors for malnutrition in geriatric patients-once co-occurring with other mental and/or physical problems that are more likely to occur in those patients experience.

  9. Understanding cognition in older patients with cancer

    PubMed Central

    Karuturi, Meghan; Wong, Melisa L.; Hsu, Tina; Kimmick, Gretchen G.; Lichtman, Stuart M.; Holmes, Holly M.; Inouye, Sharon K.; Dale, William; Loh, Kah P.; Whitehead, Mary I.; Magnuson, Allison; Hurria, Arti; Janelsins, Michelle C.; Mohile, Supriya

    2016-01-01

    Cancer and neurocognitive disorders, such as dementia and delirium, are common and serious diseases in the elderly that are accompanied by high degree of morbidity and mortality. Furthermore, evidence supports the under-diagnosis of both dementia and delirium in older adults. Complex questions exist regarding the interaction of dementia and delirium with cancer, beginning with guidelines on how best measure disease severity, the optimal screening test for either disorder, the appropriate level of intervention in the setting of abnormal findings, and strategies aimed at preventing the development or progression of either process. Ethical concerns emerge in the research setting, pertaining to the detection of cognitive dysfunction in participants, validity of consent, disclosure of abnormal results if screening is pursued, and recommended level of intervention by investigators. Furthermore, understanding the ways in which comorbid cognitive dysfunction and cancer impact both cancer and non-cancer-related outcomes is essential in guiding treatment decisions. In the following article, we will discuss what is presently known of the interactions of pre-existing cognitive impairment and delirium with cancer. We will also discuss identified deficits in our knowledge base, and propose ways in which innovative research may address these gaps. PMID:27282296

  10. Looking age-appropriate while growing old gracefully: A qualitative study of ageing and body image among older adults.

    PubMed

    Jankowski, Glen S; Diedrichs, Phillippa C; Williamson, Heidi; Christopher, Gary; Harcourt, Diana

    2016-04-01

    Body dissatisfaction can be significantly detrimental to wellbeing. Little is known about older adults' body image, despite the fact that ageing causes unique bodily changes and that sociocultural pressures to resist these changes abound. We conducted six focus groups with a UK community sample of White British and South Asian older adults aged 65-92 years. Thematic analysis highlighted four themes: appearance indicates capability and identity; physical ability trumps appearance; felt pressures to age 'gracefully' while resisting appearance changes; and gender and cultural differences. These findings suggest that older adults' body image can have important implications for their wellbeing and merits researchers' attention. PMID:24776689

  11. Medical and Obstetric Complications among Pregnant Women Aged 45 and Older

    PubMed Central

    Grotegut, Chad A.; Chisholm, Christian A.; Johnson, Lauren N. C.; Brown, Haywood L.; Heine, R. Phillips; James, Andra H.

    2014-01-01

    Objective The number of women aged 45 and older who become pregnant is increasing. The objective of this study was to estimate the risk of medical and obstetric complications among women aged 45 and older. Methods The Nationwide Inpatient Sample was used to identify pregnant woman during admission for delivery. Deliveries were identified using International Classification of Diseases, Ninth Revision (ICD-9-CM) codes. Using ICD-9-CM codes, pre-existing medical conditions and medical and obstetric complications were identified in women at the time of delivery and were compared for women aged 45 years and older to women under age 35. Outcomes among women aged 35–44 were also compared to women under age 35 to determine if women in this group demonstrated intermediate risk between the older and younger groups. Logistic regression analyses were used to calculate odds ratios with 95% confidence intervals for pre-existing medical conditions and medical and obstetric complications for both older groups relative to women under 35. Multivariable logistic regression analyses were also developed for outcomes at delivery among older women, while controlling for pre-existing medical conditions, multiple gestation, and insurance status, to determine the effect of age on the studied outcomes. Results Women aged 45 and older had higher adjusted odds for death, transfusion, myocardial infarction/ischemia, cardiac arrest, acute heart failure, pulmonary embolism, deep vein thrombosis, acute renal failure, cesarean delivery, gestational diabetes, fetal demise, fetal chromosomal anomaly, and placenta previa compared to women under 35. Conclusion Pregnant women aged 45 and older experience significantly more medical and obstetric complications and are more likely to die at the time of a delivery than women under age 35, though the absolute risks are low and these events are rare. Further research is needed to determine what associated factors among pregnant women aged 45 and older may

  12. Dealing with the difficult older patient.

    PubMed Central

    Laurence, M K

    1986-01-01

    Physicians are often asked to intervene when elderly patients in acute or long-term care facilities are disruptive, demanding or abusive. Though medication may be the immediate response, it often fails to solve the problem, which, being situational and behavioural, calls for a situational and behavioural solution. An organized approach to solving such problems is presented that takes into account the interactions among the patient, family, staff, setting and circumstances. The role of the physician as leader in the process is also discussed. PMID:3697858

  13. Age or Disability? Age-Based Disparities in Service Provision for Older People with Intellectual Disabilities in Great Britain.

    ERIC Educational Resources Information Center

    Walker, Alan; Walker, Carol

    1998-01-01

    This paper argues that a key factor in the dependency of older people with intellectual disabilities is the age discriminatory attitudes held by many service providers. Two research projects of deinstitutionalization in Britain found greater improvement in competencies or less deterioration in older than younger individuals at follow-up despite…

  14. Conflict and collaboration in middle-aged and older couples: I. Age differences in agency and communion during marital interaction.

    PubMed

    Smith, Timothy W; Berg, Cynthia A; Florsheim, Paul; Uchino, Bert N; Pearce, Gale; Hawkins, Melissa; Henry, Nancy J M; Beveridge, Ryan M; Skinner, Michelle A; Olsen-Cerny, Chrisanna

    2009-06-01

    Prior theory and research regarding age differences in marital interaction suggest that older couples display and experience more positivity and less negativity than middle-aged couples. However, studies of overt behavior in older couples are relatively rare and have emphasized disagreement, neglecting other important contexts for older couples such as collaboration during everyday problem solving. Further, the affiliation or communion dimension of social interaction (i.e., warmth vs. hostility) is commonly assessed but not the control or agency dimension (e.g., dominance vs. submissiveness). The present study examined affect, cognitive appraisals, and overt behavior during disagreement (i.e., discussing a current conflict) and collaboration (i.e., planning errands) in 300 middle-aged and older married couples. Older couples reported less negative affect during disagreement and rated spouses as warmer than did middle-aged couples. However, these effects were eliminated when older couples' greater marital satisfaction was controlled. For observed behavior, older couples displayed little evidence of greater positivity and reduced negativity-especially women. During collaboration, older couples displayed a unique blend of warmth and control, suggesting a greater focus on emotional and social concerns during problem solving. PMID:19485646

  15. Depression Treatment Preferences in Older Primary Care Patients

    ERIC Educational Resources Information Center

    Gum, Amber M.; Arean, Patricia A.; Hunkeler, Enid; Tang, Lingqi; Katon, Wayne; Hitchcock, Polly; Steffens, David C.; Dickens, Jeanne; Unutzer, Jurgen

    2006-01-01

    Purpose: For depressed older primary care patients, this study aimed to examine (a) characteristics associated with depression treatment preferences; (b) predictors of receiving preferred treatment; and (c) whether receiving preferred treatment predicted satisfaction and depression outcomes. Design and Methods: Data are from 1,602 depressed older…

  16. Approximate Quantification in Young, Healthy Older Adults', and Alzheimer Patients

    ERIC Educational Resources Information Center

    Gandini, Delphine; Lemaire, Patrick; Michel, Bernard Francois

    2009-01-01

    Forty young adults, 40 healthy older adults, and 39 probable AD patients were asked to estimate small (e.g., 25) and large (e.g., 60) collections of dots in a choice condition and in two no-choice conditions. Participants could choose between benchmark and anchoring strategies on each collection of dots in the choice condition and were required to…

  17. Older Age is Associated with More Successful Aging: Role of Resilience and Depression

    PubMed Central

    Jeste, Dilip V.; Savla, Gauri N.; Thompson, Wesley K.; Vahia, Ipsit V.; Glorioso, Danielle K.; Martin, A’verria Sirkin; Palmer, Barton W.; Rock, David; Golshan, Shahrokh; Kraemer, Helena C.; Depp, Colin A.

    2013-01-01

    Background There is growing public health interest in understanding and promoting successful aging. While there has been some exciting empirical work on objective measures of physical health, relatively little published research combines physical, cognitive, and psychological assessments in large, randomly selected, community-based samples to assess self-rated successful aging (SRSA). Methods In this Successful AGing Evaluation (SAGE) study, we used a structured multi-cohort design to assess successful aging in 1,006 community-dwelling adults in San Diego County, aged 50–99 years, with over-sampling of people over 80. A modified version of random digit dialing was used to recruit subjects. Evaluations included a 25-minute phone interview followed by a comprehensive mail-in survey of physical, cognitive, and psychological domains, including SRSA (scaled from 1 [lowest] to 10 [highest]) and positive psychological traits. Results In our sample with mean age of 77.3 years, the mean SRSA score was 8.2, and older age was associated with higher SRSA (R2 = 0.027), despite worsening physical and cognitive functioning. The best multiple regression model achieved, using all the potential correlates, accounted for 30% of variance in SRSA, and included resilience, depression, physical functioning, and age (entering the regression model in that order). Conclusions Resilience and depression had a significant association with SRSA with effect sizes comparable to that for physical health. While no causality can be inferred from cross-sectional data, increasing resilience and reducing depression might have as strong effects on successful aging as reducing physical disability, suggesting an important role for psychiatry in promoting successful aging. PMID:23223917

  18. Age-Related Differences in Vehicle Control and Eye Movement Patterns at Intersections: Older and Middle-Aged Drivers

    PubMed Central

    Yamani, Yusuke; Horrey, William J.; Liang, Yulan; Fisher, Donald L.

    2016-01-01

    Older drivers are at increased risk of intersection crashes. Previous work found that older drivers execute less frequent glances for detecting potential threats at intersections than middle-aged drivers. Yet, earlier work has also shown that an active training program doubled the frequency of these glances among older drivers, suggesting that these effects are not necessarily due to age-related functional declines. In light of findings, the current study sought to explore the ability of older drivers to coordinate their head and eye movements while simultaneously steering the vehicle as well as their glance behavior at intersections. In a driving simulator, older (M = 76 yrs) and middle-aged (M = 58 yrs) drivers completed different driving tasks: (1) travelling straight on a highway while scanning for peripheral information (a visual search task) and (2) navigating intersections with areas potential hazard. The results replicate that the older drivers did not execute glances for potential threats to the sides when turning at intersections as frequently as the middle-aged drivers. Furthermore, the results demonstrate costs of performing two concurrent tasks, highway driving and visual search task on the side displays: the older drivers performed more poorly on the visual search task and needed to correct their steering positions more compared to the middle-aged counterparts. The findings are consistent with the predictions and discussed in terms of a decoupling hypothesis, providing an account for the effects of the active training program. PMID:27736887

  19. Hospice Use Following Implantable Cardioverter-Defibrillator Implantation in Older Patients

    PubMed Central

    Reynolds, Matthew R.; Normand, Sharon-Lise; Parzynski, Craig S.; Spertus, John A.; Mor, Vincent; Mitchell, Susan L.

    2016-01-01

    Background— Older recipients of implantable cardioverter-defibrillators (ICDs) are at increased risk for short-term mortality in comparison with younger patients. Although hospice use is common among decedents aged >65, its use among older ICD recipients is unknown. Methods and Results— Medicare patients aged >65 matched to data in the National Cardiovascular Data Registry – ICD Registry from January 1, 2006 to March 31, 2010 were eligible for analysis (N=194 969). The proportion of ICD recipients enrolled in hospice, cumulative incidence of hospice admission, and factors associated with time to hospice enrollment were evaluated. Five years after device implantation, 50.9% of patients were either deceased or in hospice. Among decedents, 36.8% received hospice services. The cumulative incidence of hospice enrollment, accounting for the competing risk of death, was 4.7% (95% confidence interval [CI], 4.6%–4.8%) within 1 year and 21.3% (95% CI, 20.7%–21.8%) at 5 years. Factors most strongly associated with shorter time to hospice enrollment were older age (adjusted hazard ratio, 1.77; 95% CI, 1.73–1.81), class IV heart failure (versus class I; adjusted hazard ratio, 1.79; 95% CI, 1.66–1.94); ejection fraction <20 (adjusted hazard ratio, 1.57; 95% CI, 1.48–1.67), and greater hospice use among decedents in the patients’ health referral region. Conclusions— More than one-third of older patients dying with ICDs receive hospice care. Five years after implantation, half of older ICD recipients are either dead or in hospice. Hospice providers should be prepared for ICD patients, whose clinical trajectories and broader palliative care needs require greater focus. PMID:27016104

  20. Treatment of colorectal cancer in older patients: International Society of Geriatric Oncology (SIOG) consensus recommendations 2013.

    PubMed

    Papamichael, D; Audisio, R A; Glimelius, B; de Gramont, A; Glynne-Jones, R; Haller, D; Köhne, C-H; Rostoft, S; Lemmens, V; Mitry, E; Rutten, H; Sargent, D; Sastre, J; Seymour, M; Starling, N; Van Cutsem, E; Aapro, M

    2015-03-01

    Colorectal cancer (CRC) is one of the most commonly diagnosed cancers in Europe and worldwide, with the peak incidence in patients >70 years of age. However, as the treatment algorithms for the treatment of patients with CRC become ever more complex, it is clear that a significant percentage of older CRC patients (>70 years) are being less than optimally treated. This document provides a summary of an International Society of Geriatric Oncology (SIOG) task force meeting convened in Paris in 2013 to update the existing expert recommendations for the treatment of older (geriatric) CRC patients published in 2009 and includes overviews of the recent data on epidemiology, geriatric assessment as it relates to surgery and oncology, and the ability of older CRC patients to tolerate surgery, adjuvant chemotherapy, treatment of their metastatic disease including palliative chemotherapy with and without the use of the biologics, and finally the use of adjuvant and palliative radiotherapy in the treatment of older rectal cancer patients. An overview of each area was presented by one of the task force experts and comments invited from other task force members.

  1. Helping Older Patients to Eat Well

    PubMed Central

    Dyer, Sandra E.

    1984-01-01

    Because increase in chronic disease and illness, and changes in physiological, social, economic, and psychological status may adversely affect food intake, it is important to assess the nutritional status of elderly patients. Canada's Food Guide provides a rapid screening tool for evaluating food intake and may also be used as a teaching aid. Nutritional goals in the elderly include preventing deficiencies or excesses and maintaining a desirable body weight. Diet can help manage nutrition-related diseases, including hypertension, diabetes, and osteoporosis. Special attention should be paid to the social aspects of nutrition. PMID:21279082

  2. 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

  3. Keeping up! Older workers' adaptation in the workplace after age 55.

    PubMed

    Ng, Eddy S W; Law, Alan

    2014-03-01

    How do older workers keep up and adapt to a changing workplace after age 55? In exploring that question, this study specifically examined how age-related changes affect workers, how older workers deal with a loss of resources, how they engage in life management, and why some are more successful than others. An in-depth analysis was undertaken using 32 semi-structured interviews conducted with workers aged 55 to 64. Findings revealed that older workers use various strategies to adapt to a change in resources, and that these strategies help them cope and maintain their functioning in the workplace. Because older workers require different types of employer support, this study offers an understanding of how employers can provide that support to encourage older workers to remain in the workforce longer. Several avenues for future research are suggested, including an exploration of the role played by internal sources of support.

  4. Keeping up! Older workers' adaptation in the workplace after age 55.

    PubMed

    Ng, Eddy S W; Law, Alan

    2014-03-01

    How do older workers keep up and adapt to a changing workplace after age 55? In exploring that question, this study specifically examined how age-related changes affect workers, how older workers deal with a loss of resources, how they engage in life management, and why some are more successful than others. An in-depth analysis was undertaken using 32 semi-structured interviews conducted with workers aged 55 to 64. Findings revealed that older workers use various strategies to adapt to a change in resources, and that these strategies help them cope and maintain their functioning in the workplace. Because older workers require different types of employer support, this study offers an understanding of how employers can provide that support to encourage older workers to remain in the workforce longer. Several avenues for future research are suggested, including an exploration of the role played by internal sources of support. PMID:24345532

  5. (Un)Healthy immigrant citizens: naturalization and activity limitations in older age.

    PubMed

    Gubernskaya, Zoya; Bean, Frank D; Van Hook, Jennifer

    2013-01-01

    This research argues that immigrants' political, social, and economic incorporation experiences, which are embedded in individual life course trajectories and heavily influenced by governmental policies, play an important role in producing diverse health outcomes among older U.S. foreign-born persons. Using data from the 2008-2010 American Community Survey and 1998-2010 Integrated Health Interview Series, we demonstrate how naturalization, a key indicator of social and political inclusion, is related to functional health in midlife and older age. Consistent with the theoretical framework, we find that among those foreign-born who immigrated as children and young adults, naturalized citizens show better health at older ages compared with noncitizens, although this relationship is partly mediated by education. But among those older foreign-born who immigrated at middle and older ages, naturalized citizens report worse health compared with noncitizens. Moreover, this negative health selection into naturalization becomes stronger for those naturalizing after the 1996 Welfare Reform Act.

  6. Angiotensin-converting enzyme (ACE) genotypes and disability in hospitalized older patients.

    PubMed

    Seripa, Davide; Paroni, Giulia; Matera, Maria G; Gravina, Carolina; Scarcelli, Carlo; Corritore, Michele; D'Ambrosio, Luigi P; Urbano, Maria; D'Onofrio, Grazia; Copetti, Massimiliano; Kehoe, Patrick G; Panza, Francesco; Pilotto, Alberto

    2011-09-01

    The association between angiotensin-converting enzyme (ACE) genotypes and functional decline in older adults remains controversial. To assess if ACE gene variations influences functional abilities at older age, the present study explored the association between the common ACE insertion/deletion (I/D) polymorphism and disability measured with activities of daily living (ADL) in hospitalized older patients. We analyzed the frequency of the ACE genotypes (I/I, I/D, and D/D) in a population of 2,128 hospitalized older patients divided according to presence or absence of ADL disability. Logistic regression analysis adjusted for possible confounding factors, identified an association between the I/I genotype with ADL disability (OR=1.54, 95% CI 1.04-2.29). This association was significant in men (OR=2.01, 95% CI 1.07-3.78), but not in women (OR=1.36, 95% CI 0.82-2.25). These results suggested a possible role of the ACE polymorphism as a genetic marker for ADL disability in hospitalized older patients.

  7. Alloimmunization is associated with older age of transfused red blood cells in sickle cell disease

    PubMed Central

    Desai, Payal C.; Deal, Allison M.; Pfaff, Emily R.; Qaqish, Bahjat; Hebden, Leyna M.; Park, Yara A.; Ataga, Kenneth I.

    2016-01-01

    Red blood cell (RBC) alloimmunization is a significant clinical complication of sickle cell disease (SCD). It can lead to difficulty with cross-matching for future transfusions and may sometimes trigger life-threatening delayed hemolytic transfusion reactions. We conducted a retrospective study to explore the association of clinical complications and age of RBC with alloimmunization in patients with SCD followed at a single institution from 2005 to 2012. One hundred and sixty six patients with a total of 488 RBC transfusions were evaluated. Nineteen patients (11%) developed new alloantibodies following blood transfusions during the period of review. The median age of RBC units was 20 days (interquartile range: 14–27 days). RBC antibody formation was significantly associated with the age of RBC units (P = 0.002), with a hazard ratio of 3.5 (95% CI: 1.71–7.11) for a RBC unit that was 7 days old and 9.8 (95% CI: 2.66–35.97) for a unit that was 35 days old, 28 days after the blood transfusion. No association was observed between RBC alloimmunization and acute vaso-occlusive complications. Although increased echocardiography-derived tricuspid regurgitant jet velocity (TRV) was associated with the presence of RBC alloantibodies (P = 0.02), TRV was not significantly associated with alloimmunization when adjusted for patient age and number of transfused RBC units. Our study suggests that RBC antibody formation is significantly associated with older age of RBCs at the time of transfusion. Prospective studies in patients with SCD are required to confirm this finding. PMID:25963831

  8. Older-Adult Playfulness: An Innovative Construct and Measurement for Healthy Aging Research

    ERIC Educational Resources Information Center

    Yarnal, Careen; Qian, Xinyi

    2011-01-01

    Few studies of adult playfulness exist, but limited research on older adults and playfulness suggests that playfulness in later life improves cognitive, emotional, social, and psychological functioning and healthy aging overall. Older adults represent a rapidly growing segment of the U.S. population, underscoring the need to understand the aging…

  9. Children's Attitudes toward Older Adults and Aging: A Synthesis of Research

    ERIC Educational Resources Information Center

    Gilbert, Cara N.; Ricketts, Kristina G.

    2008-01-01

    This paper serves as a summation of literature on children's attitudes toward older adults and aging. Research indicates that the vast amount of information available provides varying levels of understanding toward children's actual views of older adults. Differences between measurements, settings, and procedures stand as barriers in…

  10. Barriers to Care for Depressed Older People: Perceptions of Aged Care among Medical Professionals

    ERIC Educational Resources Information Center

    McCabe, Marita P.; Davison, Tanya; Mellor, David; George, Kuruvilla

    2009-01-01

    The current study evaluated barriers to detection of depression among older people. Focus groups were conducted with 21 professional carers, 4 nurses, 10 general practitioners, and 7 aged care managers. The results demonstrated that care for older people is primarily focused on physical care. Further, staff resources, a lack of continuity of care,…

  11. Nutrition and the Older Adult. Module A-9. Block A. Basic Knowledge of the Aging Process.

    ERIC Educational Resources Information Center

    Harvey, Dexter; Cap, Orest

    This instructional module on nutrition and the older adult is one in a block of 10 modules designed to provide the human services worker who works with older adults with basic information regarding the aging process. An introduction provides an overview of the module content. A listing of general objectives follows. Five sections present…

  12. Confusion and the Older Adult. Module A-8. Block A. Basic Knowledge of the Aging Process.

    ERIC Educational Resources Information Center

    Harvey, Dexter; Cap, Orest

    This instructional module on confusion and the older adult is one in a block of 10 modules designed to provide the human services worker who works with older adults with basic information regarding the aging process. An introduction provides an overview of the module content. A listing of general objectives follows. Three sections present…

  13. Attitudes about Aging Well among a Diverse Group of Older Americans: Implications for Promoting Cognitive Health

    ERIC Educational Resources Information Center

    Laditka, Sarah B.; Corwin, Sara J.; Laditka, James N.; Liu, Rui; Tseng, Winston; Wu, Bei; Beard, Renee L.; Sharkey, Joseph R.; Ivey, Susan L.

    2009-01-01

    Purpose: To examine perceptions about aging well in the context of cognitive health among a large and diverse group of older adults. Design and Methods: Forty-two focus groups were conducted with older adults living in the community ( N = 396; White, African American, American Indian, Chinese, Vietnamese, and Hispanic). Participant descriptions …

  14. Trajectories of the healthy ageing phenotype among middle-aged and older Britons, 2004–2013

    PubMed Central

    Tampubolon, Gindo

    2016-01-01

    Objectives Since the ageing population demands a response to ensure older people remain healthy and active, we studied the dynamics of a recently proposed healthy ageing phenotype. We drew the phenotype’s trajectories and tested whether their levels and rates of change are influenced by health behaviours, comorbidities and socioeconomic positions earlier in the life course. Design and outcomes The English Longitudinal Ageing Study, a prospective, nationally representative sample of people aged ≥50 years, measured a set of eight biomarkers which make up the outcome of the healthy ageing phenotype three times over nearly a decade (N2004 = 5009, N2008 = 5301, N2013 = 4455). A cluster of health behaviours, comorbidities and socioeconomic positions were also measured repeatedly. We assessed the phenotype’s distribution non-parametrically, then fitted linear mixed models to phenotypic change and further examined time interactions with gender and socioeconomic position. We ran additional analyses to test robustness. Results Women had a wider distribution of the healthy ageing phenotype than men had. The phenotype declined annually by −0.242 (95% confidence interval [CI]: −0.352, −0.131). However, there was considerable heterogeneity in the levels and rates of phenotypic change. Women started at higher levels, then declined more steeply by −0.293 (CI: −0.403, −0.183) annually, leading to crossover in the trajectories. Smoking and physical activity assessed on the Allied Dunbar scale were strongly associated with the trajectories. Conclusion Though marked by secular decline, the trajectories of the healthy ageing phenotype showed distinct socioeconomic gradients. The trajectories were also susceptible to variations in health behaviours, strengthening the case for serial interventions to attain healthy and active ageing. PMID:27105690

  15. Effect of a national requirement to introduce named accountable general practitioners for patients aged 75 or older in England: regression discontinuity analysis of general practice utilisation and continuity of care

    PubMed Central

    Barker, Isaac; Lloyd, Therese; Steventon, Adam

    2016-01-01

    Objective To assess the effect of introducing named accountable general practitioners (GPs) for patients aged 75 years on patterns of general practice utilisation, including continuity of care. Design Regression discontinuity design applied to data from the Clinical Practice Research Datalink to estimate the treatment effect for compliers aged 75. Setting 200 general practices in England. Participants 255 469 patients aged between 65 and 85, after excluding those aged 75. Intervention From April 2014, general practices in England were required to offer patients aged 75 or over a named accountable GP. This study compared having named accountable GPs for patients aged just over 75 with usual care provided for patients just under 75. Outcomes Number of contacts (face-to-face or telephone) with GPs, longitudinal continuity of care (usual provider of care, or UPC, index), number of referrals to specialist care and numbers of common diagnostic tests. Outcomes were measured over 9 months following assignment to a named accountable GP and for a comparable period for those unassigned. Results The proportion of patients with a named accountable GP increased from 3.5% to 79.8% at age 75. No statistically significant effects were detected for continuity of care (estimated treatment effect 0.00, 95% CI −0.01 to 0.02) or the number of GP contacts per person (estimated treatment effect −0.11, 95% CI −0.31 to 0.09) over 9 months. No significant change was seen in the number of referrals, blood pressure or HbA1c diagnostic tests per person. A statistically significant treatment effect of −0.05 cholesterol tests per person (95% CI −0.07 to −0.02) was estimated; however, sensitivity analysis indicated that this effect predated the introduction of named accountable GPs. Conclusions Continuity of care is valued by patients, but the named accountable GP initiative did not improve continuity of care or change patterns of GP utilisation in the first 9 months of the

  16. Management of older or unfit patients with acute myeloid leukemia.

    PubMed

    Walter, R B; Estey, E H

    2015-04-01

    Acute myeloid leukemia (AML) is primarily a disease of older adults, for whom optimal treatment strategies remain controversial. Because of the concern for therapeutic resistance and, in particular, excessive toxicity or even treatment-related mortality, many older or medically unfit patients do not receive AML-directed therapy. Yet, evidence suggests that outcomes are improved if essentially all of these patients are offered AML therapy, ideally at a specialized cancer center. Medical fitness for tolerating intensive chemotherapy can be estimated relatively accurately with multiparameter assessment tools; this information should serve as basis for the assignment to intensive or non-intensive therapy. Until our accuracy in predicting the success of individual therapies improves, all patients should be considered for participation in a randomized controlled trial. Comparisons between individual trials will be facilitated once standardized, improved response criteria are developed, and standard treatment approaches have been defined against which novel therapies can be tested.

  17. Online Health Information Tool Effectiveness for Older Patients: A Systematic Review of the Literature.

    PubMed

    Bolle, Sifra; van Weert, Julia C M; Daams, Joost G; Loos, Eugène F; de Haes, Hanneke C J M; Smets, Ellen M A

    2015-01-01

    Online health information tools (OHITs) have been found to be effective in improving health outcomes. However, the effectiveness of these tools for older patients has been far from clear. This systematic literature review therefore provides an overview of online health information tool effectiveness for older patients using a two-dimensional framework of OHIT functions (i.e., providing information, enhancing information exchange, and promoting self-management) and outcomes (i.e., immediate, intermediate, and long-term outcomes). Comprehensive searches of the PubMed, EMBASE, and PsycINFO databases are conducted to identify eligible studies. Articles describing outcomes of patient-directed OHITs in which a mean sample or subgroup of age ≥65 years was used are included in the literature review. A best evidence synthesis analysis provides evidence that OHITs improve self-efficacy, blood pressure, hemoglobin levels, and cholesterol levels. Limited evidence is found in support of OHIT effects on knowledge, perceived social support, health service utilization, glycemic control, self-care adherence, exercise performance, endurance, and quality of life. OHITs seem promising tools to facilitate immediate, intermediate, and long-term outcomes in older patients by providing information, enhancing information exchange, and promoting self-management. However, future studies should evaluate the effectiveness of OHITs for older patients to achieve stronger levels of evidence. PMID:26165846

  18. Creative Ageing? Selfhood, Temporality and the Older Adult Learner

    ERIC Educational Resources Information Center

    Sabeti, Shari

    2015-01-01

    This paper is based on a long-term ethnography of an adult creative writing class situated in a major urban art gallery in the United Kingdom. It takes the claims of one group of older adults--that creative writing made them "feel younger"--as the starting point for exploring this connection further. It places these claims broadly within…

  19. Future Selves and Aging: Older Adults' Memory Fears

    ERIC Educational Resources Information Center

    Dark-Freudeman, Alissa; West, Robin L.; Viverito, Kristen M.

    2006-01-01

    Thoughts about the self in the future, called possible selves, are an important component of the current identity of individuals. This study specifically focused on possible selves in the domain of memory and cognition. Both older and younger groups spontaneously reported possible selves in the cognitive domain, e.g., "learning a new skill," but…

  20. 42 CFR 440.181 - Home and community-based services for individuals age 65 or older.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Definitions § 440.181 Home and community-based services for individuals age 65 or older. (a) Description of services— Home and community-based services for individuals age 65 or older means services, not otherwise... age 65 or older. 440.181 Section 440.181 Public Health CENTERS FOR MEDICARE & MEDICAID...

  1. 42 CFR 440.181 - Home and community-based services for individuals age 65 or older.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Definitions § 440.181 Home and community-based services for individuals age 65 or older. (a) Description of services— Home and community-based services for individuals age 65 or older means services, not otherwise... age 65 or older. 440.181 Section 440.181 Public Health CENTERS FOR MEDICARE & MEDICAID...

  2. 42 CFR 440.181 - Home and community-based services for individuals age 65 or older.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Definitions § 440.181 Home and community-based services for individuals age 65 or older. (a) Description of services— Home and community-based services for individuals age 65 or older means services, not otherwise... age 65 or older. 440.181 Section 440.181 Public Health CENTERS FOR MEDICARE & MEDICAID...

  3. 42 CFR 440.181 - Home and community-based services for individuals age 65 or older.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Definitions § 440.181 Home and community-based services for individuals age 65 or older. (a) Description of services— Home and community-based services for individuals age 65 or older means services, not otherwise... age 65 or older. 440.181 Section 440.181 Public Health CENTERS FOR MEDICARE & MEDICAID...

  4. 42 CFR 440.181 - Home and community-based services for individuals age 65 or older.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... age 65 or older. 440.181 Section 440.181 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... Definitions § 440.181 Home and community-based services for individuals age 65 or older. (a) Description of services— Home and community-based services for individuals age 65 or older means services, not...

  5. Impact of frailty in older patients with diabetes mellitus: An overview.

    PubMed

    Cobo, Amelia; Vázquez, Luis A; Reviriego, Jesús; Rodríguez-Mañas, Leocadio

    2016-01-01

    Diabetes and frailty are two conditions that frequently occur concurrently and are increasingly prevalent in the older patient. We review the concept, epidemiology and consequences of frailty, and the implications of the presence of frailty in the management of diabetes. Frailty is associated with decreased quality of life, a risk of falls, new or increased disability, hospitalization, and increased mortality. All of these factors affect the management of diabetes in older patients. It is important to rule out frailty in all diabetic patients aged >70 years; if frailty is suspected, a comprehensive and multidisciplinary medical and functional assessment of the patient should be conducted to develop an individualized treatment plan. This plan should include nutritional measures, physical activity, and education on self-care and diabetes; drugs should not be used without a clear indication. Antihyperglycemic drugs that may cause excessive weight loss and/or are associated with a high risk of hypoglycemia should be avoided. PMID:26971016

  6. Liver Transplantation Outcomes Using Grafts From Donors Older Than the Age of 80 Years.

    PubMed

    Rabelo, A V; Alvarez, M J; Méndez, C S M; Villegas, M T; MGraneroa, K; Becerra, A; Dominguez, M; Raya, A M; Exposito, M; Suárez, Y F

    2015-11-01

    We performed a retrospective cohort study between 2002 and 2014 to compare liver transplantation outcomes between recipients of grafts from donors older than and younger than the age of 80 years. Numerical variables were compared with the Student t test when their distribution was normal and the Mann-Whitney test when it was not, whereas categorical variables were compared with Pearson chi-squared test or Fisher test, as appropriate; P < .05 was considered significant. The study included 312 patients with organs from donors younger than 80 years of age and 17 with organs from older donors. The 2 recipient groups did not significantly differ in weight, height, gender, body mass index (BMI), CHILD or MELD score, intensive care unit (ICU) or hospital stay, need for intraoperative hemoderivatives, postreperfusion syndrome, biliary or vascular complications, ischemic cholangiopathy, number of repeat surgeries, graft rejection, retransplantation, or survival at 6 months. Although earlier studies considered livers from elderly donors to be suboptimal, our results support the proposition that octogenarian donors can be an excellent source of liver grafts.

  7. Liver Transplantation Outcomes Using Grafts From Donors Older Than the Age of 80 Years.

    PubMed

    Rabelo, A V; Alvarez, M J; Méndez, C S M; Villegas, M T; MGraneroa, K; Becerra, A; Dominguez, M; Raya, A M; Exposito, M; Suárez, Y F

    2015-11-01

    We performed a retrospective cohort study between 2002 and 2014 to compare liver transplantation outcomes between recipients of grafts from donors older than and younger than the age of 80 years. Numerical variables were compared with the Student t test when their distribution was normal and the Mann-Whitney test when it was not, whereas categorical variables were compared with Pearson chi-squared test or Fisher test, as appropriate; P < .05 was considered significant. The study included 312 patients with organs from donors younger than 80 years of age and 17 with organs from older donors. The 2 recipient groups did not significantly differ in weight, height, gender, body mass index (BMI), CHILD or MELD score, intensive care unit (ICU) or hospital stay, need for intraoperative hemoderivatives, postreperfusion syndrome, biliary or vascular complications, ischemic cholangiopathy, number of repeat surgeries, graft rejection, retransplantation, or survival at 6 months. Although earlier studies considered livers from elderly donors to be suboptimal, our results support the proposition that octogenarian donors can be an excellent source of liver grafts. PMID:26680060

  8. Potentially Inappropriate Prescribing of Primarily Renally Cleared Medications for Older Veterans Affairs Nursing Home Patients

    PubMed Central

    Hanlon, Joseph T.; Wang, Xiaoqiang; Handler, Steven M.; Weisbord, Steven; Pugh, Mary Jo; Semla, Todd; Stone, Roslyn A.; Aspinall, Sherrie L.

    2010-01-01

    Background Inappropriate prescribing of primarily renally cleared medications in older patients with kidney disease can lead to adverse outcomes. Objectives To estimate the prevalence of potentially inappropriate prescribing of 21 primarily renally cleared medications based on 2 separate estimates of renal function and to identify factors associated with this form of suboptimal prescribing in older VA nursing home (NH) patients. Design Longitudinal study Participants Participants were 1304 patients, aged 65 years or older, admitted between January 1, 2004, and June 30, 2005, for 90 days or more to 1 of 133 VA NHs. Main Measures Potentially inappropriate prescribing of primarily renally cleared medications determined by estimating creatinine clearance using the Cock-croft Gault (CG) and Modification of Diet in Renal Disease (MDRD) equations and applying explicit guidelines for contraindicated medications and dosing. Key Results The median estimated creatinine clearance via CG was 67 mL/min, whereas it was 80 mL/min/1.73m2 with the MDRD. Overall, 11.89% patients via CG and only 5.98% via MDRD had evidence of potentially inappropriate prescribing of at least 1 renally cleared medication. The most commonly involved medications were ranitidine, glyburide, gabapentin, and nitrofurantoin. Factors associated with potentially inappropriate prescribing as per the CG were age older than 85 (adjusted odds ratio [AOR] 4.24, 95% confidence interval [CI] 2.42–7.43), obesity (AOR 0.26, 95% CI 0.14–0.50) and having multiple comorbidities (AOR 1.09 for each unit increase in the Charlson comorbidity index, 95% CI 1.01–1.19). Conclusions Potentially inappropriate prescribing of renally cleared medications is common in older VA NH patients. Intervention studies to improve the prescribing of primarily renally cleared medications in nursing homes are needed. PMID:21450179

  9. Exploring opportunities for healthy aging among older persons with a history of homelessness in Toronto, Canada.

    PubMed

    Waldbrook, Natalie

    2015-03-01

    Within the areas of literature on both population aging and health and homelessness, little attention has been given to the opportunities and barriers to healthy aging among older persons with a history of homelessness. Set in the context of inner-city Toronto, Canada, this article reports on the findings from qualitative interviews with 29 formerly homeless older persons. The findings illustrate participants' experiences of positive health change since moving into a stable housing environment and the aspects of housing they perceive to have improved their health and wellbeing. The qualitative findings also draw attention to the ongoing barriers to healthy aging that can be experienced among older persons with a history of homelessness. Overall, this study draws on the lived experiences of formerly homeless older persons to offer a better understanding of the long-term effects of homelessness on health, wellbeing, and aging.

  10. Age Integration and the Lives of Older People.

    ERIC Educational Resources Information Center

    Riley, Matilda White; Riley, John W., Jr.

    1994-01-01

    Argues that currently age-differentiated society will give way to age-integrated one; that age will lose its power to constrain people's entry, exist, and performance in such basic social institutions as education, work, and retirement. Sees revolutionary changes toward age integration as needed to reduce structural lag in which dynamism of human…

  11. Targeted Therapy for Older Patients with Uncontrolled Severe Asthma: Current and Future Prospects.

    PubMed

    de Roos, E W; In 't Veen, J C C M; Braunstahl, G-J; Lahousse, L; Brusselle, G G O

    2016-09-01

    Severe asthma in the elderly places a high burden on affected individuals and society. Emerging therapies target specific phenotypes of the asthma disease spectrum, and can be beneficial for older asthmatics, albeit their response might be altered due to age-related characteristics. Paradoxically, these characteristics are often ground for exclusion from clinical trials. The question thus arises how the senior asthmatic population can successfully enter the era of targeted therapy. Therefore, we highlight characteristics of this population relevant to effective treatment, and review the evidence for targeted therapy in elderly patients. For targeted therapy it is important to account for aging, as this affects the distribution of phenotypes (e.g. late-onset asthma, non-eosinophilic asthma) and may alter biomarkers and drug metabolism. Elderly asthmatics suffer from age-related comorbidities and subsequent polypharmacy. A systematic search into targeted asthma therapy yielded no randomized clinical trials dedicated to older asthmatics. Post hoc analyses of the anti-immunoglobulin E agent omalizumab indicate similar efficacy in both younger and older adults. Conference abstracts on anti-interleukin-5 and anti-interleukin-13 therapy suggest even more pronounced effects of targeted treatments in late-onset disease and in asthmatic patients 65 years or older, but full reports are lacking. For non-eosinophilic asthma in the elderly, there is not yet high-level evidence for targeted therapy, but macrolides may offer a viable option. In conclusion, there is a gap in knowledge regarding the effect of older age on the safety and efficacy of targeted asthma therapy. Further investigations in the elderly are needed, with special emphasis on both late-onset asthma and therapeutics for non-eosinophilic asthma. PMID:27638817

  12. Association between frailty and delirium in older adult patients discharged from hospital

    PubMed Central

    Verloo, Henk; Goulet, Céline; Morin, Diane; von Gunten, Armin

    2016-01-01

    Background Delirium and frailty – both potentially reversible geriatric syndromes – are seldom studied together, although they often occur jointly in older patients discharged from hospitals. This study aimed to explore the relationship between delirium and frailty in older adults discharged from hospitals. Methods Of the 221 patients aged >65 years, who were invited to participate, only 114 gave their consent to participate in this study. Delirium was assessed using the confusion assessment method, in which patients were classified dichotomously as delirious or nondelirious according to its algorithm. Frailty was assessed using the Edmonton Frailty Scale, which classifies patients dichotomously as frail or nonfrail. In addition to the sociodemographic characteristics, covariates such as scores from the Mini-Mental State Examination, Instrumental Activities of Daily Living scale, and Cumulative Illness Rating Scale for Geriatrics and details regarding polymedication were collected. A multidimensional linear regression model was used for analysis. Results Almost 20% of participants had delirium (n=22), and 76.3% were classified as frail (n=87); 31.5% of the variance in the delirium score was explained by frailty (R2=0.315). Age; polymedication; scores of the Confusion Assessment Method (CAM), instrumental activities of daily living, and Cumulative Illness Rating Scale for Geriatrics; and frailty increased the predictability of the variance of delirium by 32% to 64% (R2=0.64). Conclusion Frailty is strongly related to delirium in older patients after discharge from the hospital. PMID:26848261

  13. Self-management of coronary heart disease in older patients after elective percutaneous transluminal coronary angioplasty

    PubMed Central

    Dawkes, Susan; Smith, Graeme D; Elliott, Lawrie; Raeside, Robert; Donaldson, Jayne H

    2016-01-01

    Objective To explore how older patients self-manage their coronary heart disease (CHD) after undergoing elective percutaneous transluminal coronary angioplasty (PTCA). Methods This mixed methods study used a sequential, explanatory design and recruited a convenience sample of patients (n = 93) approximately three months after elective PTCA. The study was conducted in two phases. Quantitative data collected in Phase 1 by means of a self-administered survey were subject to univariate and bivariate analysis. Phase 1 findings informed the purposive sampling for Phase 2 where ten participants were selected from the original sample for an in-depth interview. Qualitative data were analysed using thematic analysis. This paper will primarily report the findings from a sub-group of older participants (n = 47) classified as 65 years of age or older. Results 78.7% (n = 37) of participants indicated that they would manage recurring angina symptoms by taking glyceryl trinitrate and 34% (n = 16) thought that resting would help. Regardless of the duration or severity of the symptoms 40.5% (n = 19) would call their general practitioner or an emergency ambulance for assistance during any recurrence of angina symptoms. Older participants weighed less (P = 0.02) and smoked less (P = 0.01) than their younger counterparts in the study. Age did not seem to affect PTCA patients' likelihood of altering dietary factors such as fruit, vegetable and saturated fat consumption (P = 0.237). Conclusions The findings suggest that older people in the study were less likely to know how to correctly manage any recurring angina symptoms than their younger counterparts but they had fewer risk factors for CHD. Age was not a factor that influenced participants' likelihood to alter lifestyle factors. PMID:27594866

  14. The Accuracy of Older and Younger Australians' Understanding of Mental Health and Aging.

    ERIC Educational Resources Information Center

    Peterson, Candida C.

    1993-01-01

    Administered quiz about positive and negative aspects of mental health in old age to 250 Australian adults (ages 17-81). Retirees scored lowest, with no significant differences among younger students versus nonstudents. Age was more important mediator of retirees' low scores than was gender, living with older person, or self-definition as retired.…

  15. Do Out-of-Pocket Health Expenditures Rise with Age Among Older Americans?

    ERIC Educational Resources Information Center

    Stewart, Susan T.

    2004-01-01

    Purpose: Relationships are examined between age and out-of-pocket costs for different health goods and services among the older population. Design and Methods: Age patterns in health service use and out-of-pocket costs are examined by use of the 1990 Elderly Health Supplement to the Panel Study of Income Dynamics (N = 1,031, age 66+). Multivariate…

  16. Exercise and older patients: guidelines for the clinician.

    PubMed

    Christmas, C; Andersen, R A

    2000-03-01

    Sedentary persons who improve their physical fitness are less likely to die of all causes and of cardiovascular disease than are those who remain sedentary. There now exists a wealth of data demonstrating that physical activity and exercise may ameliorate disease and delay decline in function in the geriatric population. We review evidence that exercise can improve body composition, diminish falls, increase strength, reduce depression, reduce arthritis pain, reduce risks for diabetes and coronary artery disease, and improve longevity. However, many healthcare professionals do not feel adequately prepared to design and prescribe exercise programs for their patients. This review provides a basic overview of the benefits of exercise in the geriatric population and guidelines indicating how to prescribe and facilitate adherence to an exercise program. Healthcare providers are strongly encouraged to promote a less sedentary life style for their older patients, which may augment quality of life in these older individuals.

  17. Drug use among HIV+ adults aged 50 and older: findings from the GOLD II study.

    PubMed

    Ompad, Danielle C; Giobazolia, Tatiana T; Barton, Staci C; Halkitis, Sophia N; Boone, Cheriko A; Halkitis, Perry N; Kapadia, Farzana; Urbina, Antonio

    2016-11-01

    Understanding the nexus of aging, HIV, and substance use is key to providing appropriate services and support for their aging, HIV seropositive patients. The proportion of PLWHA aged 50 and older is growing due to a variety of factors like decreases in mortality due to highly active retroviral therapy and non-negligible HIV incidence. We describe prevalence of alcohol, tobacco, and other drug use and participation in substance use treatment and 12-step programs among 95 HIV-positive patients aged 50 and older engaged in care. Most (73.7%) smoked cigarettes in their lifetime and 46.3% were current smokers. Most were at medium (81.1%) or high risk (13.7%) for an alcohol use disorder. With respect to illicit drug use, 48.4% had used marijuana, cocaine, crack, methamphetamines, heroin, and/or prescription opiates without a prescription in the last 12 months; 23.2% met criteria for drug dependence. Marijuana was the most commonly reported illicit drug (32.6%) followed by cocaine and crack (10.5% each), heroin and prescription opiates (7.4% each), and methamphetamines (6.3%). Among those who had not used drugs in the past 12 months, 36.7% had been in a substance use treatment program and 26.5% had participated in a 12-step program in their lifetime; 8.2% were currently in treatment and 16.3% were currently participating in a 12-step program. Among those who had used an illicit drug in the past 12 months, 37.0% had never been in treatment, 34.8% had been in treatment in their lifetime, and 28.3% were currently in treatment. With respect to 12-step programs, 27.3% of those meeting dependence criteria had never participated, 45.5% had participated in their lifetimes, and 27.3% were currently participating. Our findings suggest that older adults in HIV care settings could benefit from Screening, Brief Intervention, and Referral to Treatment interventions and/or integrated services for substance abuse and medical treatment.

  18. Drug use among HIV+ adults aged 50 and older: findings from the GOLD II study.

    PubMed

    Ompad, Danielle C; Giobazolia, Tatiana T; Barton, Staci C; Halkitis, Sophia N; Boone, Cheriko A; Halkitis, Perry N; Kapadia, Farzana; Urbina, Antonio

    2016-11-01

    Understanding the nexus of aging, HIV, and substance use is key to providing appropriate services and support for their aging, HIV seropositive patients. The proportion of PLWHA aged 50 and older is growing due to a variety of factors like decreases in mortality due to highly active retroviral therapy and non-negligible HIV incidence. We describe prevalence of alcohol, tobacco, and other drug use and participation in substance use treatment and 12-step programs among 95 HIV-positive patients aged 50 and older engaged in care. Most (73.7%) smoked cigarettes in their lifetime and 46.3% were current smokers. Most were at medium (81.1%) or high risk (13.7%) for an alcohol use disorder. With respect to illicit drug use, 48.4% had used marijuana, cocaine, crack, methamphetamines, heroin, and/or prescription opiates without a prescription in the last 12 months; 23.2% met criteria for drug dependence. Marijuana was the most commonly reported illicit drug (32.6%) followed by cocaine and crack (10.5% each), heroin and prescription opiates (7.4% each), and methamphetamines (6.3%). Among those who had not used drugs in the past 12 months, 36.7% had been in a substance use treatment program and 26.5% had participated in a 12-step program in their lifetime; 8.2% were currently in treatment and 16.3% were currently participating in a 12-step program. Among those who had used an illicit drug in the past 12 months, 37.0% had never been in treatment, 34.8% had been in treatment in their lifetime, and 28.3% were currently in treatment. With respect to 12-step programs, 27.3% of those meeting dependence criteria had never participated, 45.5% had participated in their lifetimes, and 27.3% were currently participating. Our findings suggest that older adults in HIV care settings could benefit from Screening, Brief Intervention, and Referral to Treatment interventions and/or integrated services for substance abuse and medical treatment. PMID:27145363

  19. McBride's operation for hallux valgus can be used in patients older than 30 years.

    PubMed

    Gebuhr, P; Soelberg, M; Larsen, T; Niclasen, B V; Laursen, N O

    1992-01-01

    Over a 10-year period, 46 feet with hallux valgus in 36 patients were treated with the McBride procedure. The median age was 35 years. At follow-up of 2 to 11 years after operation, a reduction in the hallux valgus angles, the intermetatarsal angles and the width of the forefeet was found. In patients older than 30 years there were significant reductions. In patients younger than 30 years, the reduction was not significant. The rate of problems with daily footwear was reduced from 36 of 46 feet to 13 of 38 feet. The authors noted few problems and a high rate of satisfied patients, despite the age. In 37 of 46 feet the overall result was found satisfactory by the patients. The authors find that McBride's operation can be used for hallux valgus, also in patients above 30 years, in spite of the generally accepted restriction to younger individuals.

  20. Partner age-disparity and HIV incidence risk for older women in rural South Africa

    PubMed Central

    Harling, Guy; Newell, Marie-Louise; Tanser, Frank; Bärnighausen, Till

    2014-01-01

    While sexual partner age disparity is frequently considered as a potential risk factor for HIV amongst young women in Africa, no research has addressed this question amongst older women. Our aim was thus to determine whether sex partner age disparity was associated with subsequent HIV acquisition in women aged over 30. Methods To achieve this aim we conducted a quantitative analysis of a population-based, open cohort of women in rural KwaZulu-Natal, South Africa (n=1,737) using Cox proportional hazards models. Results As partner age rose, HIV acquisition risk fell significantly: compared to a same-aged partner, a five-year older partner was associated with a one-third reduction (hazard ratio [HR]: 0.63, 95%CI: 0.52–0.76) and a ten-year older partner with a one-half reduction (HR: 0.48, 95%CI: 0.35–0.67). This result was neither confounded nor effect-modified by women’s age or socio-demographic factors. Conclusions These findings suggest that existing HIV risk-reduction campaigns warning young women about partnering with older men may be inappropriate for older women. HIV prevention strategies interventions specifically tailored to older women are needed. PMID:25670473

  1. Slowing of Mortality Rates at Older Ages in Large Medfly Cohorts

    NASA Astrophysics Data System (ADS)

    Carey, James R.; Liedo, Pablo; Orozco, Dina; Vaupel, James W.

    1992-10-01

    It is generally assumed for most species that mortality rates increase monotonically at advanced ages. Mortality rates were found to level off and decrease at older ages in a population of 1.2 million medflies maintained in cages of 7,200 and in a group of approximately 48,000 adults maintained in solitary confinement. Thus, life expectancy in older individuals increased rather than decreased with age. These results cast doubt on several central concepts in gerontology and the biology of aging: (i) that senescence can be characterized by an increase in age-specific mortality, (ii) that the basic pattern of mortality in nearly all species follows the same unitary pattern at older ages, and (iii) that species have absolute life-span limits.

  2. Aging in community: mobilizing a new paradigm of older adults as a core social resource.

    PubMed

    Black, Kathy; Dobbs, Debra; Young, Tiffany L

    2015-03-01

    Dignity and independence are widely considered as core concepts to aging well, yet little research has explored how older adults perceive these issues in the context of community life. Moreover, little is known regarding the ways in which the broader public views and enhances aging with dignity and independence with their older residents. Using participatory action research, multiple methods of qualitative inquiry, and tenets of appreciative inquiry, this article reports on a community-based initiative aimed to better understand the positive aspects of aging with dignity and independence. Synthesized findings yielded 6 "actionable themes": (1) meaningful involvement, (2) aging in place, (3) respect and inclusion, (4) communication and information, (5) transportation and mobility, and (6) health and well-being. The findings invoke a new paradigm for community aging that highlights the unique contributions of older adults as a core social resource. Implications for mobilizing community action to promote aging with dignity and independence are discussed. PMID:25681387

  3. Meconium ileus equivalent in older patients with cystic fibrosis.

    PubMed

    Hanly, J G; Fitzgerald, M X

    1983-04-30

    Meconium ileus equivalent is one of the lesser known manifestations of cystic fibrosis, and occurs most often in older patients. With the improved overall survival of patients with cystic fibrosis, one would expect to see this condition more often in the future. Of 53 patients attending our cystic fibrosis clinic for adolescents and adults, eight had experienced a total of 25 episodes of meconium ileus equivalent. Recurrent attacks occurred in seven patients, of whom four had at least four separate, well documented episodes: these episodes were associated with obvious recognised precipitating factors in only three patients. All patients responded to appropriate medical treatment with acetylcysteine or sodium diatrizoate, including three who had previously undergone surgery for meconium ileus equivalent elsewhere. Controversies remain, however, concerning the role of prophylactic medical management with acetylcysteine, sodium diatrizoate, and pancreatic supplements. PMID:6404483

  4. [Comprehensive geriatric assessment in older patients with diabetes mellitus].

    PubMed

    Araki, Atsushi

    2013-11-01

    Because the prevalence of older old patients with diabetes is increasing in Japan, diabetic patients with physical or cognitive impairment are also becoming to be more prevalent in clinical practice. The comprehensive geriatric assessment (CGA) consists of 5 important domains: physical function (basic ADL, instrumental ADL, vision, etc.), psychological function, mental function, socio-economic conditions, and patient's preference. The functions in CGA can be used as predictors for prognosis, a tool for early diagnosis of dementia, assessment tool of patient's capacity for insulin self-injection, and outcomes of diabetes treatment. The CGA is also useful in performing a patient-centered approach to improve the physical, psychological, and mental functions as well as to individualize a treatment goal of HbA1c in elderly patients with diabetes mellitus.

  5. Age, marital satisfaction, and optimism as predictors of positive sentiment override in middle-aged and older married couples.

    PubMed

    Story, T Nathan; Berg, Cynthia A; Smith, Timothy W; Beveridge, Ryan; Henry, Nancy J M; Pearce, Gale

    2007-12-01

    This study examined whether positive sentiment override (greater positive appraisal of spouse's affiliative behavior than is warranted by observed behavior) occurred more frequently in older compared with middle-aged married couples and whether age differences were mediated by older adults' greater marital satisfaction when controlling for optimism. Participants included 270 middle-aged (40-50 years old) and older (60-70 years old) couples who discussed a marital disagreement and completed an errand task. Couples provided appraisals of their spouse's affiliation, and the authors coded affiliative interactions using the structural analysis of social behavior. Hierarchical multivariate linear modeling indicated that older husbands and wives viewed their spouse's behavior as more positive during disagreement interactions than did independent observers; in the errand task, only older wives demonstrated positive sentiment override. Age differences in positive sentiment override were mediated by marital satisfaction, even when controlling for optimism. The results are consistent with theories of emotion regulation, such as socioemotional selectivity theory, that suggest that older adults are biased toward the positive aspects of close relationships.

  6. Age, race, diabetes, blood pressure, and mortality among hemodialysis patients.

    PubMed

    Myers, Orrin B; Adams, Christopher; Rohrscheib, Mark R; Servilla, Karen S; Miskulin, Dana; Bedrick, Edward J; Zager, Philip G

    2010-11-01

    Observational studies involving hemodialysis patients suggest a U-shaped relationship between BP and mortality, but the majority of these studies followed large, heterogeneous cohorts. To examine whether age, race, and diabetes status affect the association between systolic BP (SBP; predialysis) and mortality, we studied a cohort of 16,283 incident hemodialysis patients. We constructed a series of multivariate proportional hazards models, adding age and BP to the analyses as cubic polynomial splines to model potential nonlinear relationships with mortality. Overall, low SBP associated with increased mortality, and the association was more pronounced among older patients and those with diabetes. Higher SBP associated with increased mortality among younger patients, regardless of race or diabetes status. We observed a survival advantage for black patients primarily among older patients. Diabetes associated with increased mortality mainly among older patients with low BP. In conclusion, the design of randomized clinical trials to identify optimal BP targets for patients with ESRD should take age and diabetes status into consideration.

  7. Choosing relevant endpoints for older breast cancer patients in clinical trials: an overview of all current clinical trials on breast cancer treatment.

    PubMed

    de Glas, N A; Hamaker, M E; Kiderlen, M; de Craen, A J M; Mooijaart, S P; van de Velde, C J H; van Munster, B C; Portielje, J E A; Liefers, G J; Bastiaannet, E

    2014-08-01

    With the ongoing ageing of western societies, the proportion of older breast cancer patients will increase. For several years, clinicians and researchers in geriatric oncology have urged for new clinical trials that address patient-related endpoints such as functional decline after treatment of older patients. The aim of this study was to present an overview of trial characteristics and endpoints of all currently running clinical trials in breast cancer, particularly in older patients. The clinical trial register of the United States National Institutes of Health Differences was searched for all current clinical trials on breast cancer treatment. Trial characteristics and endpoints were retrieved from the register and differences in characteristics between studies in older patients specifically (defined as a lower age-limit of 60 years or older) and trials in all patients were assessed using χ(2) tests. We included 463 clinical trials. Nine trials (2 %) specifically investigated breast cancer treatment in older patients. Ninety-one breast cancer trials included any patient-related endpoint (20 %), while five trials specifically addressing older patients included any patient-related endpoint (56 %, P = 0.02). Five of the trials in older patients incorporated a geriatric assessment (56 %). Clinical trials still rarely incorporate patient-related endpoints, even in trials that specifically address older patients. Trials that are specifically designed for older patients do not often incorporate a geriatric assessment in their design. This implicates that current clinical studies are not expected to fill the gap in knowledge concerning treatment of older breast cancer patients in the next decade.

  8. Probiotics for the prevention and treatment of Clostridium difficile in older patients.

    PubMed

    Islam, Jasmin; Cohen, Jonathan; Rajkumar, Chakravarthi; Llewelyn, Martin J

    2012-11-01

    Clostridium difficile infection (CDI) is the leading cause of nosocomial diarrhoea in older people, causing substantial morbidity and mortality. The fact that CDI is almost exclusively a disease of older people and the debilitated indicates that patient susceptibility is a major determinant of who gets CDI. It would help efforts to combat this disease if we better understood and could reduce patient susceptibility. In this regard, several strategies are currently under investigation. The use of probiotics for CDI has received particular attention in the medical and lay media. Patients and their carers often ask doctors about them. In this review article, we describe the pathogenesis of CDI before looking at the ageing host in more detail. We discuss how probiotics may work and review the current evidence for their use in CDI.

  9. Knowledge of Aging and Life Satisfaction among Older Adults

    ERIC Educational Resources Information Center

    Davis, Neil C.; Friedrich, Douglas

    2004-01-01

    Four hundred young-, middle-, and old-old adults responded to a battery of quizzes dealing with life satisfaction and objective aging knowledge in the physical, psychological, and social domains. Analyses incorporated domains of aging knowledge, life satisfaction, age, gender, and demographic variables. Both means difference and regression…

  10. The Difference that Age Makes: Cultural Factors that Shape Older Adults' Responses to Age-Related Macular Degeneration

    ERIC Educational Resources Information Center

    Mogk, Marja

    2008-01-01

    This article suggests that approaching vision loss from age-related macular degeneration from a sociocultural perspective, specifically considering perceptions of aging, blindness, disability, and generational viewpoints and norms, may be critical to understanding older adults' responses to vision loss and visual rehabilitation.

  11. The general age of leadership: older-looking presidential candidates win elections during war.

    PubMed

    Spisak, Brian R

    2012-01-01

    As nation-state leaders age they increasingly engage in inter-state militarized disputes yet in industrialized societies a steady decrease in testosterone associated with aging is observed--which suggests a decrease in dominance behavior. The current paper points out that from modern societies to Old World monkeys increasing both in age and social status encourages dominant strategies to maintain acquired rank. Moreover, it is argued this consistency has shaped an implicit prototype causing followers to associate older age with dominance leadership. It is shown that (i) faces of older leaders are preferred during intergroup conflict and (ii) morphing U.S. Presidential candidates to appear older or younger has an overriding effect on actual election outcomes. This indicates that democratic voting can be systematically adjusted by activating innate biases. These findings appear to create a new line of research regarding the biology of leadership and contextual cues of age.

  12. The General Age of Leadership: Older-Looking Presidential Candidates Win Elections during War

    PubMed Central

    Spisak, Brian R.

    2012-01-01

    As nation-state leaders age they increasingly engage in inter-state militarized disputes yet in industrialized societies a steady decrease in testosterone associated with aging is observed – which suggests a decrease in dominance behavior. The current paper points out that from modern societies to Old World monkeys increasing both in age and social status encourages dominant strategies to maintain acquired rank. Moreover, it is argued this consistency has shaped an implicit prototype causing followers to associate older age with dominance leadership. It is shown that (i) faces of older leaders are preferred during intergroup conflict and (ii) morphing U.S. Presidential candidates to appear older or younger has an overriding effect on actual election outcomes. This indicates that democratic voting can be systematically adjusted by activating innate biases. These findings appear to create a new line of research regarding the biology of leadership and contextual cues of age. PMID:22649504

  13. Changes in Quality of Life in 7 Older Adult Patients Receiving Activator Methods Chiropractic Technique

    PubMed Central

    Russell, David G.; Kimura, Melissa N.; Cowie, Harriet R.; de Groot, Caroline M.M.; McMinn, Elise A.P.; Sherson, Matthew W.

    2016-01-01

    Objective The purpose of this case series is to report on symptomatic and quality of life (QoL) changes in 7 older adult chiropractic patients who were receiving care using Activator Methods Chiropractic Technique (AMCT). Clinical Features Seven patients were selected from 2 chiropractic offices in Auckland, New Zealand. Patients were included if they were older adults receiving AMCT care and for whom at least 2 QoL assessments had been performed. The patients, aged 69-80 years, primarily received care for a variety of musculoskeletal complaints. Intervention and Outcomes The patients reported improvements in their presenting complaints as well as a number of nonmusculoskeletal symptoms. Each patient demonstrated clinical improvements in their RAND 36-Item Short Form Health Survey (SF-36) results. The average improvement in QoL measured using a SF-36 questionnaire was 8.0 points in the physical component and 4.1 points in the mental component. Four cases had a second progress evaluation using the SF-36 and showed an overall improvement of 5.2 in the physical and 9.8 in the mental components from baseline. Conclusion This case series describes an improvement in QoL, as measured by the SF-36 instrument, as well as subjectively reported improvements in both musculoskeletal and nonmusculoskeletal symptoms in 7 older adults receiving chiropractic care. PMID:27069434

  14. Preoperative assessment of the older surgical patient: honing in on geriatric syndromes.

    PubMed

    Kim, Sunghye; Brooks, Amber K; Groban, Leanne

    2015-01-01

    Nearly 50% of Americans will have an operation after the age of 65 years. Traditional preoperative anesthesia consultations capture only some of the information needed to identify older patients (defined as ≥65 years of age) undergoing elective surgery who are at increased risk for postoperative complications, prolonged hospital stays, and delayed or hampered functional recovery. As a catalyst to this review, we compared traditional risk scores (eg, cardiac-focused) to geriatric-specific risk measures from two older female patients seen in our preoperative clinic who were scheduled for elective, robotic-assisted hysterectomies. Despite having a lower cardiac risk index and Charlson comorbidity score, the younger of the two patients presented with more subtle negative geriatric-specific risk predictors - including intermediate or pre-frail status, borderline malnutrition, and reduced functional/mobility - which may have contributed to her 1-day-longer length of stay and need for readmission. Adequate screening of physiologic and cognitive reserves in older patients scheduled for surgery could identify at-risk, vulnerable elders and enable proactive perioperative management strategies (eg, strength, balance, and mobility prehabilitation) to reduce adverse postoperative outcomes and readmissions. Here, we describe our initial two cases and review the stress response to surgery and the impact of advanced age on this response as well as preoperative geriatric assessments, including frailty, nutrition, physical function, cognition, and mood state tests that may better predict postoperative outcomes in older adults. A brief overview of the literature on anesthetic techniques that may influence geriatric-related syndromes is also presented.

  15. Memory Loss, Dementia, and Stroke: Implications for Rehabilitation of Older Adults with Age-Related Macular Degeneration

    ERIC Educational Resources Information Center

    Warren, Mary

    2008-01-01

    Older adults with age-related macular degeneration (AMD) are not immune to the other diseases of aging. Although AMD is the leading cause of low vision in older Americans, stroke is the leading cause of disability, and dementias affect another 2.5 million older Americans. Each condition alone can significantly impair a person's ability to…

  16. Burden of poor oral health in older age: findings from a population-based study of older British men

    PubMed Central

    Ramsay, S E; Whincup, P H; Watt, R G; Tsakos, G; Papacosta, A O; Lennon, L T; Wannamethee, S G

    2015-01-01

    Objectives Evidence of the extent of poor oral health in the older UK adult population is limited. We describe the prevalence of oral health conditions, using objective clinical and subjective measures, in a population-based study of older men. Design Cross-sectional study. Setting and participants A representative sample of men aged 71–92 years in 2010–2012 from the British Regional Heart Study, initially recruited in 1978–1980 from general practices across Britain. Physical examination among 1660 men included the number of teeth, and periodontal disease in index teeth in each sextant (loss of attachment, periodontal pocket, gingival bleeding). Postal questionnaires (completed by 2147 men including all participants who were clinically examined) included self-rated oral health, oral impacts on daily life and current perception of dry mouth experience. Results Among 1660 men clinically examined, 338 (20%) were edentulous and a further 728 (43%) had <21 teeth. For periodontal disease, 233 (19%) had loss of attachment (>5.5 mm) affecting 1–20% of sites while 303 (24%) had >20% sites affected. The prevalence of gingival bleeding was 16%. Among 2147 men who returned postal questionnaires, 35% reported fair/poor oral health; 11% reported difficulty eating due to oral health problems. 31% reported 1–2 symptoms of dry mouth and 20% reported 3–5 symptoms of dry mouth. The prevalence of edentulism, loss of attachment, or fair/poor self-rated oral health was greater in those from manual social class. Conclusions These findings highlight the high burden of poor oral health in older British men. This was reflected in both the objective clinical and subjective measures of oral health conditions. The determinants of these oral health problems in older populations merit further research to reduce the burden and consequences of poor oral health in older people. PMID:26715480

  17. Prognostication in Acutely Admitted Older Patients by Nurses and Physicians

    PubMed Central

    Buurman, Bianca M.; van Munster, Barbara C.; Abu-Hanna, Ameen; Levi, Marcel; de Rooij, Sophia E.

    2008-01-01

    Background The process of prognostication has not been described for acutely hospitalized older patients. Objective To investigate (1) which factors are associated with 90-day mortality risk in a group of acutely hospitalized older medical patients, and (2) whether adding a clinical impression score of nurses or physicians improves the discriminatory ability of mortality prediction. Design Prospective cohort study. Participants Four hundred and sixty-three medical patients 65 years or older acutely admitted from November 1, 2002, through July 1, 2005, to a 1024-bed tertiary university teaching hospital. Measurements At admission, the attending nurse and physician were asked to give a clinical impression score for the illness the patient was admitted for. This score ranged from 1 (high possibility of a good outcome) until 10 (high possibility of a bad outcome, including mortality). Of all patients baseline characteristics and clinical parameters were collected. Mortality was registered up to 90 days after admission. Main Results In total, 23.8% ( = 110) of patients died within 90 days of admission. Four parameters were significantly associated with mortality risk: functional impairment, diagnosis malignancy, co-morbidities and high urea nitrogen serum levels. The AUC for the baseline model which included these risk factors (model 1) was 0.76 (95% CI 0.71 to 0.82). The AUC for the model using the risk factors and the clinical impression score of the physician (model 2) was 0.77 (0.71 to 0.82). The AUC for the model using the risk factors and the clinical impression score of the nurse (model 3) was 0.76 (0.71 to 0.82) and the AUC for the model, including the baseline covariates and the clinical impression score of both nurses and physicians was 0.77 (0.72 to 0.82). Adding clinical impression scores to model 1 did not significantly improve its accuracy. Conclusion A set of four clinical variables predicted mortality risk in acutely hospitalized older patients

  18. Management of Persistent Pain in the Older Patient A Clinical Review

    PubMed Central

    Makris, Una E.; Abrams, Robert C.; Gurland, Barry; Reid, M. Carrington

    2015-01-01

    Importance Persistent pain is highly prevalent, costly, and frequently disabling in later life. Objective To describe barriers to the management of persistent pain among older adults, summarize current management approaches, including pharmacologic and nonpharmacologic modalities; present rehabilitative approaches; and highlight aspects of the patient-physician relationship that can help to improve treatment outcomes. This review is relevant for physicians who seek an age-appropriate approach to delivering pain care for the older adult. Evidence Acquisition Search of MEDLINE and the Cochrane database from January 1990 through May 2014, using the search terms older adults, senior, ages 65 and above, elderly, and aged along with non-cancer pain, chronic pain, persistent pain, pain management, intractable pain, and refractory pain to identify English-language peer-reviewed systematic reviews, meta-analyses, Cochrane reviews, consensus statements, and guidelines relevant to the management of persistent pain in older adults. Findings Of the 92 identified studies, 35 evaluated pharmacologic interventions, whereas 57 examined nonpharmacologic modalities; the majority (n = 50) focused on older adults with osteoarthritis. This evidence base supports a stepwise approach with acetaminophen as first-line therapy. If treatment goals are not met, a trial of a topical nonsteroidal anti-inflammatory drug, tramadol, or both is recommended. Oral nonsteroidal anti-inflammatory drugs are not recommended for long-term use. Careful surveillance to monitor for toxicity and efficacy is critical, given that advancing age increases risk for adverse effects. A multimodal approach is strongly recommended–emphasizing a combination of both pharmacologic and nonpharmacologic treatments to include physical and occupational rehabilitation, as well as cognitive-behavioral and movement-based interventions. An integrated pain management approach is ideally achieved by cultivating a strong

  19. Biological ageing and frailty markers in breast cancer patients

    PubMed Central

    Hatse, Sigrid; Laenen, Annouschka; Kenis, Cindy; Swerts, Evalien; Neven, Patrick; Smeets, Ann; Schöffski, Patrick; Wildiers, Hans

    2015-01-01

    Older cancer patients are a highly heterogeneous population in terms of global health and physiological reserves, and it is often difficult to determine the best treatment. Moreover, clinical tools currently used to assess global health require dedicated time and lack a standardized end score. Circulating markers of biological age and/or fitness could complement or partially substitute the existing screening tools. In this study we explored the relationship of potential ageing/frailty biomarkers with age and clinical frailty. On a population of 82 young and 162 older non-metastatic breast cancer patients, we measured mean leukocyte telomere length and plasma levels of interleukin-6 (IL-6), regulated upon activation, normal T cell expressed and secreted (RANTES), monocyte chemotactic protein 1 (MCP-1), insulin-like growth factor 1 (IGF-1). We also developed a new tool to summarize clinical frailty, designated Leuven Oncogeriatric Frailty Score (LOFS), by integrating GA results in a single, semi-continuous score. LOFS' median score was 8, on a scale from 0=frail to 10=fit. IL-6 levels were associated with chronological age in both groups and with clinical frailty in older breast cancer patients, whereas telomere length, IGF-1 and MCP-1 only correlated with age. Plasma IL-6 should be further explored as frailty biomarker in cancer patients. PMID:25989735

  20. Successful Aging Among LGBT Older Adults: Physical and Mental Health-Related Quality of Life by Age Group

    PubMed Central

    Kim, Hyun-Jun; Shiu, Chengshi; Goldsen, Jayn; Emlet, Charles A.

    2015-01-01

    Purpose: Lesbian, gay, bisexual, and transgender (LGBT) people are a health disparate population as identified in Healthy People 2020. Yet, there has been limited attention to how LGBT older adults maintain successful aging despite the adversity they face. Utilizing a Resilience Framework, this study investigates the relationship between physical and mental health-related quality of life (QOL) and covariates by age group. Design and Methods: A cross-sectional survey of LGBT adults aged 50 and older (N = 2,560) was conducted by Caring and Aging with Pride: The National Health, Aging, and Sexuality Study via collaborations with 11 sites across the U.S. Linear regression analyses tested specified relationships and moderating effects of age groups (aged 50–64; 65–79; 80 and older). Results: Physical and mental health QOL were negatively associated with discrimination and chronic conditions and positively with social support, social network size, physical and leisure activities, substance nonuse, employment, income, and being male when controlling for age and other covariates. Mental health QOL was also positively associated with positive sense of sexual identity and negatively with sexual identity disclosure. Important differences by age group emerged and for the old–old age group the influence of discrimination was particularly salient. Implications: This is the first study to examine physical and mental health QOL, as an indicator of successful aging, among LGBT older adults. An understanding of the configuration of resources and risks by age group is important for the development of aging and health initiatives tailored for this growing population. PMID:25213483

  1. Exploring identity and aging: auto-photography and narratives of low income older adults.

    PubMed

    Kohon, Jacklyn; Carder, Paula

    2014-08-01

    This study focused on meanings of health, housing, independence and aging among low-income adults age 55 and older who live in, or are on a waiting list for, publicly subsidized rental housing. The purpose was to learn how low-income older adults perceive their independence and health, and how their place of residence contributes to these perceptions, as well as related perceptions of self. Qualitative data were collected using in-person narrative interviews with 45 individuals and a second photo elicitation interview with 31 of these persons. Themes describe how disrupted identities influence subjective thoughts about the aging process, housing, health, and finances, the process of clinicalization, and place identities. These findings highlight the relationship between housing status, dignity, and shifting identities as older adults experience the aging process in a low-income context. This study expands the current scholarship on the relationship between environment and aging as well as our understanding of poverty among older persons. These topics are relevant for new policies and programs to support the aging in place of older persons in subsidized housing. Understanding the life worlds of those who live in or have applied to this form of housing will be instrumental in developing such strategies. PMID:24984907

  2. Multiple Trajectories of Successful Aging of Older and Younger Cohorts

    ERIC Educational Resources Information Center

    Hsu, Hui-Chuan; Jones, Bobby L.

    2012-01-01

    Purpose: The purpose of this study was to apply group-based trajectory analysis to identify multiple successful aging trajectories by multiple indicators and to examine the factors related to successful aging among the elderly population in Taiwan. Design and Methods: Nation-representative longitudinal data collected from 1993 to 2007 and…

  3. Age, Health and Life Satisfaction among Older Europeans

    ERIC Educational Resources Information Center

    Angelini, Viola; Cavapozzi, Danilo; Corazzini, Luca; Paccagnella, Omar

    2012-01-01

    In this paper we investigate how age affects the self-reported level of life satisfaction among the elderly in Europe. By using a vignette approach, we find evidence that age influences life satisfaction through two counterbalancing channels. On the one hand, controlling for the effects of all other variables, the own perceived level of life…

  4. Preventive Medicine in the Older Patient: A United Kingdom Perspective

    PubMed Central

    Kakar, Puneet

    2012-01-01

    Preventive Medicine in the elderly is often regarded as a redundant concept and pre-existing opinions are barriers in the provision of this service. This article explores the concepts of preventive medicine in the elderly from a United Kingdom perspective and examines current trends, opinions and sets out a path for the future. In particular it focusses on the theories of morbidity associated with ageing, economic viability of providing preventive medicine care for the older person and attempts to seek redress for the current situation. PMID:22783463

  5. Chemistry of the older supracrustals of Archaean age around Sargur

    NASA Technical Reports Server (NTRS)

    Janardhan, A. S.; Shadaksharaswamy, N.; Capdevila, R.

    1988-01-01

    In the Archaeans of the Karnataka craton two stratigraphically distinct volcano-sedimentary sequences occur, namely the older supracrustals of the Sargur type and the younger Dharwar greenstones. The dividing line between these is the 3 by old component of the Peninsular gneiss. The trace and rare earth element chemistry of the Sargur metasediments show, in general, marked similarity to the Archaean sediments. The significant departures are in the nickel and chromium abundances. The REE data of the Sargur pelites of the Terakanambi region represented by Silli-gt-bio-feldspar schists and paragneisses show LREE enrichment and flat to depleted HREE pattern. Banded iron formations have very low REE abundance. They show slightly enriched LREE and flat to depleted HREE pattern. REE abundance in the Mn-horizons is comparable to that of the Archaean sediments. Mn-horizons show enriched LREE and flat HREE with anamolous Eu. REE patterns of these bands is well evolved and has similarities with PAAS.

  6. Spatial-Sequential Working Memory in Younger and Older Adults: Age Predicts Backward Recall Performance within Both Age Groups

    PubMed Central

    Brown, Louise A.

    2016-01-01

    Working memory is vulnerable to age-related decline, but there is debate regarding the age-sensitivity of different forms of spatial-sequential working memory task, depending on their passive or active nature. The functional architecture of spatial working memory was therefore explored in younger (18–40 years) and older (64–85 years) adults, using passive and active recall tasks. Spatial working memory was assessed using a modified version of the Spatial Span subtest of the Wechsler Memory Scale – Third Edition (WMS-III; Wechsler, 1998). Across both age groups, the effects of interference (control, visual, or spatial), and recall type (forward and backward), were investigated. There was a clear effect of age group, with younger adults demonstrating a larger spatial working memory capacity than the older adults overall. There was also a specific effect of interference, with the spatial interference task (spatial tapping) reliably reducing performance relative to both the control and visual interference (dynamic visual noise) conditions in both age groups and both recall types. This suggests that younger and older adults have similar dependence upon active spatial rehearsal, and that both forward and backward recall require this processing capacity. Linear regression analyses were then carried out within each age group, to assess the predictors of performance in each recall format (forward and backward). Specifically the backward recall task was significantly predicted by age, within both the younger and older adult groups. This finding supports previous literature showing lifespan linear declines in spatial-sequential working memory, and in working memory tasks from other domains, but contrasts with previous evidence that backward spatial span is no more sensitive to aging than forward span. The study suggests that backward spatial span is indeed more processing-intensive than forward span, even when both tasks include a retention period, and that age predicts

  7. Experience of an incontinence clinic for older women: no apparent age limit for potential physical and psychological benefits.

    PubMed

    Tannenbaum, C; Bachand, G; Dubeau, C E; Kuchel, G A

    2001-10-01

    Urinary incontinence (UI) is a common but undertreated condition in older women. Although a variety of noninvasive interventions is available, older women may be hesitant to seek care for UI because of misconceptions about normal aging and treatment futility. We sought to evaluate the effectiveness of a UI clinic specifically tailored to the needs of older women to promote a sense of empowerment and to enhance satisfaction with treatment and outcome. We describe a case series of 52 women between the ages of 65 and 98 who were evaluated at the Geriatric Incontinence Clinic at the McGill University Health Centre over a 1-year period. A standardized telephone questionnaire was administered by a nurse consultant 6 months after each subject's final visit to assess patient satisfaction and current incontinence status. Forty-five women (86%) were available for telephone follow-up and completed the questionnaire. Mean age was 80 years, with urge incontinence in 45%, mixed incontinence (stress and urge) in 33%, impaired bladder emptying with urge symptoms in 10%, and other diagnoses in 12%. Overall, a mean reduction of 1.4 incontinent episodes per day was reported. At follow-up, 30% of the subjects reported being cured of their incontinence, 30% had improved, 20% were the same, and 20% were worse. Over 85% of all women reported satisfaction with their new incontinence status. Women of all ages, independent of the type of UI, type of treatment, and cognitive status, were able to achieve reductions in incontinence symptoms. All patients who had worsened were noncompliant with treatment recommendations at follow-up. Older women can derive significant benefit from a UI assessment. Neither advanced age nor category of incontinence precludes improvements or enhanced satisfaction with treatment. Efforts to improve targeting and compliance may improve outcomes. PMID:11703887

  8. Finances in the Older Patient with Cognitive Impairment

    PubMed Central

    Widera, Eric; Steenpass, Veronika; Marson, Daniel; Sudore, Rebecca

    2013-01-01

    Financial capacity is the ability to manage money and financial assets in ways that meet a person’s needs and which are consistent with his/her values and self-interest. Financial capacity is essential for an individual to function independently in our society; however, dementia eventually leads to a complete loss of financial capacity. Many patients with cognitive impairment and their families turn to their primary care clinician for help with financial impairment, yet most clinicians do not understand their role or how to help. We review the prevalence and impact of financial incapacity in older adults with cognitive impairment. We also articulate the role of the primary clinician which includes: (1) educating older adult patients and families about the need for advance financial planning; (2) recognizing signs of possible impaired financial capacity; (3) assessing financial impairments in cognitively impaired adults; (4) recommending interventions to help patients maintain financial independence; and (5) knowing when and to whom to make medical and legal referrals. Clearly delineating the clinician’s role in financial impairment can lead to the establishment of effective financial protections and can limit the economic, psychological, and legal hardships of financial incapacity on patients with dementia and their families. PMID:21325186

  9. AGE AND GENDER DIFFERENCES IN ACUTE STROKE HOSPITAL PATIENTS.

    PubMed

    Kes, Vanja Bašić; Jurašić, Miljenka-Jelena; Zavoreo, Iris; Lisak, Marijana; Jelec, Vjekoslav; Matovina, Lucija Zadro

    2016-03-01

    Stroke is the second leading cause of death and the most important cause of adult disability worldwide and in Croatia. In the past, stroke was almost exclusively considered to be a disease of the elderly; however, today the age limit has considerably lowered towards younger age. The aim of this study was to determine age and gender impact on stroke patients in a Croatian urban area during one-year survey. The study included all acute stroke patients admitted to our Department in 2004. A compiled stroke questionnaire was fulfilled during hospitalization by medical personnel on the following items: stroke risk factors including lifestyle habits (smoking and alcohol), pre-stroke physical ability evaluation, stroke evolution data, laboratory and computed tomography findings, outcome data and post-stroke disability assessment. Appropriate statistical analysis of numerical and categorical data was performed at the level of p < 0.05. Analysis was performed on 396 patients, 24 of them from the younger adult stroke group. Older stroke patients had worse disability at hospital discharge and women had worse disabilities at both stroke onset and hospital discharge, probably due to older age at stroke onset. Younger patients recovered better, while older patients had to seek secondary medical facilities more often, as expected. The most important in-hospital laboratory findings in young stroke patients were elevated lipid levels, while older patients had elevated serum glucose and C-reactive protein. Stroke onset in younger patients most often presented with sudden onset headache; additionally, onset seizure was observed more frequently than expected. Stroke risk factor analysis showed that women were more prone to hypertension, chronic heart failure and atrial fibrillation, whereas men had carotid disease more frequently, were more often smokers and had higher alcohol intake. Additionally, age analysis showed that heart conditions and smoking were more prevalent among older

  10. The Arkansas Aging Initiative: An Innovative Approach for Addressing the Health of Older Rural Arkansans

    ERIC Educational Resources Information Center

    Beverly, Claudia J.; McAtee, Robin E.; Chernoff, Ronni; Davis, Gwynn V.; Jones, Susan K.; Lipschitz, David A.

    2007-01-01

    The Donald W. Reynolds Institute on Aging at the University of Arkansas for Medical Sciences in Little Rock is addressing one of the most pressing policy issues facing the United States: how to care for the burgeoning number of older adults. In 2001, the Institute created the Arkansas Aging Initiative, which established seven satellite centers on…

  11. The Effect of Retirement versus Age on the Shopping Orientations of the Older Consumer.

    ERIC Educational Resources Information Center

    Lumpkin, James R.

    1984-01-01

    Surveyed 933 middle aged and older adults to compare shopping behavior in retired and nonretired consumers. Results indicated the elderly enjoy shopping less and are less concerned with bargains than adults 55-64. Age, rather than retirement status, was a key factor. (JAC)

  12. Memory Aging Knowledge and Memory Self-Appraisal in Younger and Older Adults

    ERIC Educational Resources Information Center

    Cherry, Katie E.; Brigman, Susan; Reese-Melancon, Celinda; Burton-Chase, Allison; Holland, Kayla

    2013-01-01

    The purpose of this study was to examine relationships among memory aging knowledge and memory self-appraisal in college students and community-dwelling older adults. Participants completed the Knowledge of Memory Aging Questionnaire ([KMAQ] Cherry, Brigman, Hawley, & Reese, 2003) and the Memory Functioning Questionnaire ([MFQ] Gilewski, Zelinski,…

  13. Negotiations of the Ageing Process: Older Adults' Stories of Sports Participation

    ERIC Educational Resources Information Center

    Dionigi, Rylee A.; Horton, Sean; Baker, Joseph

    2013-01-01

    The purpose of this paper is to examine the talk of older athletes, with particular focus on how the context of sport helps them negotiate the ageing process. It draws on personal stories provided by 44 World Masters Games competitors (23 women; 21 men; aged 56-90 years; "M" = 72). Four themes emerged: "There's no such thing as…

  14. Age Group Differences in Depressive Symptoms among Older Adults with Functional Impairments

    ERIC Educational Resources Information Center

    Choi, Namkee G.; Kim, Johnny S.

    2007-01-01

    This study used data from the 2000 interview wave of the Health and Retirement Study to examine age group differences in the likelihood of self-reported depressive symptomatology among a nationally representative sample of 3,035 adults age 55 years or older who had at least one activities of daily living (ADL) or instrumental activities of daily…

  15. Older Men's Lay Definitions of Successful Aging over Time: The Manitoba Follow-Up Study

    ERIC Educational Resources Information Center

    Tate, Robert B.; Swift, Audrey U.; Bayomi, Dennis J.

    2013-01-01

    The concept of "successful aging" has become widely accepted in gerontology, yet continues to have no common underlying definition. Researchers have increasingly looked to older individuals for their lay definitions of successful aging. The present analysis is based on responses to five questionnaires administered to surviving participants of the…

  16. New Ideas for Promoting Physical Activity among Middle Age and Older Adults

    ERIC Educational Resources Information Center

    Godbey, Geoffrey; Burnett-Wolle, Sarah; Chow, Hsueh-Wen

    2007-01-01

    Promoting physical activity among middle age and older adults to decrease the incidence of disease and premature death and to combat the health care costs associated with a sedentary lifestyle is more important now than ever. There is now a better understanding of what "successful aging" means and of what aspects of life have the greatest…

  17. From Loving Grandma to Working with Older Adults: Promoting Positive Attitudes towards Aging

    ERIC Educational Resources Information Center

    Goncalves, Daniela C.

    2009-01-01

    The steady increase of population aging requires not only more people working within the field of aging but also the creation of new services. However, current students from areas such as medicine, nursing, psychology, and social work frequently have low interest in working with older adults. The low interest relates to this task's lack of…

  18. 20 CFR 404.745 - Evidence of school attendance for child age 18 or older.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... employer to attend school. (b) If you apply before the school year has started and the school is not a high... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false Evidence of school attendance for child age... § 404.745 Evidence of school attendance for child age 18 or older. If you apply for child's benefits...

  19. 20 CFR 404.745 - Evidence of school attendance for child age 18 or older.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... employer to attend school. (b) If you apply before the school year has started and the school is not a high... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false Evidence of school attendance for child age... § 404.745 Evidence of school attendance for child age 18 or older. If you apply for child's benefits...

  20. 20 CFR 404.745 - Evidence of school attendance for child age 18 or older.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... employer to attend school. (b) If you apply before the school year has started and the school is not a high... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false Evidence of school attendance for child age... § 404.745 Evidence of school attendance for child age 18 or older. If you apply for child's benefits...

  1. 20 CFR 404.745 - Evidence of school attendance for child age 18 or older.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... employer to attend school. (b) If you apply before the school year has started and the school is not a high... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false Evidence of school attendance for child age... § 404.745 Evidence of school attendance for child age 18 or older. If you apply for child's benefits...

  2. 20 CFR 404.745 - Evidence of school attendance for child age 18 or older.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... employer to attend school. (b) If you apply before the school year has started and the school is not a high... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Evidence of school attendance for child age... § 404.745 Evidence of school attendance for child age 18 or older. If you apply for child's benefits...

  3. Service Providers' Perceptions of Active Ageing among Older Adults with Lifelong Intellectual Disabilities

    ERIC Educational Resources Information Center

    Buys, L.; Aird, R.; Miller, E.

    2012-01-01

    Background: Considerable attention is currently being directed towards both active ageing and the revising of standards for disability services within Australia and internationally. Yet, to date, no consideration appears to have been given to ways to promote active ageing among older adults with intellectual disabilities (IDs). Methods:…

  4. Structural and Cultural Factors in Successful Aging Among Older Hispanics

    PubMed Central

    Angel, Ronald J.

    2014-01-01

    Successful or healthful aging are terms that draw attention to life course issues related to individual, physical, and psychologic development and maturation, but they also draw attention to the material basis of successful aging and the social structures that determine one’s place in the social hierarchy. This article focuses on barriers to optimal aging for Hispanics, especially those of Mexican origin, and argues that cultural factors and social class are closely associated. The reduction of health disparities and equity in medical and long-term care requires an understanding of both cultural and material sources of differential health levels. PMID:19065093

  5. Promoting successful aging through competitive sports participation: insights from older adults.

    PubMed

    Heo, Jinmoo; Culp, Brian; Yamada, Naoko; Won, Youngshin

    2013-01-01

    In this study we explored the experience of competing in the Senior Games and the resultant contributions to the successful aging of older adults. We used in-depth interviews with older adults who participated in the National Senior Games. Analysis of the data produced five central themes: (a) perseverance, (b) career development and significant effort, (c) personal and social benefits, (d) unique ethos, and (e) identification as a senior athlete. We found that participating in the Senior Games as a form of serious leisure enhanced the well-being of older adults and could be utilized as a means by which to maintain a healthy lifestyle. PMID:22927703

  6. Aging-Related Geniohyoid Muscle Atrophy Is Related to Aspiration Status in Healthy Older Adults

    PubMed Central

    2013-01-01

    Background. Age-related muscle weakness due to atrophy and fatty infiltration in orofacial muscles may be related to swallowing deficits in older adults. An important component of safe swallowing is the geniohyoid (GH) muscle, which helps elevate and stabilize the hyoid bone, thus protecting the airway. This study aimed to explore whether aging and aspiration in older adults were related to GH muscle atrophy and fatty infiltration. Method. Eighty computed tomography scans of the head and neck from 40 healthy older (average age 78 years) and 40 younger adults (average age 32 years) were analyzed. Twenty aspirators and 20 nonaspirators from the 40 older adults had been identified previously. Two-dimensional views in the sagittal and coronal planes were used to measure the GH cross-sectional area and fatty infiltration. Results. GH cross-sectional area was larger in men than in women (p < .05). Decreased cross-sectional area was associated with aging (p < .05), and cross-sectional area was significantly smaller in aspirators compared with nonaspirators, but only among the older men (p < .01). Increasing fatty infiltration was associated with aging in the middle (p < .05) and posterior (p < .01) portions of the GH muscle. There was no significant difference in fatty infiltration of the GH muscle among aspirators and nonaspirators. Conclusion. GH muscle atrophy was associated with aging and aspiration. Fatty infiltration in the GH muscle was increased with aging but not related to aspiration status. These findings suggest that GH muscle atrophy may be a component of decreased swallowing safety and aspiration in older adults and warrants further investigation. PMID:23112114

  7. Warfarin maintenance dose in older patients: higher average dose and wider dose frequency distribution in patients of African ancestry than those of European ancestry.

    PubMed

    Garwood, Candice L; Clemente, Jennifer L; Ibe, George N; Kandula, Vijay A; Curtis, Kristy D; Whittaker, Peter

    2010-06-15

    Studies report that warfarin doses required to maintain therapeutic anticoagulation decrease with age; however, these studies almost exclusively enrolled patients of European ancestry. Consequently, universal application of dosing paradigms based on such evidence may be confounded because ethnicity also influences dose. Therefore, we determined if warfarin dose decreased with age in Americans of African ancestry, if older African and European ancestry patients required different doses, and if their daily dose frequency distributions differed. Our chart review examined 170 patients of African ancestry and 49 patients of European ancestry cared for in our anticoagulation clinic. We calculated the average weekly dose required for each stable, anticoagulated patient to maintain an international normalized ratio of 2.0 to 3.0, determined dose averages for groups <70, 70-79, and >80 years of age and plotted dose as a function of age. The maintenance dose in patients of African ancestry decreased with age (P<0.001). In addition, older patients of African ancestry required higher average weekly doses than patients of European ancestry: 33% higher in the 70- to 79-year-old group (38.2+/-1.9 vs. 28.8+/-1.7 mg; P=0.006) and 52% in the >80-year-old group (33.2+/-1.7 vs. 21.8+/-3.8 mg; P=0.011). Therefore, 43% of older patients of African ancestry required daily doses >5mg and hence would have been under-dosed using current starting-dose guidelines. The dose frequency distribution was wider for older patients of African ancestry compared to those of European ancestry (P<0.01). The higher doses required by older patients of African ancestry indicate that strategies for initiating warfarin therapy based on studies of patients of European ancestry could result in insufficient anticoagulation and thereby potentially increase their thromboembolism risk.

  8. Anaemia in the older surgical patient: a review of prevalence, causes, implications and management.

    PubMed

    Partridge, Judith; Harari, Danielle; Gossage, Jessica; Dhesi, Jugdeep

    2013-07-01

    This review provides the clinician with a summary of the causes, implications and potential treatments for the management of anaemia in the older surgical patient. The prevalence of anaemia increases with age and is frequently identified in older surgical patients. Anaemia is associated with increased postoperative morbidity and mortality. Allogenic blood transfusion is commonly used to treat anaemia but involves inherent risks and may worsen outcomes. Various strategies for the correction of pre- and postoperative anaemia have evolved. These include correction of nutritional deficiencies and the use of intravenous iron and erythropoesis stimulating therapy. Clear differences exist between the elective and emergency surgical populations and the translation of research findings into these individual clinical settings requires more work. This should lead to a standardized approach to the management of this frequently encountered clinical scenario.

  9. The Ethics of Chronic Dialysis for the Older Patient: Time to Reevaluate the Norms.

    PubMed

    Thorsteinsdottir, Bjorg; Swetz, Keith M; Albright, Robert C

    2015-11-01

    Recent research highlights the potential burdens of hemodialysis for older patients with significant comorbidities, for whom there is clinical equipoise regarding the net benefits. With the advent of accountable care and bundled payment, previous incentives to offer hemodialysis to as many patients as possible are being replaced with a disincentive to dialyze high-risk patients. While this may offset the harm of overtreatment for some elderly patients, some voice concerns that the pendulum will swing too far back, with a return to ageist rationing of hemodialysis. Nephrologists should ensure that the patient's rights to be informed about the potential benefits and burdens of hemodialysis are respected, particularly because age, functional status, nutritional status, and comorbidities affect the net balance between benefits and burdens. Nephrologists are also called on to help patients make a decision, for which the patient's goals of care guide determination of potential benefit from hemodialysis. This article addresses concerns about present overtreatment and future risk of undertreatment of older adults with ESRD. It also discusses ways in which providers can ethically approach the question of initiation of hemodialysis in the elderly patient by including patient-specific estimates of prognosis, shared decision-making, and the use of specialist palliative care clinicians or ethics consultants for complex cases. PMID:25873266

  10. Age and the purchase of prescription drug insurance by older adults.

    PubMed

    Szrek, Helena; Bundorf, M Kate

    2011-06-01

    The Medicare Part D Prescription Drug Program places an unprecedented degree of choice in the hands of older adults despite concerns over their ability to make effective decisions and desire to have extensive choice in this context. While previous research has compared older adults to younger adults along these dimensions, our study, in contrast, examines how likelihood to delay decision making and preferences for choice differ by age among older age cohorts. Our analysis is based on responses of older adults to a simulation of enrollment in Medicare Part D. We examine how age, numeracy, cognitive reflection, and the interaction between age and performance on these instruments are related to the decision to enroll in a Medicare prescription drug plan and preference for choice in this context. We find that numeracy and cognitive reflection are positively associated with enrollment likelihood and that they are more important determinants of enrollment than age. We also find that greater numeracy is associated with a lower willingness to pay for choice. Hence, our findings raise concern that older adults, and, in particular, those with poorer numerical processing skills, may need extra support in enrolling in the program: they are less likely to enroll than those with stronger numerical processing skills, even though they show greater willingness to pay for choice. PMID:21534689

  11. Kicking Back Cognitive Ageing: Leg Power Predicts Cognitive Ageing after Ten Years in Older Female Twins

    PubMed Central

    Steves, Claire J.; Mehta, Mitul M.; Jackson, Stephen H.D.; Spector, Tim D.

    2016-01-01

    Background Many observational studies have shown a protective effect of physical activity on cognitive ageing, but interventional studies have been less convincing. This may be due to short time scales of interventions, suboptimal interventional regimes or lack of lasting effect. Confounding through common genetic and developmental causes is also possible. Objectives We aimed to test whether muscle fitness (measured by leg power) could predict cognitive change in a healthy older population over a 10-year time interval, how this performed alongside other predictors of cognitive ageing, and whether this effect was confounded by factors shared by twins. In addition, we investigated whether differences in leg power were predictive of differences in brain structure and function after 12 years of follow-up in identical twin pairs. Methods A total of 324 healthy female twins (average age at baseline 55, range 43-73) performed the Cambridge Neuropsychological Test Automated Battery (CANTAB) at two time points 10 years apart. Linear regression modelling was used to assess the relationships between baseline leg power, physical activity and subsequent cognitive change, adjusting comprehensively for baseline covariates (including heart disease, diabetes, blood pressure, fasting blood glucose, lipids, diet, body habitus, smoking and alcohol habits, reading IQ, socioeconomic status and birthweight). A discordant twin approach was used to adjust for factors shared by twins. A subset of monozygotic pairs then underwent magnetic resonance imaging. The relationship between muscle fitness and brain structure and function was assessed using linear regression modelling and paired t tests. Results A striking protective relationship was found between muscle fitness (leg power) and both 10-year cognitive change [fully adjusted model standardised β-coefficient (Stdβ) = 0.174, p = 0.002] and subsequent total grey matter (Stdβ = 0.362, p = 0.005). These effects were robust in discordant

  12. Never-married childless women in Australia: health and social circumstances in older age.

    PubMed

    Cwikel, Julie; Gramotnev, Helen; Lee, Christina

    2006-04-01

    A growing proportion of women reach older age without having married or having children. Assumptions that these older women are lonely, impoverished, and high users of social and health services are based on little evidence. This paper uses data from the Older cohort of the Australian Longitudinal Study on Women's Health to describe self-reported demographics, physical and emotional health, and use of services among 10,108 women aged 73-78, of whom 2.7% are never-married and childless. The most striking characteristic of this group is their high levels of education, which are associated with fewer reported financial difficulties and higher rates of private health insurance. There are few differences in self-reported physical or emotional health or use of health services between these and other groups of older women. Compared with older married women with children, they make higher use of formal services such as home maintenance and meal services, and are also more likely to provide volunteer services and belong to social groups. Overall, there is no evidence to suggest that these women are a "problem" group. Rather, it seems that their life experiences and opportunities prepare them for a successful and productive older age. PMID:16225976

  13. [Consensus document on overactive bladder in older patients].

    PubMed

    Verdejo-Bravo, Carlos; Brenes-Bermúdez, Francisco; Valverde-Moyar, Maria Victoria; Alcántara-Montero, Antonio; Pérez-León, Noemí

    2015-01-01

    Overactive nladder (OAB) is a clinical entity with a high prevalence in the population, having a high impact on quality of life, especially when it occurs with urge urinary incontinence. It is very important to highlight the low rate of consultation of this condition by the older population. This appears to depend on several factors (educational, cultural, professional), and thus leads to the low percentage of older patients who receive appropriate treatment and, on the other hand, a large percentage of older patients with a significant deterioration in their quality of life. Therefore, Scientific societies and Working Groups propose the early detection of OAB in their documents and clinical guidelines. Its etiology is not well known, but is influenced by cerebrovascular processes and other neurological problems, abnormalities of the detrusor muscle of bladder receptors, and obstructive and inflammatory processes of the lower urinary tract. Its diagnosis is clinical, and in the great majority of the cases it can be possible to establish its diagnosis and etiopathogenic orientation, without the need for complex diagnostic procedures. Currently, there are effective treatments for OAB, and we should decide the most appropriate for each elderly patient, based on their individual characteristics. Based on the main clinical practice guidelines, a progressive treatment is proposed, with the antimuscarinics being the most recommended drug treatment. Therefore, a group of very involved professionals in clinical practice for the elderly, and representing two scientific Societies (Spanish Society of Geriatrics and Gerontology [SEGG], and the Spanish Society of Primary Care Physicians [SEMERGEN]) developed this consensus document with the main objective of establishing practices and valid strategies, focused to simplify the management of this clinical entity in the elderly population, and especially to improve their quality of life. The recommendations presented in this

  14. Spousal Caregiving in Late Mid-Life Versus Older Ages: Implications of Work and Family Obligations

    PubMed Central

    Lima, Julie C.; Allen, Susan M.; Goldscheider, Frances; Intrator, Orna

    2015-01-01

    Objectives This study examined life stage differences in the provision of care to spouses with functional impairment. Methods We examined 1218 married adults aged 52 and older from the 2000 wave of the Health and Retirement Study (HRS) who received impairment-related help with at least one activity of daily living. We examined the differential likelihood that spouses serve as primary caregiver and the hours of care provided by spousal primary caregivers by life stage. Results We found that late middle-aged care recipients were more likely than their older counterparts to receive the majority of their care from their spouse, but received fewer hours of spousal care, mostly when spouses worked full time. Competing demands of caring for children or parents did not affect the amount of care provided by a spouse. Discussion Late middle-aged adults with functional limitations are more likely than older groups to be married and cared for primarily by spouses; however they may be particularly vulnerable to unmet need for care. As the baby boom generation ages, retirement ages increase, and federal safety nets weaken, people with health problems at older ages may soon find themselves in the same caregiving predicament as those in late middle age. PMID:18689772

  15. Vulnerabilities in Older Patients when Cancer Treatment is Initiated: Does a Cognitive Impairment Impact the Two-Year Survival?

    PubMed Central

    Borghgraef, Cindy; Etienne, Anne-Marie; Merckaert, Isabelle; Paesmans, Marianne; Reynaert, Christine; Roos, Myriam; Slachmuylder, Jean-Louis; Vandenbossche, Sandrine; Bron, Dominique; Razavi, Darius

    2016-01-01

    Introduction Dementia is a known predictor of shorter survival times in older cancer patients. However, no empirical evidence is available to determine how much a cognitive impairment shortens survival in older patients when cancer treatment is initiated. Purpose To longitudinally investigate how much a cognitive impairment detected at the initiation of cancer treatment influences survival of older patients during a two-year follow-up duration and to compare the predictive value of a cognitive impairment on patients survival with the predictive value of other vulnerabilities associated with older age. Methods Three hundred and fifty-seven consecutive patients (≥65 years old) admitted for breast, prostate, or colorectal cancer surgeries were prospectively recruited. A cognitive impairment was assessed with the Montreal Cognitive Assessment (MoCA<26). Socio-demographic, disease-related, and geriatric vulnerabilities were assessed using validated tools. Univariate and subsequent multivariate Cox proportional hazards models stratified for diagnosis (breast/prostate cancer versus colorectal cancer) and disease status (metastatic versus non-metastatic) were used. Results A cognitive impairment was detected in 46% (n = 163) of patients. Survival was significantly influenced by a cognitive impairment (HR = 6.13; 95% confidence interval [CI] = 2.07–18.09; p = 0.001), a loss in instrumental autonomy (IADL ≤7) (HR = 3.06; 95% CI = 1.31–7.11; p = 0.009) and fatigue (Mob-T<5) (HR = 5.98; 95% CI = 2.47–14.44; p <0.001). Conclusions During the two years following cancer treatment initiation, older patients with a cognitive impairment were up to six times more likely to die than patients without. Older patients should be screened for cognitive impairments at cancer treatment initiation to enable interventions to reduce morbidity and mortality. Further studies should address processes underlying the relationship between cognitive impairments and an increased risk of dying

  16. Spa therapy for elderly: a retrospective study of 239 older patients with osteoarthritis

    NASA Astrophysics Data System (ADS)

    Karagülle, Mine; Kardeş, Sinan; Dişçi, Rian; Gürdal, Hatice; Karagülle, Müfit Zeki

    2016-10-01

    Very few studies tested the effectiveness of spa therapy in older patients with osteoarthritis. Therefore, we aimed to evaluate the short-term effects of spa therapy in patients aged 65 years and older with generalized, knee, hip, and cervical and lumbar spine osteoarthritis. In an observational retrospective study design at the Medical Ecology and Hydroclimatology Department of Istanbul Medical Faculty, we analyzed the records of 239 patients aged over 65 years with the diagnosis of all types of osteoarthritis who were prescribed a spa therapy course in some spa resorts in Turkey between 7 March 2002 and 31 December 2012. They travelled to a spa resort where they stayed at a thermal spa hotel and followed the usual therapy packages for 2 weeks. Patients were assessed by an experienced physician within a week before the spa journey and within a week after the completion of the spa therapy. Compared with baseline in whole sample, statistically significant improvements were observed in pain (visual analog scale, VAS), patient and physician global assessments (VAS), Health Assessment Questionnaire disability index (HAQ-DI), Lequesne algofunctional index (LAFI) for knee, Western Ontario and McMaster Universities index (WOMAC), Waddell disability index (WDI), and Neck Pain and Disability Scale (NPAD). According to Outcome Measures in Rheumatology—Osteoarthritis Research Society International (OMERACT-OARSI) Set of Responder Criteria, responder rate were 63.8 % (51/80) in generalized, 52 % (13/25) in knee, 50 % (2/4) in hip, 66.7 % (8/12) in lumbar, and 100 % (6/6) in cervical osteoarthritis subgroups. Spa therapy improved pain and physical functional status in older patients with osteoarthritis, especially generalized osteoarthritis and multiple joint osteoarthritis with involvement of knee. This improvement was clinically important in majority of the patients. To confirm the results of this preliminary study, there is a need of a randomized controlled clinical study

  17. Spa therapy for elderly: a retrospective study of 239 older patients with osteoarthritis

    NASA Astrophysics Data System (ADS)

    Karagülle, Mine; Kardeş, Sinan; Dişçi, Rian; Gürdal, Hatice; Karagülle, Müfit Zeki

    2016-01-01

    Very few studies tested the effectiveness of spa therapy in older patients with osteoarthritis. Therefore, we aimed to evaluate the short-term effects of spa therapy in patients aged 65 years and older with generalized, knee, hip, and cervical and lumbar spine osteoarthritis. In an observational retrospective study design at the Medical Ecology and Hydroclimatology Department of Istanbul Medical Faculty, we analyzed the records of 239 patients aged over 65 years with the diagnosis of all types of osteoarthritis who were prescribed a spa therapy course in some spa resorts in Turkey between 7 March 2002 and 31 December 2012. They travelled to a spa resort where they stayed at a thermal spa hotel and followed the usual therapy packages for 2 weeks. Patients were assessed by an experienced physician within a week before the spa journey and within a week after the completion of the spa therapy. Compared with baseline in whole sample, statistically significant improvements were observed in pain (visual analog scale, VAS), patient and physician global assessments (VAS), Health Assessment Questionnaire disability index (HAQ-DI), Lequesne algofunctional index (LAFI) for knee, Western Ontario and McMaster Universities index (WOMAC), Waddell disability index (WDI), and Neck Pain and Disability Scale (NPAD). According to Outcome Measures in Rheumatology—Osteoarthritis Research Society International (OMERACT-OARSI) Set of Responder Criteria, responder rate were 63.8 % (51/80) in generalized, 52 % (13/25) in knee, 50 % (2/4) in hip, 66.7 % (8/12) in lumbar, and 100 % (6/6) in cervical osteoarthritis subgroups. Spa therapy improved pain and physical functional status in older patients with osteoarthritis, especially generalized osteoarthritis and multiple joint osteoarthritis with involvement of knee. This improvement was clinically important in majority of the patients. To confirm the results of this preliminary study, there is a need of a randomized controlled clinical study

  18. Racial/Ethnic Differences in Breast Cancer Outcomes among Older Patients: Effects of Physician Communication and Patient Empowerment

    PubMed Central

    Maly, Rose C.; Stein, Judith A.; Umezawa, Yoshiko; Leake, Barbara; Douglas Anglin, M.

    2009-01-01

    Objectives To examine racial/ethnic disparities in older women’s health-related quality of life (QOL) and type of breast cancer treatment as mediated by physician level and individual level variables. Methods A cross-sectional survey of a population-based, consecutive sample identified through the Los Angeles Cancer Surveillance Program of Latina (n = 99), African-American (n = 66), and White (n = 92) women aged 55 years or older (N = 257) between 3 and 9 months after primary breast cancer diagnosis and at least one month post treatment. An exploratory, empirically-developed latent variable model tested the relationships among demographic and physician-related variables, patient attitudes, and health-related outcomes. Health-related outcomes included QOL measures and receipt of breast conserving surgery (BCS). Results Latinas reported less BCS and poorer QOL compared to Whites. Physician communication that can empower patients, in terms of patient efficacy in patient-physician interactions and breast cancer knowledge, mitigated racial/ethnic disparities in receipt of BCS. Physician emotional support was not related to patient cognitive empowerment and treatment outcomes. Medical mistrust in minority women was related to less self-efficacy and less positive coping, as well as, both directly and indirectly, to reduced QOL. Latinas reported poorer QOL in the tested model. Conclusions Physician communication style, specifically information-giving and participatory decision-making, may empower older women with breast cancer and help mitigate racial/ethnic disparities in surgical treatment received. PMID:19025268

  19. Aging expectations are associated with physical activity and health among older adults of low socioeconomic status.

    PubMed

    Dogra, Shilpa; Al-Sahab, Ban; Manson, James; Tamim, Hala

    2015-04-01

    The purpose of the current study was to determine whether aging expectations (AE) are associated with physical activity participation and health among older adults of low socioeconomic status (SES). A cross-sectional analysis of a sample of 170 older adults (mean age 70.9 years) was conducted. Data on AE, physical activity, and health were collected using the 12 item Expectations Regarding Aging instrument, the Healthy Physical Activity Participation Questionnaire, and the Short Form-36, respectively. Adjusted linear regression models showed significant associations between AE and social functioning, energy/vitality, mental health, and self-rated general health, as well as physical activity. These results suggest that AE may help to better explain the established association between low SES, low physical activity uptake, and poor health outcomes among older adults.

  20. Support Networks of Middle-Aged and Older Adults.

    ERIC Educational Resources Information Center

    Ingersoll, Berit; Depner, Charlene

    Research on social supports of the aged indicates that creation and maintenance of supportive interpersonal bonds among the elderly result in an enhancement of their quality of life. The nature of social support networks at different points in the life course was investigated to determine the relative size of social networks and the way men and…

  1. Age Stereotypes of Older Primary Teachers in Taiwan

    ERIC Educational Resources Information Center

    Chen, Hsin-Jen; Wang, Ya-Hsaun

    2012-01-01

    Elder respect in East Asia has a long history that could be derived from Confucian philosophy. However, with the rapid development of westernization, younger people have gradually depreciated the value of elder respect and seek a reciprocal relationship with the elderly. A literature search revealed that age stereotypes would be both negative and…

  2. Health-related quality of life predicts mortality in older but not younger patients following cardiac surgery.

    PubMed

    Ho, P Michael; Masoudi, Frederick A; Peterson, Pamela N; Shroyer, A Laurie; McCarthy, Martin; Grover, Frederick L; Hammermeister, Karl E; Rumsfeld, John S

    2005-01-01

    The investigators assessed preoperative health-related quality of life as a predictor of 6-month mortality after cardiac surgery in older (65 years of age and older) vs. younger patients. Multivariable regression, stratified by age groups, was used to compare the association between preoperative Physical Component Summary and Mental Component Summary scores from the Short Form-36 health status survey and mortality. In multivariable analyses of older patients, lower preoperative Physical Component Summary (odds ratio, 1.54; 95% confidence interval, 1.19-2.00; p=0.01) and Mental Component Summary (odds ratio, 1.26; 95% confidence interval, 1.06-1.49; p=0.03) scores were independently associated with mortality. In contrast, neither Physical Component Summary (p=0.82) nor Mental Component Summary (p=0.79) scores were associated with mortality in the younger subgroup. This study demonstrated that preoperative health status is an independent predictor of mortality following cardiac surgery in older but not younger patients. Preoperative patient self-report of health status may be particularly useful in refining risk stratification and informing decision-making before and following cardiac surgery in older patients.

  3. Generativity in Older Age: A Challenge for Universities of the Third Age (U3A)

    ERIC Educational Resources Information Center

    Villar, Feliciano; Celdran, Montserrat

    2012-01-01

    This paper discusses the ways in which university programs for older people should change to cater to the interests and concerns of generative older people. We describe university programs offered at present, underlining their emphasis on personal growth and on learning for the sake of learning. We argue that these programs are not entirely…

  4. Risk preferences and aging: The “Certainty Effect” in older adults’ decision making

    PubMed Central

    Mather, Mara; Mazar, Nina; Gorlick, Marissa A.; Lighthall, Nichole R.; Burgeno, Jessica; Schoeke, Andrej; Ariely, Dan

    2013-01-01

    A prevalent stereotype is that people become less risk taking and more cautious as they get older. However, in laboratory studies, findings are mixed and often reveal no age differences. In the current series of experiments, we examined whether age differences in risk seeking are more likely to emerge when choices include a certain option (a sure gain or a sure loss). In four experiments, we found that age differences in risk preferences only emerged when participants were offered a choice between a risky and a certain gamble but not when offered two risky gambles. In particular, Experiments 1 and 2 included only gambles about potential gains. Here, compared with younger adults, older adults preferred a certain gain over a chance to win a larger gain and thus, exhibited more risk aversion in the domain of gains. But in Experiments 3 and 4, when offered the chance to take a small sure loss rather than risking a larger loss, older adults exhibited more risk seeking in the domain of losses than younger adults. Both their greater preference for sure gains and greater avoidance of sure losses suggest that older adults weigh certainty more heavily than younger adults. Experiment 4 also indicates that older adults focus more on positive emotions than younger adults do when considering their options and that this emotional shift can at least partially account for age differences in how much people are swayed by certainty in their choices. PMID:23066800

  5. Age, stress, and isolation in older adults living with HIV

    PubMed Central

    Webel, Allison R.; Longenecker, Chris T.; Gripshover, Barbara; Hanson, Jan E.; Schmotzer, Brian J.; Salata, Robert A.

    2013-01-01

    People living with HIV (PLWH) have increasingly longer life spans. This age group faces different challenges than younger PLWH, which may include increased stress and social isolation. The purpose of this study was to determine if the age and sex of PLWH is associated with measures of physiologic stress, perceived stress and social isolation. In this cross-sectional study, we enrolled 102 PLWH equally into four groups divided by age (< or > 50 years) and gender. Participants completed well-validated survey measurements of stress and isolation, and their heart rate variability over 60 minutes was measured by Holter monitor. The mean (standard deviation) Perceived Stress Scale score was 17.4 (6.94), mean visual analog stress scale score was 3.51 (2.79), and mean Hawthorne Friendship Scale score, a measure of social isolation, was 17.03 (4.84). Mean heart rate variability expressed as the standard deviation of successive N-N intervals was 65.47 (31.16) msec. In multivariable regression models that controlled for selected demographic variables, there was no relationship between the Perceived Stress Scale and age (coefficient=−0.09, p=−.23) or female gender (coefficient=−0.12, p=0.93); however, there was a modest relationship between female gender and stress using the visual analog stress scale (coefficient=1.24, p=0.05). Perceived Stress was negatively associated with the Hawthorne Friendship score (coefficient=−0.34, p=0.05). Hawthorne Friendship score was positively associated with younger age (coefficient=0.11, p=0.02). Age was the only independent predictor of physiologic stress as measured by heart rate variability (coefficient=−1.3, p<0.01). Our findings suggest that younger PLWH may experience more social isolation; however, age-related changes in heart rate variability do not appear to be related to perceived stress or social isolation. Future longitudinal research is required to more thoroughly understand this relationship and its impact on the

  6. Age estimation among Brazilians: Younger or older than 18?

    PubMed

    Deitos, Alexandre Raphael; Costa, Claudio; Michel-Crosato, Edgard; Galić, Ivan; Cameriere, Roberto; Biazevic, Maria Gabriela Haye

    2015-07-01

    The age estimation of living or dead individuals is an important part of forensic science because it can be used in various situations, including mass disasters, or for civil or criminal reasons, such as adoption or asylum. Teeth play a major role in this context because they are more resistant than bones in extreme environmental conditions and their development is hardly affected by exogenous or endogenous factors. Because the third molars (3rdM) are still in development from the age of 14, they are useful for determining whether an individual has reached the legal age of 18 years. This study aims to verify the method of Cameriere et al. (2008) in Brazil to discriminate whether an individual is under or over 18 years from the maturity index of the 3rdM (I3m). The analysis of 444 panoramic radiographs resulted in a sensitivity of 78.3%, a specificity of 85.1% and a correct classification of 87%. Significant differences in sexual dimorphism in the early mineralization of males were found only for the average age with I3m ≥ 0.08, except for the range (0.7, 0.9). Due to the high miscegenation ratio of the Brazilian population the ancestry was not one of the studied variables. The method is suitable for estimating adulthood for forensic purposes in Brazil, although it must be applied carefully and judiciously. We recommend a combination of several methods that are available to increase accuracy as well as the establishment of different parameters that are likely to determine whether a person is more or less than 18 years of age, depending on the different legal requirements, whether civil or criminal.

  7. Increasing opportunities for the productive engagement of older adults: a response to population aging.

    PubMed

    Gonzales, Ernest; Matz-Costa, Christina; Morrow-Howell, Nancy

    2015-04-01

    "Productive aging" puts forward the fundamental view that the capacity of older adults must be better developed and utilized in activities that make economic contributions to society-working, caregiving, volunteering. It is suggested that productive engagement can lead to multiple positive ends: offsetting fiscal strains of a larger older population, contributing to the betterment of families and civil society, and maintaining the health and economic security of older adults. Advocates claim that outdated social structures and discriminatory behaviors limit participation of older adults in these important social roles as well as prevent the optimization of outcomes for older adults, families, and society. We ask two important questions: (a) How can we shape policies and programs to optimally engage the growing resources of an aging population for the sake of society and older adults themselves? and (b) How can policies pertaining to productive engagement reduce health and economic disparities? We answer these questions by first describing the current state of engagement in each of the three productive activities and summarize some current policies and programs that affect engagement. Next we highlight challenges that cross-cut productive engagement. Finally, we provide policy recommendations to address these challenges. PMID:26035601

  8. Factors associated with tobacco smoking practices among middle-aged and older women in Texas.

    PubMed

    Smith, Matthew Lee; Colwell, Brian; Ahn, Sangnam; Ory, Marcia G

    2012-01-01

    This study examines middle-aged and older women's smoking practices and identifies factors associated with tobacco use and cessation in this population. Data of 593 women were analyzed from a seven-county random household sample in Texas. Sequential multinomial logistic regression compared associations with having never smoked, having quit smoking, and currently smoking. Compared to smokers, never smokers and past smokers were significantly more likely to be older, more educated, of better general health, and report past-year physician visits and fewer depressive symptoms. Mental health and smoking are interrelated, indicating the need for addressing depression in smoking-cessation efforts for aging women.

  9. Another health insurance gap: gaining and losing coverage among natives and immigrants at older ages.

    PubMed

    Reyes, Adriana M; Hardy, Melissa

    2014-01-01

    As the immigrant population grows older and larger, limitations on access to health insurance may create a new subgroup of people who remain outside or on the margin of coverage. Using the Survey of Income and Program Participation (SIPP) data from the 2004 and 2008 panels, we address the health insurance gap between foreign-born and native-born adults among those aged 50-64 and the 65 and older, two sub-populations that have received relatively little attention in past research. We argue that current practices leave a significant minority of older foreign-born residents inconsistently covered or without any insurance. We find that health insurance coverage for older immigrants is both less likely and more episodic even when compositional differences in SES and assimilation are controlled.

  10. Which screening method is appropriate for older cancer patients at risk for malnutrition?

    PubMed

    Isenring, Elizabeth; Elia, Marinos

    2015-04-01

    The risk for malnutrition increases with age and presence of cancer, and it is particularly common in older cancer patients. A range of simple and validated nutrition screening tools can be used to identify malnutrition risk in cancer patients (e.g., Malnutrition Screening Tool, Mini Nutritional Assessment Short Form Revised, Nutrition Risk Screening, and the Malnutrition Universal Screening Tool). Unintentional weight loss and current body mass index are common components of screening tools. Patients with cancer should be screened at diagnosis, on admission to hospitals or care homes, and during follow-up at outpatient or general practitioner clinics, at regular intervals depending on clinical status. Nutritional assessment is a comprehensive assessment of dietary intake, anthropometrics, and physical examination often conducted by dietitians or geriatricians after simple screening has identified at-risk patients. The result of nutritional screening, assessment and the associated care plans should be documented, and communicated, within and between care settings for best patient outcomes.

  11. Altered Mental Status in Older Emergency Department Patients

    PubMed Central

    Wilber, Scott T.

    2012-01-01

    Synopsis Altered mental status is a common chief complaint among older emergency department (ED) patients. Acute changes in mental status are more concerning and are usually secondary to delirium, stupor, and coma. These forms of acute brain dysfunction are commonly precipitated by an underlying medical illness that can be potentially life-threatening and are associated with a multitude of adverse outcomes. Though stupor and coma are easily identifiable, the clinical presentation of delirium can be subtle and is often missed without actively screening for it. For patients with acute brain dysfunction, the ED evaluation should focus on searching for the underlying etiology. Infection is one of the most common precipitants of delirium, but multiple etiologies may exist concurrently. PMID:23177603

  12. The effect of age on cognitive performance of frontal patients

    PubMed Central

    Cipolotti, Lisa; Healy, Colm; Chan, Edgar; MacPherson, Sarah E.; White, Mark; Woollett, Katherine; Turner, Martha; Robinson, Gail; Spanò, Barbara; Bozzali, Marco; Shallice, Tim

    2015-01-01

    Age is known to affect prefrontal brain structure and executive functioning in healthy older adults, patients with neurodegenerative conditions and TBI. Yet, no studies appear to have systematically investigated the effect of age on cognitive performance in patients with focal lesions. We investigated the effect of age on the cognitive performance of a large sample of tumour and stroke patients with focal unilateral, frontal (n=68), or non-frontal lesions (n=45) and healthy controls (n=52). We retrospectively reviewed their cross sectional cognitive and imaging data. In our frontal patients, age significantly predicted the magnitude of their impairment on two executive tests (Raven's Advanced Progressive Matrices, RAPM and the Stroop test) but not on nominal (Graded Naming Test, GNT) or perceptual (Incomplete Letters) task. In our non-frontal patients, age did not predict the magnitude of their impairment on the RAPM and GNT. Furthermore, the exacerbated executive impairment observed in our frontal patients manifested itself from middle age. We found that only age consistently predicted the exacerbated executive impairment. Lesions to specific frontal areas, or an increase in global brain atrophy or white matter abnormalities were not associated with this impairment. Our results are in line with the notion that the frontal cortex plays a critical role in aging to counteract cognitive and neuronal decline. We suggest that the combined effect of aging and frontal lesions impairs the frontal cortical systems by causing its computational power to fall below the threshold needed to complete executive tasks successfully. PMID:26102190

  13. Age-related differences in street-crossing safety before and after training of older pedestrians.

    PubMed

    Dommes, Aurélie; Cavallo, Viola; Vienne, Fabrice; Aillerie, Isabelle

    2012-01-01

    International accident statistics indicate that elderly pedestrians make up an extremely vulnerable road-user group. Past research has shown that older adults make many unsafe street-crossing decisions and adopt insufficient safety margins, especially when vehicles are approaching at high speed. Apart from studies on road design and speed-limit countermeasures, there is surprisingly no road-safety research on behavior-based measures to improve older pedestrians' safety. In this line, the present study was aimed at (i) assessing the effectiveness of a training program for older pedestrians that combined behavioral and educational interventions, and (ii) examining whether and to what extent age-related differences in street-crossing safety could be reduced after training older adults. Twenty seniors were enrolled in a training program. Before, immediately after, and six months after training, street-crossing behavior was assessed using a simulated street-crossing task. Twenty younger participants performed the same simulated task to obtain a baseline measure. The results showed that the training produced significant short- and long-term benefits, due to a shifting of the decision criteria among the older participants towards more conservative judgments. When compared with the younger group, the older participants improved their behavior considerably so that significant differences in the mean safety-related indicators were no longer observed. However, the older participants' ability to take the oncoming car's speed into account did not improve. Even after training, and contrary to younger adults, older participants were found to make more and more unsafe decisions as the car's speed increased, putting them at a higher risk at high speeds. This finding may reflect age-related perceptual and cognitive difficulties that cannot be remedied by a behavioral or educational training method. The present findings underline that high speed is an important risk factor for

  14. Age-related differences in street-crossing safety before and after training of older pedestrians.

    PubMed

    Dommes, Aurélie; Cavallo, Viola; Vienne, Fabrice; Aillerie, Isabelle

    2012-01-01

    International accident statistics indicate that elderly pedestrians make up an extremely vulnerable road-user group. Past research has shown that older adults make many unsafe street-crossing decisions and adopt insufficient safety margins, especially when vehicles are approaching at high speed. Apart from studies on road design and speed-limit countermeasures, there is surprisingly no road-safety research on behavior-based measures to improve older pedestrians' safety. In this line, the present study was aimed at (i) assessing the effectiveness of a training program for older pedestrians that combined behavioral and educational interventions, and (ii) examining whether and to what extent age-related differences in street-crossing safety could be reduced after training older adults. Twenty seniors were enrolled in a training program. Before, immediately after, and six months after training, street-crossing behavior was assessed using a simulated street-crossing task. Twenty younger participants performed the same simulated task to obtain a baseline measure. The results showed that the training produced significant short- and long-term benefits, due to a shifting of the decision criteria among the older participants towards more conservative judgments. When compared with the younger group, the older participants improved their behavior considerably so that significant differences in the mean safety-related indicators were no longer observed. However, the older participants' ability to take the oncoming car's speed into account did not improve. Even after training, and contrary to younger adults, older participants were found to make more and more unsafe decisions as the car's speed increased, putting them at a higher risk at high speeds. This finding may reflect age-related perceptual and cognitive difficulties that cannot be remedied by a behavioral or educational training method. The present findings underline that high speed is an important risk factor for

  15. Cluster Analysis of Physical and Cognitive Ageing Patterns in Older People from Shanghai.

    PubMed

    Bandelow, Stephan; Xu, Xin; Xiao, Shifu; Hogervorst, Eef

    2016-01-01

    This study investigated the relationship between education, cognitive and physical function in older age, and their respective impacts on activities of daily living (ADL). Data on 148 older participants from a community-based sample recruited in Shanghai, China, included the following measures: age, education, ADL, grip strength, balance, gait speed, global cognition and verbal memory. The majority of participants in the present cohort were cognitively and physically healthy and reported no problems with ADL. Twenty-eight percent of participants needed help with ADL, with the majority of this group being over 80 years of age. Significant predictors of reductions in functional independence included age, balance, global cognitive function (MMSE) and the gait measures. Cluster analysis revealed a protective effect of education on cognitive function that did not appear to extend to physical function. Consistency of such phenotypes of ageing clusters in other cohort studies may provide helpful models for dementia and frailty prevention measures. PMID:26907351

  16. Cluster Analysis of Physical and Cognitive Ageing Patterns in Older People from Shanghai

    PubMed Central

    Bandelow, Stephan; Xu, Xin; Xiao, Shifu; Hogervorst, Eef

    2016-01-01

    This study investigated the relationship between education, cognitive and physical function in older age, and their respective impacts on activities of daily living (ADL). Data on 148 older participants from a community-based sample recruited in Shanghai, China, included the following measures: age, education, ADL, grip strength, balance, gait speed, global cognition and verbal memory. The majority of participants in the present cohort were cognitively and physically healthy and reported no problems with ADL. Twenty-eight percent of participants needed help with ADL, with the majority of this group being over 80 years of age. Significant predictors of reductions in functional independence included age, balance, global cognitive function (MMSE) and the gait measures. Cluster analysis revealed a protective effect of education on cognitive function that did not appear to extend to physical function. Consistency of such phenotypes of ageing clusters in other cohort studies may provide helpful models for dementia and frailty prevention measures. PMID:26907351

  17. Cluster Analysis of Physical and Cognitive Ageing Patterns in Older People from Shanghai.

    PubMed

    Bandelow, Stephan; Xu, Xin; Xiao, Shifu; Hogervorst, Eef

    2016-01-01

    This study investigated the relationship between education, cognitive and physical function in older age, and their respective impacts on activities of daily living (ADL). Data on 148 older participants from a community-based sample recruited in Shanghai, China, included the following measures: age, education, ADL, grip strength, balance, gait speed, global cognition and verbal memory. The majority of participants in the present cohort were cognitively and physically healthy and reported no problems with ADL. Twenty-eight percent of participants needed help with ADL, with the majority of this group being over 80 years of age. Significant predictors of reductions in functional independence included age, balance, global cognitive function (MMSE) and the gait measures. Cluster analysis revealed a protective effect of education on cognitive function that did not appear to extend to physical function. Consistency of such phenotypes of ageing clusters in other cohort studies may provide helpful models for dementia and frailty prevention measures.

  18. Unexplained Falls Are Frequent in Patients with Fall-Related Injury Admitted to Orthopaedic Wards: The UFO Study (Unexplained Falls in Older Patients).

    PubMed

    Chiara, Mussi; Gianluigi, Galizia; Pasquale, Abete; Alessandro, Morrione; Alice, Maraviglia; Gabriele, Noro; Paolo, Cavagnaro; Loredana, Ghirelli; Giovanni, Tava; Franco, Rengo; Giulio, Masotti; Gianfranco, Salvioli; Niccolò, Marchionni; Andrea, Ungar

    2013-01-01

    To evaluate the incidence of unexplained falls in elderly patients affected by fall-related fractures admitted to orthopaedic wards, we recruited 246 consecutive patients older than 65 (mean age 82 ± 7 years, range 65-101). Falls were defined "accidental" (fall explained by a definite accidental cause), "medical" (fall caused directly by a specific medical disease), "dementia-related" (fall in patients affected by moderate-severe dementia), and "unexplained" (nonaccidental falls, not related to a clear medical or drug-induced cause or with no apparent cause). According to the anamnestic features of the event, older patients had a lower tendency to remember the fall. Patients with accidental fall remember more often the event. Unexplained falls were frequent in both groups of age. Accidental falls were more frequent in younger patients, while dementia-related falls were more common in the older ones. Patients with unexplained falls showed a higher number of depressive symptoms. In a multivariate analysis a higher GDS and syncopal spells were independent predictors of unexplained falls. In conclusion, more than one third of all falls in patients hospitalized in orthopaedic wards were unexplained, particularly in patients with depressive symptoms and syncopal spells. The identification of fall causes must be evaluated in older patients with a fall-related injury. PMID:23533394

  19. Unexplained Falls Are Frequent in Patients with Fall-Related Injury Admitted to Orthopaedic Wards: The UFO Study (Unexplained Falls in Older Patients).

    PubMed

    Chiara, Mussi; Gianluigi, Galizia; Pasquale, Abete; Alessandro, Morrione; Alice, Maraviglia; Gabriele, Noro; Paolo, Cavagnaro; Loredana, Ghirelli; Giovanni, Tava; Franco, Rengo; Giulio, Masotti; Gianfranco, Salvioli; Niccolò, Marchionni; Andrea, Ungar

    2013-01-01

    To evaluate the incidence of unexplained falls in elderly patients affected by fall-related fractures admitted to orthopaedic wards, we recruited 246 consecutive patients older than 65 (mean age 82 ± 7 years, range 65-101). Falls were defined "accidental" (fall explained by a definite accidental cause), "medical" (fall caused directly by a specific medical disease), "dementia-related" (fall in patients affected by moderate-severe dementia), and "unexplained" (nonaccidental falls, not related to a clear medical or drug-induced cause or with no apparent cause). According to the anamnestic features of the event, older patients had a lower tendency to remember the fall. Patients with accidental fall remember more often the event. Unexplained falls were frequent in both groups of age. Accidental falls were more frequent in younger patients, while dementia-related falls were more common in the older ones. Patients with unexplained falls showed a higher number of depressive symptoms. In a multivariate analysis a higher GDS and syncopal spells were independent predictors of unexplained falls. In conclusion, more than one third of all falls in patients hospitalized in orthopaedic wards were unexplained, particularly in patients with depressive symptoms and syncopal spells. The identification of fall causes must be evaluated in older patients with a fall-related injury.

  20. Effect of Speaker Age on Speech Recognition and Perceived Listening Effort in Older Adults with Hearing Loss

    ERIC Educational Resources Information Center

    McAuliffe, Megan J.; Wilding, Phillipa J.; Rickard, Natalie A.; O'Beirne, Greg A.

    2012-01-01

    Purpose: Older adults exhibit difficulty understanding speech that has been experimentally degraded. Age-related changes to the speech mechanism lead to natural degradations in signal quality. We tested the hypothesis that older adults with hearing loss would exhibit declines in speech recognition when listening to the speech of older adults,…

  1. The Moderating Role of Age-Group Identification and Perceived Threat on Stereotype Threat among Older Adults

    ERIC Educational Resources Information Center

    Kang, Sonia K.; Chasteen, Alison L.

    2009-01-01

    Although research has shown that older adults are negatively affected by aging stereotypes, relatively few studies have attempted to identify those older adults who may be especially susceptible to these effects. The current research takes steps toward identifying older adults most susceptible to the effects of stereotype threat and investigates…

  2. (Un)Healthy Immigrant Citizens: Naturalization and Activity Limitations in Older Age*

    PubMed Central

    Gubernskaya, Zoya; Bean, Frank D.; Van hook, Jennifer

    2014-01-01

    This research argues that immigrants’ political, social and economic incorporation experiences, which are embedded in individual life-course trajectories and heavily influenced by governmental policies, play an important role in producing diverse health outcomes among older U.S. foreign-born persons. Using data from the 2008–2010 American Community Surveys and 1998–2010 Integrated Health Interview Surveys, we demonstrate how naturalization, a key indicator of social and political inclusion, is related to functional health in midlife and older age. Consistent with the theoretical framework, we find that among those foreign-born who immigrated as children and young adults, naturalized citizens show better health at older ages compared to non-citizens, although this relationship is partly mediated by education. But among those older foreign-born who immigrated at middle and older ages, naturalized citizens report worse health compared to non-citizens. Moreover, this negative health selection into naturalization becomes stronger for those naturalizing after the 1996 Welfare Reform Act. PMID:24311754

  3. Differential aging of cerebral white matter in middle-aged and older adults: A seven-year follow-up.

    PubMed

    Bender, Andrew R; Völkle, Manuel C; Raz, Naftali

    2016-01-15

    The few extant reports of longitudinal white matter (WM) changes in healthy aging, using diffusion tensor imaging (DTI), reveal substantial differences in change across brain regions and DTI indices. According to the "last-in-first-out" hypothesis of brain aging late-developing WM tracts may be particularly vulnerable to advanced age. To test this hypothesis we compared age-related changes in association, commissural and projection WM fiber regions using a skeletonized, region of interest DTI approach. Using linear mixed effect models, we evaluated the influences of age and vascular risk at baseline on seven-year changes in three indices of WM integrity and organization (axial diffusivity, AD, radial diffusivity, RD, and fractional anisotropy, FA) in healthy middle-aged and older adults (mean age=65.4, SD=9.0years). Association fibers showed the most pronounced declines over time. Advanced age was associated with greater longitudinal changes in RD and FA, independent of fiber type. Furthermore, older age was associated with longitudinal RD increases in late-developing, but not early-developing projection fibers. These findings demonstrate the increased vulnerability of later developing WM regions and support the "last-in-first-out" hypothesis of brain aging.

  4. Labor force participation at older ages in the Western Pacific: A microeconomic analysis.

    PubMed

    Agree, E M; Clark, R L

    1991-10-01

    Retirement has become a very important stage of life for persons in developed countries. Life expectancy for those over age 60 has increased markedly. Rising real income and the institution of broad based social security systems have encouraged older workers to leave the labor force at younger ages. p]Reductions in older age mortality have also affected the less developed regions. Increases in the number of older persons, coupled with continuing high fertility, have increased the size of the working age population through both large entry cohorts and longevity of current workers. The capacity of the economy to absorb this growth is severely limited. As a result, labor force decisions by older individuals will be of increasing importance.This study provides new evidence on labor force decisions in four developing countries in the Western Pacific: Fiji, the Republic of Korea, Malaysia, and the Philippines. A uniform survey sponsored by the World Health Organization in the four countries of persons aged 60 and over is employed to estimate the determinants of work decisions. PMID:24390608

  5. Labor force participation at older ages in the Western Pacific: A microeconomic analysis.

    PubMed

    Agree, E M; Clark, R L

    1991-10-01

    Retirement has become a very important stage of life for persons in developed countries. Life expectancy for those over age 60 has increased markedly. Rising real income and the institution of broad based social security systems have encouraged older workers to leave the labor force at younger ages. p]Reductions in older age mortality have also affected the less developed regions. Increases in the number of older persons, coupled with continuing high fertility, have increased the size of the working age population through both large entry cohorts and longevity of current workers. The capacity of the economy to absorb this growth is severely limited. As a result, labor force decisions by older individuals will be of increasing importance.This study provides new evidence on labor force decisions in four developing countries in the Western Pacific: Fiji, the Republic of Korea, Malaysia, and the Philippines. A uniform survey sponsored by the World Health Organization in the four countries of persons aged 60 and over is employed to estimate the determinants of work decisions.

  6. Hearing deficits in the older patient: "I didn't notice anything".

    PubMed

    Pacala, James T; Yueh, Bevan

    2012-03-21

    Hearing loss is common in older adults. Patients, clinicians, and health care staff often do not recognize hearing loss, particularly in its early stages, and it is undertreated. Age-related hearing loss or presbycusis, the most common type of hearing loss in older adults, is a multifactorial sensorineural loss that frequently includes a component of impaired speech discrimination. Simple office-based screening and evaluation procedures can identify potential hearing disorders, which should prompt audiologic referral to confirm the diagnosis with audiometric testing. The mainstay of treatment is amplification. For many older adults, accepting the need for amplification, selecting and purchasing a hearing aid, and getting accustomed to its use is a daunting and often frustrating process. There are numerous barriers to hearing aid use, the most common of which is dissatisfaction with its performance across a range of sonic environments. Newer digital hearing aids have many features that improve performance, making them potentially more acceptable to users, but they are expensive and are not covered by Medicare. Hearing aids have been demonstrated to improve hearing function and hearing-related quality of life (QOL), but evidence is less robust for improving overall QOL. Depending upon the etiology of the hearing loss, other medical and surgical procedures, including cochlear implantation, may benefit older adults. Older adults with multiple morbidities and who are frail pose specific challenges for the management of hearing loss. These patients may require integration of hearing assessment and treatment as part of functional assessment in an interdisciplinary, team-based approach to care.

  7. Hearing deficits in the older patient: "I didn't notice anything".

    PubMed

    Pacala, James T; Yueh, Bevan

    2012-03-21

    Hearing loss is common in older adults. Patients, clinicians, and health care staff often do not recognize hearing loss, particularly in its early stages, and it is undertreated. Age-related hearing loss or presbycusis, the most common type of hearing loss in older adults, is a multifactorial sensorineural loss that frequently includes a component of impaired speech discrimination. Simple office-based screening and evaluation procedures can identify potential hearing disorders, which should prompt audiologic referral to confirm the diagnosis with audiometric testing. The mainstay of treatment is amplification. For many older adults, accepting the need for amplification, selecting and purchasing a hearing aid, and getting accustomed to its use is a daunting and often frustrating process. There are numerous barriers to hearing aid use, the most common of which is dissatisfaction with its performance across a range of sonic environments. Newer digital hearing aids have many features that improve performance, making them potentially more acceptable to users, but they are expensive and are not covered by Medicare. Hearing aids have been demonstrated to improve hearing function and hearing-related quality of life (QOL), but evidence is less robust for improving overall QOL. Depending upon the etiology of the hearing loss, other medical and surgical procedures, including cochlear implantation, may benefit older adults. Older adults with multiple morbidities and who are frail pose specific challenges for the management of hearing loss. These patients may require integration of hearing assessment and treatment as part of functional assessment in an interdisciplinary, team-based approach to care. PMID:22436959

  8. A patient-centered research agenda for the care of the acutely ill older patient

    PubMed Central

    Wald, Heidi L.; Leykum, Luci K.; Mattison, Melissa L. P.; Vasilevskis, Eduard E.; Meltzer, David O.

    2015-01-01

    Hospitalists and others acute care providers are limited by gaps in evidence addressing the needs of the acutely ill older adult population. The Society of Hospital Medicine (SHM) sponsored the Acute Care of Older Patients (ACOP) Priority Setting Partnership to develop a research agenda focused on bridging this gap. Informed by the Patient-Centered Outcomes Research Institute (PCORI) framework for identification and prioritization of research areas, we adapted a methodology developed by the James Lind Alliance to engage diverse stakeholders in the research agenda setting process. The work of the Partnership proceeded through four steps: convening, consulting, collating, and prioritizing. First, the steering committee convened a Partnership of 18 stakeholder organizations in May 2013. Next, stakeholder organizations surveyed members to identify important unanswered questions in the acute care of older persons, receiving 1299 responses from 580 individuals. Finally, an extensive and structured process of collation and prioritization resulted in a final list of ten research questions in the following areas: advanced care planning, care transitions, delirium, dementia, depression, medications, models of care, physical function, surgery, and training. With the changing demographics of the hospitalized population, a workforce with limited geriatrics training, and gaps in evidence to inform clinical decision-making for acutely ill older patients, the identified research questions deserve the highest priority in directing future research efforts to improve care for the older hospitalized patient and enrich training. PMID:25877486

  9. Optimizing perioperative outcomes for older patients with rheumatoid arthritis undergoing arthroplasty: emphasis on medication management.

    PubMed

    Goodman, Susan M

    2015-05-01

    Patients with rheumatoid arthritis continue to undergo arthroplasty despite widespread use of potent disease-modifying drugs (DMARDs), including the biologic tumor necrosis-α inhibitors. In fact, over 80 % of RA patients are taking DMARDs or biologics at the time of arthroplasty. While many RA-specific factors including disease activity and disability may contribute to the increase in infection in RA patients undergoing arthroplasty, immunosuppressant medications may also play a role. As the age of patients with RA undergoing arthroplasty is rising, and the incidence of arthroplasty among the older population is increasing, optimal perioperative management of DMARDs and biologics in older patients with RA is an increasing challenge. Although evidence is sparse, most evidence supports withholding tumor necrosis-α inhibitors and other biologics prior to surgery based on the dosing interval, and continuing methotrexate and hydroxychloroquine through the perioperative period. There is no consensus regarding leflunomide, and rituximab risk does not appear related to the interval between infusion and surgery. This paper reviews arthroplasty outcomes including complications in patients with RA, and discusses the rationale for strategies for the optimal medication management of DMARDs and biologics in the perioperative period to minimize complications and improve outcomes.

  10. Clinical Efficacy and Safety of Naltrexone Combination Therapy in Older Patients with Severe Pruritus

    PubMed Central

    Lee, Jungsoo; Shin, Jung U; Noh, Seongmin; Park, Chang Ook

    2016-01-01

    Background Severe pruritus is a challenging condition, and it is more difficult to deal with in older patients due to their limitations in taking oral medication because of underlying diseases, possible interaction with concurrent medications, and poor general condition. Objective We evaluated the efficacy and safety of naltrexone (Revia®), an opioid antagonist, in elderly patients with severe pruritus that was not easily controlled with conventional antipruritics. Methods Eighteen patients were enrolled, with a mean age of 73 years. They additionally received 50 mg of naltrexone per day for an average of 2 months. Results Using the visual analogue scale, 13 (72.2%) of 18 patients showed a "much improved" condition, reporting more than a 50% decrease in pruritus intensity. Sixteen (88.9%) showed symptomatic improvement, and only 2 (11.1%) had persistent pruritus. Five patients reported side effects including insomnia, fatigue, constipation, and anorexia. However, reactions were either limited to the first 2 weeks or well managed. Conclusion Naltrexone could be an effective and safe alternative treatment option to control severe pruritus in older patients. PMID:27081261

  11. HIV-related Pneumocystis carinii Pneumonia in Older Patients Hospitalized in the Early HAART Era

    PubMed Central

    Kim, Benjamin; Lyons, Thomas M; Parada, Jorge P; Uphold, Constance R; Yarnold, Paul R; Hounshell, Jennie B; Sipler, Alison M; Goetz, Matthew B; DeHovitz, Jack A; Weinstein, Robert A; Campo, Rafael E; Bennett, Charles L

    2001-01-01

    OBJECTIVE To determine whether older age continues to influence patterns of care and in-hospital mortality for hospitalized persons with HIV-related Pneumocustis carinii pneumonia (PCP), as determined in our prior study from the 1980s. DESIGN Retrospective chart review. PATIENTS/SETTING Patients (1,861) with HIV-related PCP at 78 hospitals in 8 cities from 1995 to 1997. MEASUREMENTS Medical record notation of possible HIV infection; alveolar-arterial oxygen gradient; CD4 lymphocyte count; presence or absence of wasting; timely use of anti-PCP medications; in-hospital mortality. MAIN RESULTS Compared to younger patients, patients ≥50 years of age were less likely to have HIV mentioned in their progress notes (70% vs 82%, P < .001), have mild or moderately severe PCP cases at admission (89% vs 96%, P < .002), receive anti-PCP medications within the first 2 days of hospitalization (86% vs 93%, P <.002), and survive hospitalization (82% vs 90%, P < .003). However, age was not a significant predicator of mortality after adjustment for severity of PCP and timeliness of therapy. CONCLUSIONS While inpatient PCP mortality has improved by 50% in the past decade, 2-fold age-related mortality differences persist. As in the 1980s, these differences are associated with lower rates of recognition of HIV, increased severity of illenss at admission, and delays in initiation of PCP-specific treatments among older individuals—factors suggestive of delayed recognition of HIV infection, pneumonia, and PCP, respectively. Continued vigilance for the possibility of HIV and HIV-related PCP among persons ≥50 years of age who present with new pulmonary symptoms should be encouraged. PMID:11556938

  12. Subliminal strengthening: improving older individuals' physical function over time with an implicit-age-stereotype intervention.

    PubMed

    Levy, Becca R; Pilver, Corey; Chung, Pil H; Slade, Martin D

    2014-12-01

    Negative age stereotypes that older individuals assimilate from their culture predict detrimental outcomes, including worse physical function. We examined, for the first time, whether positive age stereotypes, presented subliminally across multiple sessions in the community, would lead to improved outcomes. Each of 100 older individuals (age=61-99 years, M=81) was randomly assigned to an implicit-positive-age-stereotype-intervention group, an explicit-positive-age-stereotype-intervention group, a combined implicit- and explicit-positive-age-stereotype-intervention group, or a control group. Interventions occurred at four 1-week intervals. The implicit intervention strengthened positive age stereotypes, which strengthened positive self-perceptions of aging, which, in turn, improved physical function. The improvement in these outcomes continued for 3 weeks after the last intervention session. Further, negative age stereotypes and negative self-perceptions of aging were weakened. For all outcomes, the implicit intervention's impact was greater than the explicit intervention's impact. The physical-function effect of the implicit intervention surpassed a previous study's 6-month-exercise-intervention's effect with participants of similar ages. The current study's findings demonstrate the potential of directing implicit processes toward physical-function enhancement over time. PMID:25326508

  13. Subliminal strengthening: improving older individuals' physical function over time with an implicit-age-stereotype intervention.

    PubMed

    Levy, Becca R; Pilver, Corey; Chung, Pil H; Slade, Martin D

    2014-12-01

    Negative age stereotypes that older individuals assimilate from their culture predict detrimental outcomes, including worse physical function. We examined, for the first time, whether positive age stereotypes, presented subliminally across multiple sessions in the community, would lead to improved outcomes. Each of 100 older individuals (age=61-99 years, M=81) was randomly assigned to an implicit-positive-age-stereotype-intervention group, an explicit-positive-age-stereotype-intervention group, a combined implicit- and explicit-positive-age-stereotype-intervention group, or a control group. Interventions occurred at four 1-week intervals. The implicit intervention strengthened positive age stereotypes, which strengthened positive self-perceptions of aging, which, in turn, improved physical function. The improvement in these outcomes continued for 3 weeks after the last intervention session. Further, negative age stereotypes and negative self-perceptions of aging were weakened. For all outcomes, the implicit intervention's impact was greater than the explicit intervention's impact. The physical-function effect of the implicit intervention surpassed a previous study's 6-month-exercise-intervention's effect with participants of similar ages. The current study's findings demonstrate the potential of directing implicit processes toward physical-function enhancement over time.

  14. Age at Immigration and the Incomes of Older Immigrants, 1994–2010

    PubMed Central

    Tienda, Marta

    2015-01-01

    Objectives. Seniors comprise a growing proportion of new U.S. immigrants. We investigate whether late-age immigrants are disadvantaged in older age relative to those arriving earlier in life, based on income, reliance on public benefits, and access to public medical insurance. We test whether the 1996 welfare reform law altered the relationships between age at immigration and these outcomes. Method. Immigrants aged 65 and older in the 1994–2010 Current Population Surveys were classified by age at immigration. Median and logistic regressions are used to estimate the association between age at immigration and several outcomes and to test whether these associations differ for arrivals before and after welfare reform. Results. Late-age immigration is strongly associated with lower personal income, lower rates of Medicare and Social Security receipt, and higher participation in Supplemental Security Income (SSI) and Medicaid. Arrival after 1996 is associated with lower rates of SSI, Medicaid, and Medicare receipt. The association between late-age immigration and income is stronger for post-1996 arrivals relative to earlier arrivals, whereas that between late-age immigration and Medicaid is weaker, suggesting that the penalty conferred by late-age immigration grew after reform. Discussion. Late-age immigrants face formidable economic disadvantages exacerbated by exclusion from public benefits, with implications for immigration, health care, and welfare policy. PMID:24942972

  15. Older, vulnerable patient view: a pilot and feasibility study of the patient measure of safety (PMOS) with patients in Australia

    PubMed Central

    Taylor, Natalie; Hogden, Emily; Clay-Williams, Robyn; Li, Zhicheng; Lawton, Rebecca; Braithwaite, Jeffrey

    2016-01-01

    Objectives The UK-developed patient measure of safety (PMOS) is a validated tool which captures patient perceptions of safety in hospitals. We aimed (1) to investigate the extent to which the PMOS is appropriate for use with stroke, acute myocardial infarction (AMI) and hip fracture patients in Australian hospitals and (2) to pilot the PMOS for use in a large-scale, national study ‘Deepening our Understanding of Quality in Australia’ (DUQuA). Participants Stroke, AMI and hip fracture patients (n=34) receiving care in 3 wards in 1 large hospital. Methods 2 phases were conducted. First, a ‘think aloud’ study was used to determine the validity of PMOS with this population in an international setting, and to make amendments based on patient feedback. The second phase tested the revised measure to establish the internal consistency reliability of the revised subscales, and piloted the recruitment and administration processes to ensure feasibility of the PMOS for use in DUQuA. Results Of the 43 questions in the PMOS, 13 (30%) were amended based on issues patients highlighted for improvement in phase 1. In phase 2, a total of 34 patients were approached and 29 included, with a mean age of 71.3 years (SD=16.39). Internal consistency reliability was established using interitem correlation and Cronbach's α for all but 1 subscale. The most and least favourably rated aspects of safety differed between the 3 wards. A study log was categorised into 10 key feasibility factors, including liaising with wards to understand operational procedures and identify patterns of patient discharge. Conclusions Capturing patient perceptions of care is crucial in improving patient safety. The revised PMOS is appropriate for use with vulnerable older adult groups. The findings from this study have informed key decisions made for the deployment of this measure as part of the DUQuA study. PMID:27279478

  16. Healthy ageing in Isan-Thai culture--A phenomenographic study based on older persons' lived experiences.

    PubMed

    Manasatchakun, Pornpun; Chotiga, Pleumjit; Roxberg, Åsa; Asp, Margareta

    2016-01-01

    Healthy ageing is a concept that concerns older persons' quality of life and is a key factor in promoting well-being. The older population in Thailand is growing. Isan (a region of north-eastern Thailand) has been reported as having one of the most rapidly increasing older populations in the country. In order to care for and promote the health of older people, healthcare providers should understand how healthy ageing is perceived by this target group. Although healthy ageing has been studied in different contexts as well as perspectives, no studies have previously focused on older persons' experiences of healthy ageing from a lifeworld perspective in Isan-Thai. Therefore, the aim of this study is to describe older persons' qualitatively different conceptions of healthy ageing in Isan-Thai culture. A phenomenographic approach with an epistemological base in lifeworld theory was used to disclose the various ways to conceptualize healthy ageing. Individual, qualitative interviews were conducted with 17 people aged 60 and above who live in Isan-Thai. The findings of this study revealed three categories of descriptions: "being independent in dependence," "being at peace," and "being a valuable person." This study also found family members, friends, healthcare providers, and religion important to healthy ageing in the Isan-Thai culture. Understanding how older people conceptualize healthy ageing is valuable for healthcare providers. They can apply these findings regarding healthy ageing in their fieldwork when caring for older people. PMID:26960686

  17. Healthy ageing in Isan-Thai culture--A phenomenographic study based on older persons' lived experiences.

    PubMed

    Manasatchakun, Pornpun; Chotiga, Pleumjit; Roxberg, Åsa; Asp, Margareta

    2016-01-01

    Healthy ageing is a concept that concerns older persons' quality of life and is a key factor in promoting well-being. The older population in Thailand is growing. Isan (a region of north-eastern Thailand) has been reported as having one of the most rapidly increasing older populations in the country. In order to care for and promote the health of older people, healthcare providers should understand how healthy ageing is perceived by this target group. Although healthy ageing has been studied in different contexts as well as perspectives, no studies have previously focused on older persons' experiences of healthy ageing from a lifeworld perspective in Isan-Thai. Therefore, the aim of this study is to describe older persons' qualitatively different conceptions of healthy ageing in Isan-Thai culture. A phenomenographic approach with an epistemological base in lifeworld theory was used to disclose the various ways to conceptualize healthy ageing. Individual, qualitative interviews were conducted with 17 people aged 60 and above who live in Isan-Thai. The findings of this study revealed three categories of descriptions: "being independent in dependence," "being at peace," and "being a valuable person." This study also found family members, friends, healthcare providers, and religion important to healthy ageing in the Isan-Thai culture. Understanding how older people conceptualize healthy ageing is valuable for healthcare providers. They can apply these findings regarding healthy ageing in their fieldwork when caring for older people.

  18. Conventional chemotherapy or hypomethylating agents for older patients with acute myeloid leukaemia?

    PubMed

    Ferrara, Felicetto

    2014-03-01

    Acute myeloid leukaemia (AML) is the second more frequent hematologic malignancy in developed countries and primarily affects older adults with a median age at diagnosis of 69 years. Given the progressive ageing of the general population, the incidence of the disease in elderly people is expected to further increase in the years to come. Along with cytogenetics at diagnosis, age represents the most relevant prognostic factor in AML, in that the outcome steadily declines with increasing age. Reasons for poor prognosis include more frequent unfavourable karyotype and other adverse biologic characteristics, such as high rates of expression of genes drug resistance related and high prevalence of secondary AML. Noticeably, as compared with young adults, poorer results in elderly patients have been reported within any cytogenetic and molecular prognostic subgroup, because of frequent comorbid diseases, which render many patients ineligible to intensive chemotherapy. Therefore, predictive models have been developed with the aim of achieving best therapeutic results avoiding unnecessary toxicity. Following conventional induction therapy, older AML patients have complete remission rates in the range of 45-65%, and fewer than 10% of them survive for a minimum of 5 years. On the other hand, hypomethylating agents, such as azacytidine and decitabine offer the possibility of long-term disease control without necessarily achieving complete remission and can represent a reasonable alternative to intensive chemotherapy. Either intensive chemotherapy or hypomethylating agents have lights and shadows, and the therapeutic selection is often influenced by physician's and patient's attitude rather than definite criteria. Research is progress in order to assess predictive biologic factors, which would help clinicians in the selection of patients who can take actual benefit from different therapeutic options.

  19. Why Do Older Men Report Low Stress Ratings? Findings from the Veterans Affairs Normative Aging Study

    ERIC Educational Resources Information Center

    Boeninger, Daria K.; Shiraishi, Ray W.; Aldwin, Carolyn M.; Spiro, Avron, III

    2009-01-01

    We examined the interplay between three explanatory hypotheses for why older adults appear to rate their problems as less stressful than do younger adults: age-related differences in personality, in types of problems, and in the appraisal process--specifically, the number of primary stress appraisals. A sample of 1,054 men from the Normative Aging…

  20. How Older People Think about Images of Aging in Advertising and the Media.

    ERIC Educational Resources Information Center

    Bradley, Don E.; Longino, Charles F., Jr.

    2001-01-01

    A literature review documents distorted images of aging in mass media and advertising, including underrepresentation and stereotyping. Older consumers are dissatisfied with these images, and their growing purchasing power is forcing advertisers to make more effective appeals. (Contains 20 references.) (SK)

  1. The Age of Beauty Calendar for Flood Relief: Photography, Solidarity, Fundraising, and Vibrant Older Women

    ERIC Educational Resources Information Center

    Roy, Carole

    2005-01-01

    "The Age of Beauty: Women for Flood Relief 2005-2006: Celebrating the Spirit of Peterborough," is a calendar that successfully raised funds for flood victims while contributing to the reinvention of images of "powerful rebellious old women" by offering dynamic images of older women's strengths, creativity and spirit. During a time of crisis in…

  2. A Comparison of Young, Middle-Aged, and Older Adult Treatment-Seeking Pathological Gamblers

    ERIC Educational Resources Information Center

    Petry, Nancy M.

    2002-01-01

    Purpose: Pathological gambling is an increasing public health concern, but very little is known about this disorder in older adults. This study evaluated gambling and psychosocial problems across age groups in treatment-seeking gamblers. Design and Methods: At intake to gambling treatment programs, 343 pathological gamblers completed the Addiction…

  3. Health Promoting Behaviors of Older Americans Versus Young and Middle Aged Adults

    ERIC Educational Resources Information Center

    Becker, Craig M.; Arnold, William

    2004-01-01

    Health promoting behaviors have become increasingly important as Americans attempt to retain their youth and health. This study collected self-reported data from 559 participants in the Southwest United States using the Health Promoting Lifestyle Profile II to compare the health promoting behaviors of older adults (60-92 years), middle-aged adults…

  4. Health Promoting Behaviors of Older Americans versus Young and Middle Aged Adults

    ERIC Educational Resources Information Center

    Becker, Craig; Arnold, William

    2004-01-01

    Health promoting behaviors have become increasingly important as Americans attempt to retain their youth and health. This study collected self-reported data from 559 participants in the Southwest United States using the Health Promoting Lifestyle Profile II to compare the health promoting behaviors of older adults (60-92 years), middle-aged adults…

  5. 42 CFR 441.253 - Sterilization of a mentally competent individual aged 21 or older.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false Sterilization of a mentally competent individual aged 21 or older. 441.253 Section 441.253 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... LIMITS APPLICABLE TO SPECIFIC SERVICES Sterilizations § 441.253 Sterilization of a mentally...

  6. 42 CFR 441.253 - Sterilization of a mentally competent individual aged 21 or older.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 4 2012-10-01 2012-10-01 false Sterilization of a mentally competent individual aged 21 or older. 441.253 Section 441.253 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... LIMITS APPLICABLE TO SPECIFIC SERVICES Sterilizations § 441.253 Sterilization of a mentally...

  7. 42 CFR 441.253 - Sterilization of a mentally competent individual aged 21 or older.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false Sterilization of a mentally competent individual aged 21 or older. 441.253 Section 441.253 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... LIMITS APPLICABLE TO SPECIFIC SERVICES Sterilizations § 441.253 Sterilization of a mentally...

  8. 42 CFR 441.253 - Sterilization of a mentally competent individual aged 21 or older.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 4 2013-10-01 2013-10-01 false Sterilization of a mentally competent individual aged 21 or older. 441.253 Section 441.253 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... LIMITS APPLICABLE TO SPECIFIC SERVICES Sterilizations § 441.253 Sterilization of a mentally...

  9. U3A Online: A Virtual University of the Third Age for Isolated Older People.

    ERIC Educational Resources Information Center

    Swindell, Rick

    2002-01-01

    Data from 29 older adults in University of the Third Age Online in 1999 and 34 in 2001 indicated that women outnumbered men; more than 70% were from large urban areas; and 70% had professional, business, and managerial backgrounds. Many are unable to participate in mainstream adult education and derive purpose and enjoyment from virtual…

  10. Performance of Older Persons in a Simulated Shopping Task Is Influenced by Priming with Age Stereotypes

    PubMed Central

    Akpinar, Selçuk

    2016-01-01

    Previous research suggests that older persons show cognitive deficits in standardized laboratory tests, but not in more natural tests such as the Multiple Errands Task (MET). The absence of deficits in the latter tests has been attributed to the compensation of deficits by strategies based on life-long experience. To scrutinize this view, we primed older participants with positive or negative stereotypes about old age before administering MET. We found that compared to unprimed controls, priming with positive age stereotypes reduced the number of errors without changing response times, while priming with negative stereotypes changed neither errors not response times. We interpret our findings as evidence that positive age priming improved participants’ cognitive functions while leaving intact their experience-based compensation, and that negative age priming degraded participants’ cognitive functions which, however, was balanced by an even stronger experience-based compensation. PMID:27649296

  11. Performance of Older Persons in a Simulated Shopping Task Is Influenced by Priming with Age Stereotypes.

    PubMed

    Bock, Otmar; Akpinar, Selçuk

    2016-01-01

    Previous research suggests that older persons show cognitive deficits in standardized laboratory tests, but not in more natural tests such as the Multiple Errands Task (MET). The absence of deficits in the latter tests has been attributed to the compensation of deficits by strategies based on life-long experience. To scrutinize this view, we primed older participants with positive or negative stereotypes about old age before administering MET. We found that compared to unprimed controls, priming with positive age stereotypes reduced the number of errors without changing response times, while priming with negative stereotypes changed neither errors not response times. We interpret our findings as evidence that positive age priming improved participants' cognitive functions while leaving intact their experience-based compensation, and that negative age priming degraded participants' cognitive functions which, however, was balanced by an even stronger experience-based compensation. PMID:27649296

  12. On and Off the Mat: Yoga Experiences of Middle-Aged and Older Adults.

    PubMed

    Wertman, Annette; Wister, Andrew V; Mitchell, Barbara A

    2016-06-01

    This article explores potential differences in yoga practice between middle-and older-aged adults. A health belief - life course model frames this research, and a mixed-methods analytic strategy is employed to examine life course pathways into yoga and motivations to practice, as well as perceived barriers and health benefits. For the quantitative analyses, a convenience sample of 452 participants was collected using an online questionnaire. For the qualitative analyses, face-to-face interviews were conducted with a sub-set of 20 participants. Unique differences between the age groups (both current age and age when started yoga) as well as by gender were found for selected pathways, reasons/motivations, and barriers to engage in yoga as well as for perceived health benefits. In addition, results underscore the importance of informational cues and social linkages that affect how individuals adopt and experience yoga. Implications for health promotion programs that target older adults are discussed. PMID:27086476

  13. Primary Care for the Older Adult Patient: Common Geriatric Issues and Syndromes.

    PubMed

    Thompson, Katherine; Shi, Sandra; Kiraly, Carmela

    2016-06-01

    Older adults are the fastest growing segment of the US population and the majority of older adults are women. Primary care for the older adult patient requires a wide variety of skills, reflecting the complexity and heterogeneity of this patient population. Individualizing care through consideration of patients' goals, medical conditions, and prognosis is paramount. Quality care for the older adult patient requires familiarity with common geriatric syndromes, such as dementia, falls, and polypharmacy. In addition, developing the knowledge and communication skills necessary for complex care and end-of-life care planning is essential.

  14. Single Stance Stability and Proprioceptive Control in Older Adults Living at Home: Gender and Age Differences

    PubMed Central

    Riva, Dario; Mamo, Carlo; Fanì, Mara; Saccavino, Patrizia; Rocca, Flavio; Momenté, Manuel; Fratta, Marianna

    2013-01-01

    In developed countries, falls in older people represent a rising problem. As effective prevention should start before the risk becomes evident, an early predictor is needed. Single stance instability would appear as a major risk factor. Aims of the study were to describe single stance stability, its sensory components, and their correlation with age and gender. A random sample of 597 older adults (319 men, 278 women) living at home, aged 65–84, was studied. Stability tests were performed with an electronic postural station. The single stance test showed the impairment of single stance stability in older individuals (75–84 yrs). The significant decline of stability in the older subjects may be explained by the impairment of proprioceptive control together with the decrease in compensatory visual stabilization and emergency responses. Younger subjects (65–74 yrs) exhibited better, but still inadequate, proprioceptive control with compensatory visual stabilization. Gender differences appeared in older subjects: women were significantly less stable than men. The measurement of the sensory components of single stance stability could aid in the early detection of a decay in antigravity movements many years before the risk of falling becomes evident. Adequate proprioceptive control could mitigate the effects of all other risks of falling. PMID:23984068

  15. Comprehensively Assessing Cognitive and Behavioral Risks for HIV Infection among Middle-Aged and Older Adults

    ERIC Educational Resources Information Center

    Paniagua, Freddy A.; O'Boyle, Michael

    2008-01-01

    A comprehensive survey of HIV/AIDS with middle-aged and older adults should include six domains (e.g., factual knowledge regarding the acquisition and transmission of HIV, traditionally-accepted behavioral risks for HIV infection). A sample of 23 women (54.8%) and 19 men (45.2%), ranging in age from 51 to 85 were surveyed across such domains.…

  16. Hospitalization in older patients due to adverse drug reactions –the need for a prediction tool

    PubMed Central

    Parameswaran Nair, Nibu; Chalmers, Leanne; Peterson, Gregory M; Bereznicki, Bonnie J; Castelino, Ronald L; Bereznicki, Luke R

    2016-01-01

    Adverse drug reactions (ADRs) represent a major burden on society, resulting in significant morbidity, mortality, and health care costs. Older patients living in the community are particularly susceptible to ADRs, and are at an increased risk of ADR-related hospitalization. This review summarizes the available evidence on ADR-related hospital admission in older patients living in the community, with a particular focus on risk factors for ADRs leading to hospital admission and the need for a prediction tool for risk of ADR-related hospitalization in these individuals. The reported proportion of hospital admissions due to ADRs has ranged from 6% to 12% of all admissions in older patients. The main risk factors or predictors for ADR-related admissions were advanced age, polypharmacy, comorbidity, and potentially inappropriate medications. There is a clear need to design intervention strategies to prevent ADR-related hospitalization in older patients. To ensure the cost-effectiveness of such strategies, it would be necessary to target them to those older individuals who are at highest risk of ADR-related hospitalization. Currently, there are no validated tools to assess the risk of ADRs in primary care. There is a clear need to investigate the utility of tools to identify high-risk patients to target appropriate interventions toward prevention of ADR-related hospital admissions. PMID:27194906

  17. "Feeling younger, walking faster": subjective age and walking speed in older adults.

    PubMed

    Stephan, Yannick; Sutin, Angelina R; Terracciano, Antonio

    2015-10-01

    Walking speed is a key vital sign in older people. Given the implications of slower gait speed, a large literature has identified health-related, behavioral, cognitive, and biological factors that moderate age-related decline in mobility. The present study aims to contribute to existing knowledge by examining whether subjective age, how old or young individuals experience themselves to be relative to their chronological age, contributes to walking speed. Participants were drawn from the 2008 and 2012 waves of the Health and Retirement Study (HRS, N = 2970) and the 2011 and 2013 waves of the National Health and Aging Trends Study (NHATS, N = 5423). In both the HRS and the NHATS, linear regression analysis revealed that a younger subjective age was associated with faster walking speed at baseline and with less decline over time, controlling for age, sex, education, and race. These associations were partly accounted for by depressive symptoms, disease burden, physical activity, cognition, body mass index, and smoking. Additional analysis revealed that feeling younger than one's age was associated with a reduced risk of walking slower than the frailty-related threshold of 0.6 m/s at follow-up in the HRS. The present study provides novel and consistent evidence across two large prospective studies for an association between the subjective experience of age and walking speed of older adults. Subjective age may help identify individuals at risk for mobility limitations in old age and may be a target for interventions designed to mitigate functional decline. PMID:26296609

  18. "Feeling younger, walking faster": subjective age and walking speed in older adults.

    PubMed

    Stephan, Yannick; Sutin, Angelina R; Terracciano, Antonio

    2015-10-01

    Walking speed is a key vital sign in older people. Given the implications of slower gait speed, a large literature has identified health-related, behavioral, cognitive, and biological factors that moderate age-related decline in mobility. The present study aims to contribute to existing knowledge by examining whether subjective age, how old or young individuals experience themselves to be relative to their chronological age, contributes to walking speed. Participants were drawn from the 2008 and 2012 waves of the Health and Retirement Study (HRS, N = 2970) and the 2011 and 2013 waves of the National Health and Aging Trends Study (NHATS, N = 5423). In both the HRS and the NHATS, linear regression analysis revealed that a younger subjective age was associated with faster walking speed at baseline and with less decline over time, controlling for age, sex, education, and race. These associations were partly accounted for by depressive symptoms, disease burden, physical activity, cognition, body mass index, and smoking. Additional analysis revealed that feeling younger than one's age was associated with a reduced risk of walking slower than the frailty-related threshold of 0.6 m/s at follow-up in the HRS. The present study provides novel and consistent evidence across two large prospective studies for an association between the subjective experience of age and walking speed of older adults. Subjective age may help identify individuals at risk for mobility limitations in old age and may be a target for interventions designed to mitigate functional decline.

  19. 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

  20. Aging and the HPA axis: Stress and resilience in older adults.

    PubMed

    Gaffey, Allison E; Bergeman, C S; Clark, Lee Anna; Wirth, Michelle M

    2016-09-01

    Hypothalamic-pituitary-adrenal (HPA) axis function may change over the course of aging, and altered diurnal or stress-induced secretion of the hormone cortisol could predispose older adults to negative health outcomes. We propose that psychological resilience may interact with diurnal cortisol to affect health outcomes later in life. Emotion regulation and social support are two constructs that contribute to resilience and exhibit age-specific patterns in older adults. Determining how the use of resilience resources interacts with age-related diurnal cortisol will improve our understanding of the pathways between stress, resilience, and well-being. In this review, we assess published studies evaluating diurnal cortisol in older adults to better understand differences in their HPA axis functioning. Evidence thus far suggests that diurnal cortisol may increase with age, although cross-sectional studies limit the conclusions that can be drawn. We also review extant evidence connecting age-specific signatures of emotion regulation and social support with diurnal cortisol. Conclusions are used to propose a preliminary model demonstrating how resilience resources may modulate the effects of cortisol on health in aging.

  1. Knowledge about aging and worry in older adults: Testing the mediating role of intolerance of uncertainty

    PubMed Central

    Nuevo, Roberto; Wetherell, Julie Loebach; Montorio, Ignacio; Ruiz, Miguel A.; Cabrera, Isabel

    2014-01-01

    Objectives This study aims to explore the relationship between knowledge about aging and severity of worry in older adults, and to test the potential mediational role of intolerance of uncertainty. Method The sample was composed of 120 community-dwelling older adults, with a mean of age of 71.0 years (SD = 6.3). Mediational analyses and structural equation modeling were used to analyze and compare different models. Results Greater knowledge about aging was negatively related to both intolerance of uncertainty and worry, and its effect on worry was partially mediated by intolerance of uncertainty. The mediational model obtained an excellent fit to the data (i.e. Goodness of fit index (GFI) = 0.995) and clearly had a better fit than alternative models. Conclusion These results suggest that a good knowledge of the aging process could help decrease aversive uncertainty and thus reduce the level of worry among older adults. Thus, educational programs to increase knowledge about aging could serve as one preventive strategy for anxiety in old age. PMID:19197699

  2. 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

  3. 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.

  4. Suicide Risk and Precipitating Circumstances Among Young, Middle-Aged, and Older Male Veterans

    PubMed Central

    McFarland, Bentson H.; Huguet, Nathalie; Valenstein, Marcia

    2012-01-01

    Objectives. The purpose of this study was to evaluate the risk of suicide among veteran men relative to nonveteran men by age and to examine the prevalence of suicide circumstances among male veterans in different age groups (18–34, 35–44, 45–64, and ≥ 65 years). Methods. Data from the National Violent Death Reporting System (2003–2008) were used to calculate age-specific suicide rates for veterans (n = 8440) and nonveterans (n = 21 668) and to calculate the age-stratified mortality ratio for veterans. Multiple logistic regression was used to compare health status, stressful life events preceding suicide, and means of death among young, middle-aged, and older veterans. Results. Veterans were at higher risk for suicide compared with nonveterans in all age groups except the oldest. Mental health, substance abuse, and financial and relationship problems were more common in younger than in older veteran suicide decedents, whereas health problems were more prevalent in the older veterans. Most male veterans used firearms for suicide, and nearly all elderly veterans did so. Conclusions. Our study highlighted heightened risk of suicide in male veterans compared with nonveterans. Within the veteran population, suicide might be influenced by different precipitating factors at various stages of life. PMID:22390587

  5. 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

  6. Outcome of older patients with acute myeloid leukemia in first relapse.

    PubMed

    Sarkozy, Clémentine; Gardin, Claude; Gachard, Nathalie; Merabet, Fathia; Turlure, Pascal; Malfuson, Jean-Valère; Pautas, Cécile; Micol, Jean-Baptiste; Thomas, Xavier; Quesnel, Bruno; Celli-Lebras, Karine; Preudhomme, Claude; Terré, Christine; Fenaux, Pierre; Chevret, Sylvie; Castaigne, Sylvie; Dombret, Hervé

    2013-09-01

    To provide data for future drug evaluation, we analyzed the outcome of 393 patients aged 50 years or older (median, 64 years) with AML in first relapse after treatment in recent ALFA trials. Salvage options were retrospectively classified as follows: best supportive care (BSC), low-dose cytarabine (LDAC), gemtuzumab ozogamicin (GO), intensive chemotherapy (ICT), or ICT combined with GO. Second complete remission (CR2) rate was 31% and median post-relapse survival was 6.8 months (0, 17, 42.5, 53, and 80% and 3.2, 5.6, 8.9, 9, and 19.8 months in BSC, LDAC, GO, ICT, and ICT + GO subsets, respectively). Age, performance status, WBC, CR1 duration, and favorable AML karyotype, but not other cytogenetic or molecular features, influenced post-relapse outcome. Multivariate adjustment and propensity score matching showed that intensive salvage (ICT/ICT+GO/GO versus LDAC/BSC) was associated with longer post-relapse survival, at least in patients with CR1 duration ≥12 months (P = 0.001 and 0.0005, respectively). Of interest, GO appeared to be as effective as standard ICT, and ICT + GO combination more effective than standard ICT. In conclusion, older patients with CR1 duration ≥12 months appeared to benefit from intensive salvage and results observed with GO-containing salvage suggest that GO combination studies should be actively pursued in this setting. PMID:23749683

  7. Self-assessed driving behaviors associated with age among middle-aged and older adults in Japan.

    PubMed

    Arai, Asuna; Arai, Yumiko

    2015-01-01

    With the increasing number of older drivers, road traffic safety is an urgent public health issue. It is not easy for older drivers or their relatives to detect early signs of dangerous driving behaviors. We examine the types of driving behavior that increase in frequency with age. We surveyed people aged 40 and over among the general public in Japan using a self-administered questionnaire on sociodemographic factors, driving status, frequency of driving, 12-items on physical symptoms possibly related to driving performance, and 28-items on driving behaviors. Multiple logistic regression models were used to estimate the odds ratios (OR) of occurrence of each of the 28 driving behaviors for a 5-year increase in age. Significant associations with a 5-year increase in age after adjusting for confounding factors were found for the following directly unsafe driving behaviors: (1) little or no sign of attempts to avoid dangerous situations (OR for a 5-year increase in age=1.38, 95% CI: 1.18-1.63); (2) lack of attention to other people and cars (1.33, 1.12-1.60); (3) improper maneuvering around curves (1.33, 1.09-1.65); and (4) improper or no turn signals (1.33, 1.06-1.69). Information about these driving behaviors should be given to drivers and their stakeholders and used to caution participants when implementing educational programs for older drivers. Self-assessment of driving ability in older drivers provides useful information to raise awareness of their driving performance.

  8. Toward a typology of technology users: how older people experience technology's potential for active aging.

    PubMed

    Gjevjon, Edith Roth; Oderud, Tone; Wensaas, Gro H; Moen, Anne

    2014-01-01

    This paper outlines an emerging typology of older users of information and communication technology (ICT) to facilitate active aging. Through inductive data analysis from focus groups, iterative workshops, and personal interviews, we suggest three types of technology users. These types are "the Excluded," "the Entertained," and "the Networker." Clearly, ICT offers several benefits to those who are enthusiastic and frequent users, exemplified as the Entertained and the Networker. Hence, our findings support the notion of technology as a tool to maintain or increase an older person's engagement and activity level. Conversely, for those reluctant, uninterested, or incapable of using ICT, such potentials are limited and imply fewer opportunities for participation in activities.

  9. Health, Height, Height Shrinkage, and SES at Older Ages: Evidence from China†

    PubMed Central

    Huang, Wei; Lei, Xiaoyan; Ridder, Geert; Strauss, John

    2015-01-01

    In this paper, we build on the literature that examines associations between height and health outcomes of the elderly. We investigate the associations of height shrinkage at older ages with socioeconomic status, finding that height shrinkage for both men and women is negatively associated with better schooling, current urban residence, and household per capita expenditures. We then investigate the relationships between pre-shrinkage height, height shrinkage, and a rich set of health outcomes of older respondents, finding that height shrinkage is positively associated with poor health outcomes across a variety of outcomes, being especially strong for cognition outcomes. PMID:26594311

  10. Treatment planning concepts for the ageing patient.

    PubMed

    Ettinger, R L

    2015-03-01

    There is an ageing imperative in Australia as in many other industrialized nations, and these populations are extremely heterogeneous. In young adults, the factors which influence decision making for oral health care are whether the patient has the will, the time or the finances to pay for care, while for clinicians, the decisions are whether they have the skill and the resources to carry out the treatment plan. For older adults, the decision making includes all of the previous identified factors, but they are now complicated by the patient's medical and medication problems, the side effects of the medications they are taking, their cognitive status as well as the cumulative effects of a lifetime of physiological, traumatic and iatrogenic effects on the dentition and the oral cavity. The decision-making process which has evolved has been called many names, from cost-effective care to minimal invasive dentistry to rational dental care. Fundamentally, they are similar. Rational dental care has been defined as the process of decision making, which develops a treatment plan that is in the best interest of the patient after evaluating all of the modifying factors. This article will discuss the various concepts, and the strengths and weaknesses of some of these systems. It will also illustrate some of the clinical problems as there is very little evidence-based data to support any of these concepts. However, treatment planning is still an art, which can only be carried out for an individual and not a group, and the result must serve the needs of the patient and enhance the quality of his or her life. PMID:25762044

  11. Efficacy of the Herpes Zoster Subunit Vaccine in Adults 70 Years of Age or Older.

    PubMed

    Cunningham, Anthony L; Lal, Himal; Kovac, Martina; Chlibek, Roman; Hwang, Shinn-Jang; Díez-Domingo, Javier; Godeaux, Olivier; Levin, Myron J; McElhaney, Janet E; Puig-Barberà, Joan; Vanden Abeele, Carline; Vesikari, Timo; Watanabe, Daisuke; Zahaf, Toufik; Ahonen, Anitta; Athan, Eugene; Barba-Gomez, Jose F; Campora, Laura; de Looze, Ferdinandus; Downey, H Jackson; Ghesquiere, Wayne; Gorfinkel, Iris; Korhonen, Tiina; Leung, Edward; McNeil, Shelly A; Oostvogels, Lidia; Rombo, Lars; Smetana, Jan; Weckx, Lily; Yeo, Wilfred; Heineman, Thomas C

    2016-09-15

    Background A trial involving adults 50 years of age or older (ZOE-50) showed that the herpes zoster subunit vaccine (HZ/su) containing recombinant varicella-zoster virus glycoprotein E and the AS01B adjuvant system was associated with a risk of herpes zoster that was 97.2% lower than that associated with placebo. A second trial was performed concurrently at the same sites and examined the safety and efficacy of HZ/su in adults 70 years of age or older (ZOE-70). Methods This randomized, placebo-controlled, phase 3 trial was conducted in 18 countries and involved adults 70 years of age or older. Participants received two doses of HZ/su or placebo (assigned in a 1:1 ratio) administered intramuscularly 2 months apart. Vaccine efficacy against herpes zoster and postherpetic neuralgia was assessed in participants from ZOE-70 and in participants pooled from ZOE-70 and ZOE-50. Results In ZOE-70, 13,900 participants who could be evaluated (mean age, 75.6 years) received either HZ/su (6950 participants) or placebo (6950 participants). During a mean follow-up period of 3.7 years, herpes zoster occurred in 23 HZ/su recipients and in 223 placebo recipients (0.9 vs. 9.2 per 1000 person-years). Vaccine efficacy against herpes zoster was 89.8% (95% confidence interval [CI], 84.2 to 93.7; P<0.001) and was similar in participants 70 to 79 years of age (90.0%) and participants 80 years of age or older (89.1%). In pooled analyses of data from participants 70 years of age or older in ZOE-50 and ZOE-70 (16,596 participants), vaccine efficacy against herpes zoster was 91.3% (95% CI, 86.8 to 94.5; P<0.001), and vaccine efficacy against postherpetic neuralgia was 88.8% (95% CI, 68.7 to 97.1; P<0.001). Solicited reports of injection-site and systemic reactions within 7 days after injection were more frequent among HZ/su recipients than among placebo recipients (79.0% vs. 29.5%). Serious adverse events, potential immune-mediated diseases, and deaths occurred with similar frequencies in the

  12. Efficacy of the Herpes Zoster Subunit Vaccine in Adults 70 Years of Age or Older.

    PubMed

    Cunningham, Anthony L; Lal, Himal; Kovac, Martina; Chlibek, Roman; Hwang, Shinn-Jang; Díez-Domingo, Javier; Godeaux, Olivier; Levin, Myron J; McElhaney, Janet E; Puig-Barberà, Joan; Vanden Abeele, Carline; Vesikari, Timo; Watanabe, Daisuke; Zahaf, Toufik; Ahonen, Anitta; Athan, Eugene; Barba-Gomez, Jose F; Campora, Laura; de Looze, Ferdinandus; Downey, H Jackson; Ghesquiere, Wayne; Gorfinkel, Iris; Korhonen, Tiina; Leung, Edward; McNeil, Shelly A; Oostvogels, Lidia; Rombo, Lars; Smetana, Jan; Weckx, Lily; Yeo, Wilfred; Heineman, Thomas C

    2016-09-15

    Background A trial involving adults 50 years of age or older (ZOE-50) showed that the herpes zoster subunit vaccine (HZ/su) containing recombinant varicella-zoster virus glycoprotein E and the AS01B adjuvant system was associated with a risk of herpes zoster that was 97.2% lower than that associated with placebo. A second trial was performed concurrently at the same sites and examined the safety and efficacy of HZ/su in adults 70 years of age or older (ZOE-70). Methods This randomized, placebo-controlled, phase 3 trial was conducted in 18 countries and involved adults 70 years of age or older. Participants received two doses of HZ/su or placebo (assigned in a 1:1 ratio) administered intramuscularly 2 months apart. Vaccine efficacy against herpes zoster and postherpetic neuralgia was assessed in participants from ZOE-70 and in participants pooled from ZOE-70 and ZOE-50. Results In ZOE-70, 13,900 participants who could be evaluated (mean age, 75.6 years) received either HZ/su (6950 participants) or placebo (6950 participants). During a mean follow-up period of 3.7 years, herpes zoster occurred in 23 HZ/su recipients and in 223 placebo recipients (0.9 vs. 9.2 per 1000 person-years). Vaccine efficacy against herpes zoster was 89.8% (95% confidence interval [CI], 84.2 to 93.7; P<0.001) and was similar in participants 70 to 79 years of age (90.0%) and participants 80 years of age or older (89.1%). In pooled analyses of data from participants 70 years of age or older in ZOE-50 and ZOE-70 (16,596 participants), vaccine efficacy against herpes zoster was 91.3% (95% CI, 86.8 to 94.5; P<0.001), and vaccine efficacy against postherpetic neuralgia was 88.8% (95% CI, 68.7 to 97.1; P<0.001). Solicited reports of injection-site and systemic reactions within 7 days after injection were more frequent among HZ/su recipients than among placebo recipients (79.0% vs. 29.5%). Serious adverse events, potential immune-mediated diseases, and deaths occurred with similar frequencies in the

  13. Fusion mass bone quality after uninstrumented spinal fusion in older patients

    PubMed Central

    Christensen, Finn B.; Langdahl, Bente L.; Ernst, Carsten; Fruensgaard, Søren; Østergaard, Jørgen; Andersen, Jens Langer; Rasmussen, Sten; Niedermann, Bent; Høy, Kristian; Helmig, Peter; Holm, Randi; Lindblad, Bent Erling; Hansen, Ebbe Stender; Egund, Niels; Bünger, Cody

    2010-01-01

    Older people are at increased risk of non-union after spinal fusion, but little is known about the factors determining the quality of the fusion mass in this patient group. The aim of this study was to investigate fusion mass bone quality after uninstrumented spinal fusion and to evaluate if it could be improved by additional direct current (DC) electrical stimulation. A multicenter RCT compared 40 and 100 μA DC stimulation with a control group of uninstrumented posterolateral fusion in patients older than 60 years. This report comprised 80 patients who underwent DEXA scanning at the 1 year follow-up. The study population consisted of 29 men with a mean age of 72 years (range 62–85) and 51 women with a mean age of 72 years (range 61–84). All patients underwent DEXA scanning of their fusion mass. Fusion rate was assessed at the 2 year follow-up using thin slice CT scanning. DC electrical stimulation did not improve fusion mass bone quality. Smokers had lower fusion mass BMD (0.447 g/cm2) compared to non-smokers (0.517 g/cm2) (P = 0.086). Women had lower fusion mass BMD (0.460 g/cm2) compared to men (0.552 g/cm2) (P = 0.057). Using linear regression, fusion mass bone quality, measured as BMD, was significantly influenced by gender, age of the patient, bone density of the remaining part of the lumbar spine, amount of bone graft applied and smoking. Fusion rates in this cohort was 34% in the control group and 33 and 43% in the 40 and 100 μA groups, respectively (not significant). Patients classified as fused after 2 years had significant higher fusion mass BMD at 1 year (0.592 vs. 0.466 g/cm2, P = 0.0001). Fusion mass bone quality in older patients depends on several factors. Special attention should be given to women with manifest or borderline osteoporosis. Furthermore, bone graft materials with inductive potential might be considered for this patient population. PMID:20429017

  14. The attitudes of graduate healthcare students toward older adults, personal aging, health care reform, and interprofessional collaboration.

    PubMed

    Golden, Adam G; Gammonley, Denise; Hunt, Debra; Olsen, Edwin; Issenberg, S Barry

    2014-01-01

    Healthcare reform has led to an increased emphasis on interprofessional healthcare models for older adults. Unfortunately, best practice education that focuses on the interprofessional healthcare of the elderly does not yet exist. As a prelude to implementing interprofessional geriatric educational initiatives, we developed a survey to identify potential attitudinal differences among graduate healthcare students regarding personal aging, caring for older adults, healthcare reform and the role of the physician on the interprofessional team. We surveyed third-year medical students, nurse practitioner students and graduate social work students. Attitudes regarding personal aging were similar among the professions. Nurse practitioner and social work students had higher positive attitudes toward the care of older adults. Concerns about the impact of healthcare reform on quality and healthcare costs differed significantly. There was also a significant difference in attitudes concerning the role of the physician as the leader of the interprofessional team. These results provide insights into gerontologic-focused attitudes of graduate healthcare professional students. In an era of dramatic healthcare change, these findings will assist educators in the development and implementation of educational programs to prepare graduate students for the interprofessional care of elderly patients.

  15. Psychology Doctoral Students' Interest in Working with Older Adults: The Roles of Knowledge, Ageism, Aging Anxiety and Contact

    ERIC Educational Resources Information Center

    Dobbin, Carrie B.

    2012-01-01

    Given the growing population of older adults with more reported mental health needs, there are not sufficient psychologists interested in working with this population. This study looked at why interest is so low, looking particularly at the correlations between interest in working with older adults and knowledge about aging, ageism, aging anxiety…

  16. 20 CFR 404.1583 - How we determine disability for blind persons who are age 55 or older.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) Determining Disability and Blindness Blindness § 404.1583 How we determine disability for blind persons who are age 55 or older. We will...

  17. 20 CFR 404.1583 - How we determine disability for blind persons who are age 55 or older.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) Determining Disability and Blindness Blindness § 404.1583 How we determine disability for blind persons who are age 55 or older. We will...

  18. 20 CFR 404.1583 - How we determine disability for blind persons who are age 55 or older.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) Determining Disability and Blindness Blindness § 404.1583 How we determine disability for blind persons who are age 55 or older. We will...

  19. 20 CFR 404.1583 - How we determine disability for blind persons who are age 55 or older.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) Determining Disability and Blindness Blindness § 404.1583 How we determine disability for blind persons who are age 55 or older. We will...

  20. 20 CFR 404.1583 - How we determine disability for blind persons who are age 55 or older.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) Determining Disability and Blindness Blindness § 404.1583 How we determine disability for blind persons who are age 55 or older. We will...

  1. Older Age at Completion of Fontan Procedure Is Associated with Improved Percentage of Predicted Maximum Oxygen Uptake

    PubMed Central

    Maskatia, Shiraz A.; Tate, Amanda L.; Petit, Christopher J.

    2015-01-01

    We tested the hypothesis that later completion of the Fontan procedure is associated with improved exercise capacity in the current period of staged single-ventricle palliation. We performed a retrospective study, in Fontan patients, of exercise stress test data from April 2003 through March 2011. Patients were included if they had received staged palliations in accordance with current surgical strategy, defined as the performance of a superior cavopulmonary connection at ≤1 year of age, followed in subsequent years by Fontan completion. Patients with a pacemaker or respiratory exchange ratio <1 were excluded. Early and late Fontan groups were created on the basis of whether Fontan completion had been performed at <4 or ≥ 4 years of age. The primary predictor variable was age at Fontan completion, and the primary marker of exercise performance was the percentage of predicted maximum oxygen consumption. During the study period, 55 patients were identified (mean age, 11.7 ± 2.8 yr). Older age at Fontan completion correlated positively with higher percentages of predicted maximum oxygen consumption (R=0.286, P=0.034). Patients in whom Fontan completion was performed at ≥4 years of age had higher percentages of predicted maximum oxygen consumption than did those in whom completion was at <4 years of age (84.4 ± 21.5 vs 72.9 ± 18.1; P=0.041). Later Fontan completion might be associated with improved exercise capacity in patients palliated in accordance with contemporary surgical strategy. PMID:26413015

  2. Older Age at Completion of Fontan Procedure Is Associated with Improved Percentage of Predicted Maximum Oxygen Uptake.

    PubMed

    Bolin, Elijah H; Maskatia, Shiraz A; Tate, Amanda L; Petit, Christopher J

    2015-08-01

    We tested the hypothesis that later completion of the Fontan procedure is associated with improved exercise capacity in the current period of staged single-ventricle palliation. We performed a retrospective study, in Fontan patients, of exercise stress test data from April 2003 through March 2011. Patients were included if they had received staged palliations in accordance with current surgical strategy, defined as the performance of a superior cavopulmonary connection at ≤1 year of age, followed in subsequent years by Fontan completion. Patients with a pacemaker or respiratory exchange ratio <1 were excluded. Early and late Fontan groups were created on the basis of whether Fontan completion had been performed at <4 or ≥ 4 years of age. The primary predictor variable was age at Fontan completion, and the primary marker of exercise performance was the percentage of predicted maximum oxygen consumption. During the study period, 55 patients were identified (mean age, 11.7 ± 2.8 yr). Older age at Fontan completion correlated positively with higher percentages of predicted maximum oxygen consumption (R=0.286, P=0.034). Patients in whom Fontan completion was performed at ≥4 years of age had higher percentages of predicted maximum oxygen consumption than did those in whom completion was at <4 years of age (84.4 ± 21.5 vs 72.9 ± 18.1; P=0.041). Later Fontan completion might be associated with improved exercise capacity in patients palliated in accordance with contemporary surgical strategy. PMID:26413015

  3. Using Walk Score™ and Neighborhood Perceptions to Assess Walking Among Middle-Aged and Older Adults.

    PubMed

    Towne, Samuel D; Won, Jaewoong; Lee, Sungmin; Ory, Marcia G; Forjuoh, Samuel N; Wang, Suojin; Lee, Chanam

    2016-10-01

    We aimed to determine the relationship between neighborhood characteristics (walkability, cohesion/safety) and recommended activity levels among community-dwelling middle-aged and older adults. Subjective and objective data on 394 individuals aged ≥50 years were used to assess the likelihood of walking ≥150 min/week. Environmental factors associated with a greater likelihood of any walking ≥150 min/week included living in a neighborhood with high perception of cohesion/safety versus low, living in walkable areas versus car-dependent, and living in an area with a low-moderate median income versus the lowest. Middle-aged and older adults were more likely to walk ≥150 min/week in a walkable, perceived safe/cohesive neighborhood. Identifying neighborhood factors associated with promoting walking among this population can enable stakeholders (e.g., researchers, planners, and policy makers) to direct interventions focusing on the built environment.

  4. Gender, aging, poverty and health: Survival strategies of older men and women in Nairobi slums

    PubMed Central

    Mudege, Netsayi N.; Ezeh, Alex C.

    2009-01-01

    This paper is based on data from focus group discussions and in-depth individual interviews carried out in two slum areas, Korogocho and Viwandani in Nairobi, Kenya. It discusses how the division between domestic sphere and public sphere impacts on survival during, and adaptation to old age. Although this paper adopts some of the tenets of the life course approach, it posits that women's participation in the domestic sphere may sometimes give them a ‘gender advantage’ over men in terms of health and adaptation to old age. The paper also discusses the impact of gender roles on the cultivation of social networks and how these networks in turn impact on health and social adjustment as people grow older. It investigates how older people are adjusting and coping with the new challenges they face as a result of high morbidity and mortality among adults in the reproductive age groups. PMID:19907648

  5. Ageing in a spectacular 'youth culture': continuity, change and community amongst older goths.

    PubMed

    Hodkinson, Paul

    2011-06-01

    This article explores the continuing involvement in youth music and style cultures of older participants through examination of the case study of the goth scene. It does so in the context of a widespread neglect, until recently, of what happens to participants of 'youth cultures' as they move beyond adolescence and also of a growing consensus about the broadening of youth itself as a life course period. Drawing on recent work on older participants in other music and style related groupings, the article uses original qualitative research to examine the developing lives and identities of goths as they become older. Rather than regarding continuing participation as a simple extension of youth, the focus is on the ways participation accompanied and was reconciled with material, domestic and physical elements of developing adult lives. Through reference to the case study, I emphasize the ways the experience of ageing for long-term music and style culture participants can constitute a collective experience.

  6. You Never Lose the Ages You’ve Been: Affective Perspective Taking in Older Adults

    PubMed Central

    Sullivan, Sarah J.; Mikels, Joseph A.; Carstensen, Laura L.

    2009-01-01

    Aging appears to be associated with a growing preference for positive over negative information (Carstensen, Mikels, & Mather, 2006). In this study, we investigated potential awareness of the phenomenon by asking older people to recollect material from the perspective of a younger person. Younger and older participants listened to stories about 25 and 75-year-old protagonists, and then were asked to retell the stories from the perspective of the protagonists. Older adults used relatively more positive than negative words when retelling from the perspective of a 75 versus 25-year-old. Younger adults, however, used comparable numbers of positive and negative words regardless of perspective. These findings contribute to a growing literature that points to developmental gains in the emotion domain. PMID:20230142

  7. Ageing in a spectacular 'youth culture': continuity, change and community amongst older goths.

    PubMed

    Hodkinson, Paul

    2011-06-01

    This article explores the continuing involvement in youth music and style cultures of older participants through examination of the case study of the goth scene. It does so in the context of a widespread neglect, until recently, of what happens to participants of 'youth cultures' as they move beyond adolescence and also of a growing consensus about the broadening of youth itself as a life course period. Drawing on recent work on older participants in other music and style related groupings, the article uses original qualitative research to examine the developing lives and identities of goths as they become older. Rather than regarding continuing participation as a simple extension of youth, the focus is on the ways participation accompanied and was reconciled with material, domestic and physical elements of developing adult lives. Through reference to the case study, I emphasize the ways the experience of ageing for long-term music and style culture participants can constitute a collective experience. PMID:21631458

  8. Clinical outcomes and management of inflammatory bowel disease in the older patient.

    PubMed

    Ha, Christina Y; Katz, Seymour

    2013-02-01

    The management of inflammatory bowel disease in the older patient extends beyond the gastrointestinal tract. Pre-existing comorbidities, polypharmacy, functional status and physical reserve can impact disease course, response to therapy and quality of life. Current therapeutic endpoints may not be as immediately applicable to the older IBD patient at higher risk for adverse outcomes. This review focuses on the latest studies addressing the natural history, clinical course and therapeutic outcomes among the older IBD cohort.

  9. Hypofractionated Versus Standard Radiation Therapy With or Without Temozolomide for Older Glioblastoma Patients

    SciTech Connect

    Arvold, Nils D.; Aizer, Ayal A.; Chiocca, E. Antonio

    2015-06-01

    Purpose: Older patients with newly diagnosed glioblastoma have poor outcomes, and optimal treatment is controversial. Hypofractionated radiation therapy (HRT) is frequently used but has not been compared to patients receiving standard fractionated radiation therapy (SRT) and temozolomide (TMZ). Methods and Materials: We conducted a retrospective analysis of patients ≥65 years of age who received radiation for the treatment of newly diagnosed glioblastoma from 1994 to 2013. The distribution of clinical covariates across various radiation regimens was analyzed for possible selection bias. Survival was calculated using the Kaplan-Meier method. Comparison of hypofractionated radiation (typically, 40 Gy/15 fractions) versus standard fractionation (typically, 60 Gy/30 fractions) in the setting of temozolomide was conducted using Cox regression and propensity score analysis. Results: Patients received SRT + TMZ (n=57), SRT (n=35), HRT + TMZ (n=34), or HRT (n=9). Patients receiving HRT were significantly older (median: 79 vs 69 years of age; P<.001) and had worse baseline performance status (P<.001) than those receiving SRT. On multivariate analysis, older age (adjusted hazard ratio [AHR]: 1.06; 95% confidence interval [CI]: 1.01-1.10, P=.01), lower Karnofsky performance status (AHR: 1.02; 95% CI: 1.01-1.03; P=.01), multifocal disease (AHR: 2.11; 95% CI: 1.23-3.61, P=.007), and radiation alone (vs SRT + TMZ; SRT: AHR: 1.72; 95% CI: 1.06-2.79; P=.03; HRT: AHR: 3.92; 95% CI: 1.44-10.60, P=.007) were associated with decreased overall survival. After propensity score adjustment, patients receiving HRT with TMZ had similar overall survival compared with those receiving SRT with TMZ (AHR: 1.10, 95% CI: 0.50-2.4, P=.82). Conclusions: With no randomized data demonstrating equivalence between HRT and SRT in the setting of TMZ for glioblastoma, significant selection bias exists in the implementation of HRT. Controlling for this bias, we observed similar overall

  10. Associations between adult attachment characteristics, medical burden, and life satisfaction among older primary care patients.

    PubMed

    Kirchmann, Helmut; Nolte, Tobias; Runkewitz, Kristin; Bayerle, Lisa; Becker, Simone; Blasczyk, Verena; Lindloh, Julia; Strauss, Bernhard

    2013-12-01

    We investigated whether attachment security, measured by the Adult Attachment Prototype Rating (AAPR), was correlated with life satisfaction, independent of sociodemographic characteristics, medical burden, and age-related coping strategies in a sample of 81 patients (69-73 years) recruited from the register of a general primary care practice. Furthermore, we examined whether patients classified as AAPR-secure reported better adjustment to medical burden in terms of higher life satisfaction than did insecure patients. Attachment security was independently related to life satisfaction. Moreover, the association between medical burden and lower life satisfaction was significantly stronger for insecure than for secure participants. Our findings indicate that interventions to improve attachment security or coping processes related to attachment could help older adults retain life satisfaction.

  11. Contraindications to Anticoagulation Therapy and Eligibility for Novel Anticoagulants in Older Patients With Atrial Fibrillation

    PubMed Central

    Steinberg, Benjamin A.; Greiner, Melissa A.; Hammill, Bradley G.; Curtis, Lesley H.; Benjamin, Emelia J.; Heckbert, Susan R.; Piccini, Jonathan P.

    2015-01-01

    Aims Oral anticoagulation therapy prevents stroke and improves survival in patients with atrial fibrillation, but the therapy is underutilized. We sought to identify the prevalence of contraindications for oral anticoagulation and the proportion of patients potentially eligible for different agents. Methods We identified patients with nonacute atrial fibrillation in a nationally representative 5% sample of 2009 Medicare data. We divided the population into patients ineligible for any oral anticoagulant, patients eligible for warfarin only, and patients eligible for any anticoagulant. We compared patient characteristics and the use of anticoagulation among the subgroups. Results Among 86,671 patients with atrial fibrillation, 1872 (2.2%) were ineligible for anticoagulation because of an absolute contraindication, most frequently a history of intracranial hemorrhage (60%). Patients ineligible for any anticoagulant were the same age as the overall group (mean age, 80.5 vs 80.4 years). However, they had higher rates of dementia (19% vs 8.6%) and heart failure (59% vs 43%) and higher mean CHADS2 scores (3.8 vs 2.8). Of the remaining 84,799 patients eligible for anticoagulation, 7146 (8.4%) had were eligible for warfarin only (most commonly because of mechanical heart valves [66%] and end-stage renal disease [12%]). Sixty-five percent of patients eligible for anticoagulation received warfarin, and the proportion was similar for patients with a relatively high risk of bleeding. Conclusions Older adults with atrial fibrillation rarely have absolute contraindications to oral anticoagulation therapy. Among patients without contraindications, most appeared to be eligible for any anticoagulant, and relatively high-risk features appeared not to influence warfarin use. PMID:25930214

  12. Older Adults’ Perceptions of E-Prescribing: Impact on Patient Care

    PubMed Central

    Schleiden, Loren J.; Odukoya, Olufunmilola K.; Chui, Michelle A.

    2015-01-01

    Objectives To describe older adult patients’ perceptions and experiences with e-prescribing; and to explore the impact of e-prescribing on patient care, including patient-provider communication. Methods Seventy-five participants’ aged 50 and older and living within one hour of Pittsburgh, Pennsylvania, completed a telephone survey that included items regarding basic demographics, general medication-taking behavior, and experiences with e-prescribing. Results A majority of participants expected e-prescriptions (84 percent) and preferred e-prescriptions to paper prescriptions (81 percent). Of the 57 participants whose doctors sent their prescriptions electronically, 93 percent reported being very satisfied with their doctor and 84 percent reported being very satisfied with their pharmacist in dealing with e-prescribed medications. Participants who received e-prescriptions reported more communication regarding medication-related topics with their doctor. Conclusions E-prescribing is generally preferred to paper prescribing, and participants who use e-prescribing are satisfied with the e-prescribing process. E-prescribing may influence patient medication-taking behaviors through increased convenience, increased patient-provider communication, and the perception of improved care compared to traditional paper prescribing. PMID:26807076

  13. Therapeutic interaction with an older personality disordered patient.

    PubMed

    Josephs, Lawrence; Sanders, Avihay; Gorman, Bernard S

    2014-06-01

    This study reflects an assessment of the relationship between change in defensive functioning and change in the therapeutic interaction during an eight-year treatment episode of an older personality disordered woman. The patient, Ms. Q, possessed schizoid, avoidant, and depressive personality disorders as well as major depression as assessed by the Millon Clinical Multiaxial Inventory-III (MCMI-III). At the end of the treatment episode, Ms. Q still possessed an avoidant personality disorder and significant depressive personality traits but no longer possessed clinically significant schizoid traits or major depression. Ms. Q made significant positive change in her adaptive defensive functioning as assessed by the Defense Mechanism Rating Scale (DMRS). Through time-series analysis it was discovered that positive change in adaptive defenses was predicted by increases in a specific type of therapeutic interaction as assessed by the Psychotherapy Q Sort (PQS). In this therapeutic interaction the therapist in a didactic and advice-giving manner highlighted the patient's role in a problem in a clear and coherent way that could be perceived as tactless. Time-series analysis revealed a reciprocal relationship in which positive changes in adaptive defenses predicted further increases in that particular quality of therapeutic interaction.

  14. Management of prostate cancer in older patients: updated recommendations of a working group of the International Society of Geriatric Oncology.

    PubMed

    Droz, Jean-Pierre; Aapro, Matti; Balducci, Lodovico; Boyle, Helen; Van den Broeck, Thomas; Cathcart, Paul; Dickinson, Louise; Efstathiou, Eleni; Emberton, Mark; Fitzpatrick, John M; Heidenreich, Axel; Hughes, Simon; Joniau, Steven; Kattan, Michael; Mottet, Nicolas; Oudard, Stéphane; Payne, Heather; Saad, Fred; Sugihara, Toru

    2014-08-01

    In 2010, the International Society of Geriatric Oncology (SIOG) developed treatment guidelines for men with prostate cancer who are older than 70 years old. In 2013, a new multidisciplinary SIOG working group was formed to update these recommendations. The consensus of the task force is that older men with prostate cancer should be managed according to their individual health status, not according to age. On the basis of a validated rapid health status screening instrument and simple assessment, the task force recommends that patients are classed into three groups for treatment: healthy or fit patients who should have the same treatment options as younger patients; vulnerable patients with reversible impairment who should receive standard treatment after medical intervention; and frail patients with non-reversible impairment who should receive adapted treatment.

  15. The impact of age and motivation on cognitive effort: implications for cognitive engagement in older adulthood.

    PubMed

    Ennis, Gilda E; Hess, Thomas M; Smith, Brian T

    2013-06-01

    We examined age differences in the effort required to perform the basic cognitive operations needed to achieve a specified objective outcome, and how hypothesized increases in effort requirements in later life are related to intrinsic motivation associated with enjoyment of and participation in effortful cognitive activities. Young (N = 59; 20-40 years) and older (N = 57; 64-85 years) adults performed a memory-search task varying in difficulty across trials, with systolic blood pressure responsivity-calculated as the increase over baseline during task performance-used as a measure of effort expenditure and task engagement. Consistent with expectations, older adults exhibited greater levels of responsivity (i.e., effort) at all levels of objective task difficulty, and this increase was reflected in subjective perceptions of difficulty. Older adults also exhibited greater levels of disengagement (i.e., effort withdrawal) than younger adults at higher levels of task difficulty, conceivably reflecting the disproportionately greater effort required for successful performance in the former group. We also found that, relative to younger adults, older adults' engagement was more sensitive to the importance attached to the task (i.e., motivation to do well). Finally, we also obtained evidence that increased costs associated with cognitive engagement in later life were negatively associated with intrinsic levels of motivation to engage in effortful cognitive activity. The results support the general conclusion that the costs of cognitive activity increase with age in adulthood, and that these costs influence individuals' willingness to engage resources in support of demanding cognitive activities.

  16. Spain: Promoting the Welfare of Older Adults in the Context of Population Aging

    PubMed Central

    Serrano, Juan P.; Latorre, José M.; Gatz, Margaret

    2014-01-01

    Spain is one of the European countries with the most significant societal changes in the 21st century contributing to an aging population, in particular, high life expectancy coupled with low fertility, which will result in a doubling of the old-age dependency ratio. Demographic aging implies important challenges that affect the lives of people, families, the economy, public finances, and the reorganization of the health and social systems. Currently, the older population has become particularly vulnerable due to the economic crisis taking place in Spain, which has brought about the need for new policies and systems to protect older persons. The pension system is under the greatest threat in conjunction with possible changes in the national health care system. This report presents a general view of the main factors that surround and affect older adults in Spain, as well as policies developed by the government in response to the current and future situation. We highlight demographic predictions for the coming decades, quality-of-life indicators, situations of dependency, active aging policies, and the main research programs related to gerontology in Spain. PMID:24632624

  17. Spain: promoting the welfare of older adults in the context of population aging.

    PubMed

    Serrano, Juan P; Latorre, José M; Gatz, Margaret

    2014-10-01

    Spain is one of the European countries with the most significant societal changes in the 21st century contributing to an aging population, in particular, high life expectancy coupled with low fertility, which will result in a doubling of the old-age dependency ratio. Demographic aging implies important challenges that affect the lives of people, families, the economy, public finances, and the reorganization of the health and social systems. Currently, the older population has become particularly vulnerable due to the economic crisis taking place in Spain, which has brought about the need for new policies and systems to protect older persons. The pension system is under the greatest threat in conjunction with possible changes in the national health care system. This report presents a general view of the main factors that surround and affect older adults in Spain, as well as policies developed by the government in response to the current and future situation. We highlight demographic predictions for the coming decades, quality-of-life indicators, situations of dependency, active aging policies, and the main research programs related to gerontology in Spain.

  18. Age-Related Gene Expression Differences in Monocytes from Human Neonates, Young Adults, and Older Adults

    PubMed Central

    Tong, Ann-Jay; Kollmann, Tobias R.; Smale, Stephen T.

    2015-01-01

    A variety of age-related differences in the innate and adaptive immune systems have been proposed to contribute to the increased susceptibility to infection of human neonates and older adults. The emergence of RNA sequencing (RNA-seq) provides an opportunity to obtain an unbiased, comprehensive, and quantitative view of gene expression differences in defined cell types from different age groups. An examination of ex vivo human monocyte responses to lipopolysaccharide stimulation or Listeria monocytogenes infection by RNA-seq revealed extensive similarities between neonates, young adults, and older adults, with an unexpectedly small number of genes exhibiting statistically significant age-dependent differences. By examining the differentially induced genes in the context of transcription factor binding motifs and RNA-seq data sets from mutant mouse strains, a previously described deficiency in interferon response factor-3 activity could be implicated in most of the differences between newborns and young adults. Contrary to these observations, older adults exhibited elevated expression of inflammatory genes at baseline, yet the responses following stimulation correlated more closely with those observed in younger adults. Notably, major differences in the expression of constitutively expressed genes were not observed, suggesting that the age-related differences are driven by environmental influences rather than cell-autonomous differences in monocyte development. PMID:26147648

  19. Synergistic Effects of HIV Infection and Older Age on Daily Functioning

    PubMed Central

    Morgan, Erin E.; Iudicello, Jennifer E.; Weber, Erica; Duarte, Nichole A.; Riggs, P. Katie; Delano-Wood, Lisa; Ellis, Ronald; Grant, Igor; Woods, Steven Paul

    2012-01-01

    Objective To determine whether HIV infection and aging act synergistically to disrupt everyday functioning. Design Cross-sectional, factorial study of everyday functioning in the context of HIV serostatus and age (≤ 40 years vs ≥ 50 years). Methods 103 HIV+ and 87 HIV− participants were administered several measures of everyday functioning, including self-report indices of health-related quality of life (HRQoL) and instrumental and basic activities of daily living (IADLs and BADLs), and objective measures of functioning including employment and Karnofsky Performance Scale (KPS) ratings. Results Significant interaction effects of HIV and aging were observed for IADL and BADL declines, as well as KPS ratings (ps<.05), independent of potentially confounding factors. Follow-up contrasts revealed significantly worse functioning in the older HIV+ group for all functional outcome measures relative to the other study groups (ps<.05). A significant interaction effect was also observed on the emotional functioning HRQoL subscale, and additive effects of both age and HIV were observed for the physical functioning and general health perceptions HRQoL subscales (ps<.05). Significant predictors of poorer functioning in the older HIV+ group included current major depressive disorder for all outcomes, and comorbid medical conditions, lower estimated premorbid functioning, neurocognitive impairment, and nadir CD4 count for selected outcomes. Conclusion Findings suggest that older age may exacerbate the adverse effects of HIV on daily functioning, which highlights the importance of evaluating and monitoring the functional status of older HIV-infected adults. Early detection of functional difficulties could facilitate delivery of compensatory strategies (e.g., cognitive remediation) or assistive services. PMID:22878422

  20. Word-stem priming and recognition in type 2 diabetes mellitus, Alzheimer's disease patients and healthy older adults.

    PubMed

    Redondo, María Teresa; Beltrán-Brotóns, José Luís; Reales, José Manuel; Ballesteros, Soledad

    2015-11-01

    The present study investigated (a) whether the pattern of performance on implicit and explicit memory of patients with type 2 diabetes mellitus (DM2) is more similar to those of patients with Alzheimer's disease (AD) or to cognitively normal older adults and (b) whether glycosylated hemoglobin levels (a measure of glucose regulation) are related to performance on the two memory tasks, implicit word-stem completion and "old-new" recognition. The procedures of both memory tasks included encoding and memory test phases separated by a short delay. Three groups of participants (healthy older adults, DM2 patients and AD patients) completed medical and psychological assessments and performed both memory tasks on a computer. The results of the word-stem completion task showed similar implicit memory in the three groups. By contrast, explicit recognition of the three groups differed. Implicit memory was not affected by either normal or pathological aging, but explicit memory deteriorated in the two groups of patients, especially in AD patients, showing a severe impairment compared to the cognitively healthy older adults. Importantly, glycosylated hemoglobin levels were not related to performance on either implicit or explicit memory tasks. These findings revealed a clear dissociation between explicit and implicit memory tasks in normal and pathological aging. Neuropsychologists and clinicians working with TM2 patients should be aware that the decline of voluntary, long-term explicit memory could have a negative impact on their treatment management. By contrast, the intact implicit memory of the two clinical groups could be used in rehabilitation.

  1. An investigation into the relationship between age and physiological function in highly active older adults

    PubMed Central

    Pollock, Ross D; Carter, Scott; Velloso, Cristiana P; Duggal, Niharika A; Lord, Janet M; Lazarus, Norman R; Harridge, Stephen D R

    2015-01-01

    Despite extensive research, the relationship between age and physiological function remains poorly characterised and there are currently no reliable markers of human ageing. This is probably due to a number of confounding factors, particularly in studies of a cross-sectional nature. These include inter-subject genetic variation, as well as inter-generational differences in nutrition, healthcare and insufficient levels of physical activity as well as other environmental factors. We have studied a cohort of highly and homogeneously active older male (n = 84) and female (n = 41) cyclists aged 55–79 years who it is proposed represent a model for the study of human ageing free from the majority of confounding factors, especially inactivity. The aim of the study was to identify physiological markers of ageing by assessing the relationship between function and age across a wide range of indices. Each participant underwent a detailed physiological profiling which included measures of cardiovascular, respiratory, neuromuscular, metabolic, endocrine and cognitive functions, bone strength, and health and well-being. Significant associations between age and function were observed for many functions. The maximal rate of oxygen consumption ( showed the closest association with age (r = −0.443 to −0.664; P < 0.001), but even here the variance in age for any given level was high, precluding the clear identification of the age of any individual. The results of this cross-sectional study suggest that even when many confounding variables are removed the relationship between function and healthy ageing is complex and likely to be highly individualistic and that physical activity levels must be taken into account in ageing studies. Key Points The relationship between age and physiological function remains poorly defined and there are no physiological markers that can be used to reliably predict the age of an individual. This could be due to a variety of confounding

  2. An Age-Friendly Living Environment as Seen by Chinese Older Adults: A "Photovoice" Study.

    PubMed

    Chan, Aileen W K; Chan, Helen Y L; Chan, Ivy K Y; Cheung, Bonnie Y L; Lee, Diana T F

    2016-01-01

    "Ageing in place" is a policy initiative strongly advocated by the World Health Organization to face the challenge of an ageing population. This pilot study used a "photovoice" approach, aiming to explore aspects of the housing environment considered by older people as important in facilitating ageing in place. It enabled participants to express their ideas through photographs. Each participant was asked to take photos that illustrated age-friendly features they considered crucial for supporting their lives in the community. A total of 44 older people participated in the pilot study, and 300 photos were collected. Participants were invited to describe the reasons for taking these photos by filling in a journal sheet. A semi-structured interview was then conducted with individual participants, who were asked to elaborate on the meaning of their photos. The analysis revealed three themes: (1) age-friendly housing design; (2) supportive neighborhood; and (3) connection to family and the community. These three themes are pillars of an age-friendly city, which are important to seniors to facilitate ageing in place. PMID:27649217

  3. A profile of middle-aged and older adults admitted to nursing homes: 2000-2008.

    PubMed

    Miller, Nancy A; Pinet-Peralta, Luis M; Elder, Keith T

    2012-01-01

    Middle-aged adults are becoming an increasing share of the nursing home population. Minimum Data Set assessment data for 2000 and 2008 are used to explore similarities and differences in sociodemographic, residential, medical, and psychiatric characteristics of newly admitted middle-aged adults (31-64) compared to their older counterparts (65+). Relative to their share of the state population, Black middle-aged adults are overrepresented in nursing homes across 45 states and the District of Columbia. Chronic conditions, including diabetes, renal failure, chronic obstructive pulmonary disease, asthma, and circulatory/heart disorders, appeared to contribute to the increasing presence of middle-aged adults. There were substantial increases in diagnoses of psychiatric disorders at admission; psychiatric diagnoses were significantly higher among middle-aged adults. Middle-aged adults were also more likely to have residential histories of prior stays in psychiatric facilities relative to older adults. States' rebalancing efforts need to attend to the increasing presence of disability associated with chronic medical and psychiatric conditions among middle-aged adults. PMID:22720887

  4. Dermatological disease in the older age group: a cross-sectional study in aged care facilities

    PubMed Central

    Deo, Maneka S; Vandal, Alain C; Jarrett, Paul

    2015-01-01

    Objectives To estimate the prevalence of dermatological disease in aged care facilities, and the relationship between cognitive or physical disability and significant disease. Setting 2 large aged care facilities in Auckland, New Zealand, each providing low and high level care. Participants All 161 residents of the facilities were invited to participate. The only exclusion criterion was inability to obtain consent from the individual or designated guardian. 88 participants were recruited—66 females (75%), 22 males (25%) with average age 87.1 years (SD 5.5 years). Primary and secondary outcome measures Primary—presence of significant skin disease (defined as that which in the opinion of the investigators needed treatment or was identified as a patient concern) diagnosed clinically on full dermatological examination by a dermatologist or dermatology trainee. Secondary—functional and cognitive status (Rehabilitation Complexity Scale and Abbreviated Mental Test Score). Results 81.8% were found to have at least one significant condition. The most common disorders were onychomycosis 42 (47.7%), basal cell carcinoma 13 (14.8%), asteototic eczema 11 (12.5%) and squamous cell carcinoma in situ 9 (10.2%). Other findings were invasive squamous cell carcinoma 7 (8%), bullous pemphigoid 2 (2.3%), melanoma 2 (2.3%), lichen sclerosus 2 (2.3%) and carcinoma of the breast 1 (1.1%). Inflammatory disease was more common in those with little physical disability compared with those with serious physical disability (OR 3.69; 95% CI 1.1 to 12.6, p=0.04). No significant association was found between skin disease and cognitive impairment. Conclusions A high rate of dermatological disease was found. Findings ranged from frequent but not life-threatening conditions (eg, onychomycosis), to those associated with a significant morbidity (eg, eczema, lichen sclerosus and bullous pemphigoid), to potentially life-threatening (eg, squamous cell carcinoma, melanoma and breast cancer

  5. Quality of Life and Physical Function in Older Patients on Dialysis: A Comparison of Assisted Peritoneal Dialysis with Hemodialysis

    PubMed Central

    Iyasere, Osasuyi U.; Brown, Edwina A.; Johansson, Lina; Huson, Les; Smee, Joanna; Maxwell, Alexander P.; Farrington, Ken; Davenport, Andrew

    2016-01-01

    Background and objectives In-center hemodialysis (HD) is often the default dialysis modality for older patients. Few centers use assisted peritoneal dialysis (PD), which enables treatment at home. This observational study compared quality of life (QoL) and physical function between older patients on assisted PD and HD. Design, setting, participants, & measurements Patients on assisted PD who were >60 years old and on dialysis for >3 months were recruited and matched to patients on HD (needing hospital transport) by age, sex, diabetes, dialysis vintage, ethnicity, and index of deprivation. Frailty was assessed using the Clinical Frailty Scale. QoL assessments included Hospital Anxiety and Depression Scale (HADS), Short Form-12, Palliative Outcomes Symptom Scale (renal), Illness Intrusiveness Rating Scale, and Renal Treatment Satisfaction Questionnaire (RTSQ). Physical function was evaluated by Barthel Score and timed up and go test. Results In total, 251 patients (129 PD and 122 HD) were recruited. In unadjusted analysis, patients on assisted PD had a higher prevalence of possible depression (HADS>8; PD=38.8%; HD=23.8%; P=0.05) and higher HADS depression score (median: PD=6; HD=5; P=0.05) but higher RTSQ scores (median: PD=55; HD=51; P<0.01). In a generalized linear regression model adjusting for age, sex, comorbidity, dialysis vintage, and frailty, assisted PD continued to be associated with higher RTSQ scores (P=0.04) but not with other QoL measures. Conclusions There are no differences in measures of QoL and physical function between older patients on assisted PD and comparable patients on HD, except for treatment satisfaction, which is higher in patients on PD. Assisted PD should be considered as an alternative to HD for older patients, allowing them to make their preferred choices. PMID:26712808

  6. Anterior cruciate ligament reconstruction with Achilles tendon allografts in revisions and in patients older than 30.

    PubMed

    Grafe, Michael W; Kurzweil, Peter R

    2008-06-01

    We evaluated the results of anterior cruciate ligament (ACL) reconstruction using an Achilles tendon allograft in revisions and in patients older than 30. Results from 23 consecutive patients (mean age, 43 years) who underwent ACL reconstruction with fresh-frozen, irradiated (22/23) Achilles allografts were retrospectively reviewed. Seven cases were revisions. Patients were evaluated with physical examination, questionnaires, and x-rays. Twenty of the 23 patients were evaluated a mean of 28 months after surgery. There were 5 failures (21%); 3 acute failures were not evaluated at follow-up. One patient had an infection that required graft removal, 2 patients had mechanical failure of the grafts, and 2 had displacements of more than 5.5 mm as measured with a KT-1000 arthrometer. The 18 clinically successful cases had full motion, no thigh atrophy, and no effusion. Pivot shift scores were 55% A and 45% B on the International Knee Documentation Committee (IKDC) scale. Lachman scores were 40% A, 55% B, and 5% C on the IKDC scale. The KT-1000 difference was a mean of 2.9 mm at final follow-up. However, knees loosened a mean of 4.5 mm from the immediate postoperative measurements (P<.0001). Mean Lysholm and Tegner scores were 86.8 and 5.2, respectively. Tibial tunnel diameter increased by 3.1 mm on anteroposterior x-rays and 3.0 mm on lateral x-rays. Five patients developed mild medial compartment arthritis. Four of the 5 grafts with failures were from donors older than 40. Postoperative complications included deep vein thrombosis and inflammatory effusion (white blood cell count, 15,000). Twenty-one percent of ACL reconstructions with Achilles tendon allografts failed. Grafts deemed successful still had significant loosening at final follow-up. Allografts from donors older than 40 may have played a role in these failures. From the data in this study, it appears that surgeons should scrutinize the source of the allograft tissue and the age of the donor.

  7. Anterior cruciate ligament reconstruction with Achilles tendon allografts in revisions and in patients older than 30.

    PubMed

    Grafe, Michael W; Kurzweil, Peter R

    2008-06-01

    We evaluated the results of anterior cruciate ligament (ACL) reconstruction using an Achilles tendon allograft in revisions and in patients older than 30. Results from 23 consecutive patients (mean age, 43 years) who underwent ACL reconstruction with fresh-frozen, irradiated (22/23) Achilles allografts were retrospectively reviewed. Seven cases were revisions. Patients were evaluated with physical examination, questionnaires, and x-rays. Twenty of the 23 patients were evaluated a mean of 28 months after surgery. There were 5 failures (21%); 3 acute failures were not evaluated at follow-up. One patient had an infection that required graft removal, 2 patients had mechanical failure of the grafts, and 2 had displacements of more than 5.5 mm as measured with a KT-1000 arthrometer. The 18 clinically successful cases had full motion, no thigh atrophy, and no effusion. Pivot shift scores were 55% A and 45% B on the International Knee Documentation Committee (IKDC) scale. Lachman scores were 40% A, 55% B, and 5% C on the IKDC scale. The KT-1000 difference was a mean of 2.9 mm at final follow-up. However, knees loosened a mean of 4.5 mm from the immediate postoperative measurements (P<.0001). Mean Lysholm and Tegner scores were 86.8 and 5.2, respectively. Tibial tunnel diameter increased by 3.1 mm on anteroposterior x-rays and 3.0 mm on lateral x-rays. Five patients developed mild medial compartment arthritis. Four of the 5 grafts with failures were from donors older than 40. Postoperative complications included deep vein thrombosis and inflammatory effusion (white blood cell count, 15,000). Twenty-one percent of ACL reconstructions with Achilles tendon allografts failed. Grafts deemed successful still had significant loosening at final follow-up. Allografts from donors older than 40 may have played a role in these failures. From the data in this study, it appears that surgeons should scrutinize the source of the allograft tissue and the age of the donor. PMID:18716694

  8. Greater Emotional Gain from Giving in Older Adults: Age-Related Positivity Bias in Charitable Giving.

    PubMed

    Bjälkebring, Pär; Västfjäll, Daniel; Dickert, Stephan; Slovic, Paul

    2016-01-01

    Older adults have been shown to avoid negative and prefer positive information to a higher extent than younger adults. This positivity bias influences their information processing as well as decision-making. We investigate age-related positivity bias in charitable giving in two studies. In Study 1 we examine motivational factors in monetary donations, while Study 2 focuses on the emotional effect of actual monetary donations. In Study 1, participants (n = 353, age range 20-74 years) were asked to rate their affect toward a person in need and then state how much money they would be willing to donate to help this person. In Study 2, participants (n = 108, age range 19-89) were asked to rate their affect toward a donation made a few days prior. Regression analysis was used to investigate whether or not the positivity bias influences the relationship between affect and donations. In Study 1, we found that older adults felt more sympathy and compassion and were less motivated by negative affect when compared to younger adults, who were motivated by both negative and positive affect. In Study 2, we found that the level of positive emotional reactions from monetary donations was higher in older participants compared to younger participants. We find support for an age-related positivity bias in charitable giving. This is true for motivation to make a future donation, as well as affective thinking about a previous donation. We conclude that older adults draw more positive affect from both the planning and outcome of monetary donations and hence benefit more from engaging in monetary charity than their younger counterparts. PMID:27378966

  9. Greater Emotional Gain from Giving in Older Adults: Age-Related Positivity Bias in Charitable Giving

    PubMed Central

    Bjälkebring, Pär; Västfjäll, Daniel; Dickert, Stephan; Slovic, Paul

    2016-01-01

    Older adults have been shown to avoid negative and prefer positive information to a higher extent than younger adults. This positivity bias influences their information processing as well as decision-making. We investigate age-related positivity bias in charitable giving in two studies. In Study 1 we examine motivational factors in monetary donations, while Study 2 focuses on the emotional effect of actual monetary donations. In Study 1, participants (n = 353, age range 20–74 years) were asked to rate their affect toward a person in need and then state how much money they would be willing to donate to help this person. In Study 2, participants (n = 108, age range 19–89) were asked to rate their affect toward a donation made a few days prior. Regression analysis was used to investigate whether or not the positivity bias influences the relationship between affect and donations. In Study 1, we found that older adults felt more sympathy and compassion and were less motivated by negative affect when compared to younger adults, who were motivated by both negative and positive affect. In Study 2, we found that the level of positive emotional reactions from monetary donations was higher in older participants compared to younger participants. We find support for an age-related positivity bias in charitable giving. This is true for motivation to make a future donation, as well as affective thinking about a previous donation. We conclude that older adults draw more positive affect from both the planning and outcome of monetary donations and hence benefit more from engaging in monetary charity than their younger counterparts. PMID:27378966

  10. Disparities in arteriovenous fistula placement in older hemodialysis patients.

    PubMed

    Patibandla, Bhanu K; Narra, Akshita; Desilva, Ranil; Chawla, Varun; Vin, Yael; Brown, Robert S; Goldfarb-Rumyantzev, Alexander S

    2014-01-01

    The benefits of an arteriovenous fistula (AVF) as the preferred vascular access for hemodialysis have been clearly demonstrated. However, only about 20% of patients in the United States initiate hemodialysis with an AVF. In this study, we assessed whether disparities exist in the type of first hemodialysis access placed prior to dialysis start (rather than that used at dialysis initiation), to detect whether certain disadvantaged groups might have lower likelihood of AVF placement. Study cohort of 118,767 incident hemodialysis patients ≥67 years of age (1/2005-12/2008) derived from the United States Renal Data System was linked with Medicare claims data to identify the type of initial access placed predialysis. We used logistic regression model with outcome being the initial predialysis placement of an AVF as opposed to an arteriovenous graft or a central venous catheter. Increasing age, female sex, black race, lower body mass index, urban location, certain comorbidities, and shorter pre-end-stage renal disease nephrology care are all associated with a significantly lower likelihood of AVF placement as initial access predialysis. Our study suggests the presence of significant disparities in the placement of an AVF as initial hemodialysis vascular access. We suggest that additional attention should be paid to these patient groups to improve disparities by patient education, earlier referral, and close follow-up.

  11. Cost comparison of mechanically ventilated patients across the age span

    PubMed Central

    Hayman, William R.; Leuthner, Steven R.; Laventhal, Naomi T.; Brousseau, David; Lagatta, Joanne M.

    2016-01-01

    Objective to compare use of mechanical ventilation and hospital costs across ventilated patients of all ages, preterm through adults, in a nationally-representative sample. Study Design secondary analysis of the 2009 Agency for Healthcare Research and Quality National Inpatient Sample. Results 1,107,563 (2.8%) patients received mechanical ventilation. For surviving ventilated patients, median costs for infants ≤32 weeks’ gestation were $51,000–$209,000, whereas median costs for older patients were lower, from $17,000–$25,000. For non-surviving ventilated patients, median costs were $27,000–$39,000 except at the extremes of age; the median cost was $10,000 for <24 week newborns, and $14,000 for 91+ year adults. Newborns of all gestational ages had a disproportionate share of hospital costs relative to their total volume. Conclusions Most ICU resources at the extremes of age are not directed toward non-surviving patients. From a perinatal perspective, attention should be directed toward improving outcomes and reducing costs for all infants, not just at the earliest gestational ages. PMID:26468935

  12. Overlooked potential: older-age parents in the era of ART.

    PubMed

    Williams, Nathalie; Knodel, John; Kiry Kim, Sovan; Puch, Sina; Saengtienchai, Chanpen

    2008-11-01

    The advent of widespread ART provision in low- and middle-income countries requires not just medical attention, but also social and psychological support to encourage and monitor strict adherence to drug regimens. Developing innovative approaches to providing this broad support is a major challenge, especially within the financial constraints of resource-limited countries hardest hit by the epidemic. In this study, we examine the role of older-age parents in monitoring ART treatment and caring for their HIV-infected children and grandchildren in Cambodia. Our results are based on 25 open-ended interviews with older-age parents of people with AIDS (PWHA). A high level of co-residence when PWHA become ill and a sense of parental responsibility and emotional attachment facilitate high parental involvement in their children's and grandchildren's illness, care and treatment. Our interviews indicate that parents play an important role in encouraging their children to get tested and to access treatment if they test positive. They consistently monitor antiretroviral therapy (ART) adherence and opportunistic infections and remind PWHA to attend medical appointments and support-group meetings. Parents also provide for the nutrition and hygiene of PWHA essential to the success of ART treatments. We find that despite low levels of education, older parents were able to express clear, correct and detailed knowledge of complicated ART treatment regimens, nutrition and hygiene. Overall, our findings show that older parents play a pivotal role in care and treatment if they are provided with proper resources and training and have the ability to understand the necessity and details of ensuring strict adherence to medications. Based on these results, we suggest that explicitly including older parents in policy and programs for care and treatment would allow Cambodia and other countries to take advantage of this unique and effective but overlooked asset in AIDS care and treatment. PMID

  13. Influenza vaccination: the persuasiveness of messages among people aged 65 years and older.

    PubMed

    Prati, Gabriele; Pietrantoni, Luca; Zani, Bruna

    2012-01-01

    About 90% of all influenza-related deaths occur among people aged 65 years and older. Vaccination remains the primary option for preventing influenza infection. This study examined the efficacy of messages designed to increase the uptake of influenza vaccination. Two messages, narrative and didactic, were created based on the Extended Parallel Process Model (EPPM). The study employed a one-factor between-subjects experimental design with participants assigned randomly to three conditions: no message, didactic communication, and narrative communication. Participants were 311 Italian people aged 65 years or older. The results showed that, compared to no message and didactic communication, narrative communication was related to higher risk perception of influenza, to higher perception of the efficacy of the vaccine, and to self-efficacy related to vaccination, controlling for social trust, previous flu shot, and demographic variables. There were no differences among the three conditions with respect to the intention to receive the influenza vaccine. Findings suggest that narrative communication based on EPPM may have a persuasive effect on people aged 65 years or older.

  14. Investigation of the acceptance of a handbook for safe driving at an older age.

    PubMed

    Vardaki, Sophia; Yannis, George

    2012-01-01

    The objective of this research is the investigation of older drivers' attitudes towards a handbook for safe driving at an older age. The handbook was developed with the purpose of increasing elderly drivers' awareness of their driving abilities and providing information about the effects of ageing on driving and about safe driving practices and compensation strategies. A survey was carried out in which 64 active drivers between 65 and 74 years of age participated. Participants regard the handbook for safe driving as useful, interesting, providing knowledge and relevant information. More than half of them reported that they had become more aware of changes in their driving after reading it. Binary logistic analysis was conducted to identify individual driver characteristics that might predict acceptance of the handbook by active older drivers in terms of reported increased awareness and intended repeated use. The findings of the research indicate a positive attitude of elderly active drivers towards the handbook, implying acceptance by its users. The characteristics of the drivers' who reported increased awareness after reading have been identified.

  15. Investigation of the acceptance of a handbook for safe driving at an older age.

    PubMed

    Vardaki, Sophia; Yannis, George

    2012-01-01

    The objective of this research is the investigation of older drivers' attitudes towards a handbook for safe driving at an older age. The handbook was developed with the purpose of increasing elderly drivers' awareness of their driving abilities and providing information about the effects of ageing on driving and about safe driving practices and compensation strategies. A survey was carried out in which 64 active drivers between 65 and 74 years of age participated. Participants regard the handbook for safe driving as useful, interesting, providing knowledge and relevant information. More than half of them reported that they had become more aware of changes in their driving after reading it. Binary logistic analysis was conducted to identify individual driver characteristics that might predict acceptance of the handbook by active older drivers in terms of reported increased awareness and intended repeated use. The findings of the research indicate a positive attitude of elderly active drivers towards the handbook, implying acceptance by its users. The characteristics of the drivers' who reported increased awareness after reading have been identified. PMID:21736438

  16. NK cell expression of natural cytotoxicity receptors may determine relapse risk in older AML patients undergoing immunotherapy for remission maintenance

    PubMed Central

    Martner, Anna; Rydström, Anna; Riise, Rebecca E.; Aurelius, Johan; Brune, Mats; Foà, Robin; Hellstrand, Kristoffer; Thorén, Fredrik B.

    2015-01-01

    In a phase IV trial, eighty-four patients (age 18–79) with acute myeloid leukemia (AML) in first complete remission (CR) received cycles of immunotherapy with histamine dihydrochloride (HDC) and low-dose human recombinant interleukin-2 (IL-2) to prevent relapse in the post-consolidation phase. Aspects of natural killer (NK) cell biology were analyzed before and during immunotherapy with focus on outcome in older patients. In younger (<60 years old, n = 37) and older patients (>60 years old, n = 47), treatment with HDC/IL-2 resulted in an expansion of CD56bright and CD16+ NK cells in blood along with an increased NK cell expression of the natural cytotoxicity receptors (NCR) NKp30 and NKp46. In older patients, a high expression of NKp30 or NKp46 on CD16+ NK cells before and during therapy predicted leukemia-free and overall survival. These results suggest that NK cell functions determine relapse risk and survival in older AML patients and point to biomarkers of efficacy in protocols for remission maintenance. PMID:26544512

  17. A report on older-age bipolar disorder from the International Society for Bipolar Disorders Task Force

    PubMed Central

    Sajatovic, Martha; Strejilevich, Sergio A; Gildengers, Ariel G; Dols, Annemiek; Al Jurdi, Rayan K; Forester, Brent P; Kessing, Lars Vedel; Beyer, John; Manes, Facundo; Rej, Soham; Rosa, Adriane R; Schouws, Sigfried NTM; Tsai, Shang-Ying; Young, Robert C; Shulman, Kenneth I

    2015-01-01

    Objectives In the coming generation, older adults with bipolar disorder (BD) will increase in absolute numbers as well as proportion of the general population. This is the first report of the International Society for Bipolar Disorder (ISBD) Task Force on Older-Age Bipolar Disorder (OABD). Methods This task force report addresses the unique aspects of OABD including epidemiology and clinical features, neuropathology and biomarkers, physical health, cognition, and care approaches. Results The report describes an expert consensus summary on OABD that is intended to advance the care of patients, and shed light on issues of relevance to BD research across the lifespan. Although there is still a dearth of research and health efforts focused on older adults with BD, emerging data has brought some answers, innovative questions, and novel perspectives related to the notion of late onset, medical comorbidity, and the vexing issue of cognitive impairment and decline. Conclusions Improving our understanding of the biological, clinical, and social underpinnings relevant to OABD is an indispensable step in building a complete map of BD across the lifespan. PMID:26384588

  18. Gait patterns in a community-dwelling population aged 50 years and older.

    PubMed

    Verlinden, V J A; van der Geest, J N; Hoogendam, Y Y; Hofman, A; Breteler, M M B; Ikram, M A

    2013-04-01

    Poor gait is an important risk factor for falls and associated with higher morbidity and mortality. It is well established that older age is associated with worse gait, but it remains unclear at what age this association is first seen. Moreover, previous studies focused mainly on normal walking, but gait also encompasses turning and tandem walking. In a large study of community-dwelling middle-aged and elderly persons we investigated the association of age with gait, focusing on normal walking, turning and tandem walking. In 1500 persons aged 50 years and over, we measured gait using an electronic walkway. Participants performed normal walks, turning and a tandem walk. With principal components analysis of 30 variables we summarized gait into five known gait factors: Rhythm, Variability, Phases, Pace and Base of Support; and uncovered two novel gait factors: Tandem and Turning. The strongest associations with age were found for Variability (difference in Z-score -0.29 per 10 years increase (95% confidence interval: -0.34; -0.24)), Phases (-0.31 per 10 years (-0.36; -0.27)) and Tandem (-0.25 per 10 years (-0.30; -0.20)). Additionally, these factors already showed association with the youngest age groups, from 55 to 60 years of age and older. Our study shows that Variability, Phases and Tandem have the strongest association with age and are the earliest to demonstrate a poorer gait pattern with higher age. Future research should further investigate how these gait factors relate with gait-related diseases in their earliest stages.

  19. Age-associated cardiovascular changes in health: impact on cardiovascular disease in older persons.

    PubMed

    Lakatta, Edward G

    2002-01-01

    In the United States, cardiovascular disease, e.g., atherosclerosis and hypertension, that lead to heart failure and stroke, is the leading cause of mortality, accounting for over 40 percent of deaths in those aged 65 years and above. Over 80 percent of all cardio-vascular deaths occur in the same age group. Thus, age, per se, is the major risk factor for cardiovascular disease. Clinical manifestations and prognosis of these cardiovascular diseases likely become altered in older persons with advanced age because interactions occur between age-associated cardiovascular changes in health and specific pathophysiologic mechanisms that underlie a disease. A fundamental understanding of age-associated changes in cardiovascular structure and function ranging in scope from humans to molecules is required for effective and efficient prevention and treatment of cardiovascular disease in older persons. A sustained effort over the past two decades has been applied to characterize the multiple effects of aging in health on cardiovascular structure and function in a single study population, the Baltimore Longitudinal Study on Aging. In these studies, community dwelling, volunteer participants are rigorously screened to detect both clinical and occult cardiovascular disease and characterized with respect to lifestyle, e.g. exercise habits, in an attempt to deconvolute interactions among lifestyle, cardiovascular disease and the aging process in health. This review highlights some specific changes in resting cardiovascular structure and function and cardiovascular reserve capacity that occur with advancing age in healthy humans. Observations from relevant experiments in animal models have been integrated with those in humans to provide possible mechanistic insight.

  20. Supporting smoking cessation in older patients: a continuing challenge for community nurses.

    PubMed

    Phillips, Adele

    2016-09-01

    Tobacco smoking continues to pose negative health consequences for smokers and their families, and is the single greatest cause of health inequalities in the UK. Older people are particularly vulnerable to the negative health impacts of smoking and therefore, supporting older smokers to quit remains an important public health goal. Community nurses are required to help patients to lead healthier lifestyles and have ideal opportunities to encourage smoking cessation in older people who are affected by smoking-related health conditions, or whose existing conditions may be exacerbated by continued smoking. This paper discusses how community nurses can support their older patients to quit smoking by fostering a patient-centred partnership through good communication and empathy. The newly developed 'Very Brief Advice on Smoking' (VBA) interventions can provide a useful tool for community nurses who experience time constraints to advise older people that psychosocial support with treatment is the most effective method of smoking cessation, while respecting the health decisions of patients.

  1. The vulnerability of middle-aged and older adults in a multiethnic, low-income area: contributions of age, ethnicity, and health insurance.

    PubMed

    Walker, Kara Odom; Steers, Neil; Liang, Li-Jung; Morales, Leo S; Forge, Nell; Jones, Loretta; Brown, Arleen F

    2010-12-01

    This community-partnered study was developed and fielded in partnership with key community stakeholders and describes age- and race-related variation in delays in care and preventive service utilization between middle-aged and older adults living in South Los Angeles. The survey sample included adults aged 50 and older who self-identified as African American or Latino and lived in ZIP codes of South Los Angeles (N=708). Dependent variables were self-reported delays in care and use of preventive services. Insured participants aged 50 to 64 were more likely to report any delay in care (adjusted predicted percentage (APP)=18%, 95% confidence interval (CI)=14-23) and problems obtaining needed medical care (APP=15%, 95% CI=12-20) than those aged 65 and older. Uninsured participants aged 50 to 64 reported even greater delays in care (APP=45%, 95% CI=33-56) and problems obtaining needed medical (APP=33%, 95% CI=22-45) and specialty care (APP=26%, 95% CI=16-39) than those aged 65 and older. Participants aged 50 to 64 were generally less likely to receive preventive services, including influenza and pneumococcal vaccines and colonoscopy than older participants, but women were more likely to receive mammograms. Participants aged 50 to 64 had more problems obtaining recommended preventive care and faced more delays in care than those aged 65 and older, particularly if they were uninsured. Providing insurance coverage for this group may improve access to preventive care and promote wellness.

  2. Hearing loss in older critical care patients: participation in decision making.

    PubMed

    Hardin, Sonya R

    2012-12-01

    Older adults with hearing loss who receive care in the noisy environment of a critical care unit can be disadvantaged in their ability to understand speech, thus limiting their participation in decision making. Providing optimal outcomes for such patients can be understood through use of the American Association of Critical-Care Nurses Synergy Model. When older adults are admitted to a critical care unit, their spouses, children, and friends are in positions to participate in the patients' care. The AACN Synergy Model patient characteristic of participation in care is useful in enhancing optimal outcomes for older patients.

  3. Associations Between Dehydration, Cognitive Impairment, and Frailty in Older Hospitalized Patients: An Exploratory Study.

    PubMed

    McCrow, Judy; Morton, Margaret; Travers, Catherine; Harvey, Keren; Eeles, Eamonn

    2016-05-01

    patients. 2. Identify risk and management strategies related to dehydration in older hospitalized patients. DISCLOSURE STATEMENT Neither the planners nor the author have any conflicts of interest to disclose. The current exploratory study (a) assessed the prevalence of dehydration in older adults (age ≤60 years) with and without cognitive impairment (CI) admitted to the hospital; and (b) examined associations between dehydration, CI, and frailty. Forty-four patients participated and dehydration was assessed within 24 hours of admission and at Day 4 or discharge (whichever occurred first). Patients' cognitive function and frailty statuses were assessed using validated instruments. Twenty-seven (61%) patients had CI and 61% were frail. Prevalence of dehydration at admission was 29% (n = 12) and 19% (n = 6) at study exit, and dehydration status did not differ according to CI or frailty status. However, within the non-CI group, significantly more frail than fit patients were dehydrated at admission (p = 0.03). Findings indicate dehydration is common among older hospitalized patients and that frailty may increase the risk for dehydration in cognitively intact older adults. [Journal of Gerontological Nursing, 42(5), 19-27.]. PMID:26870985

  4. Associations Between Dehydration, Cognitive Impairment, and Frailty in Older Hospitalized Patients: An Exploratory Study.

    PubMed

    McCrow, Judy; Morton, Margaret; Travers, Catherine; Harvey, Keren; Eeles, Eamonn

    2016-05-01

    patients. 2. Identify risk and management strategies related to dehydration in older hospitalized patients. DISCLOSURE STATEMENT Neither the planners nor the author have any conflicts of interest to disclose. The current exploratory study (a) assessed the prevalence of dehydration in older adults (age ≤60 years) with and without cognitive impairment (CI) admitted to the hospital; and (b) examined associations between dehydration, CI, and frailty. Forty-four patients participated and dehydration was assessed within 24 hours of admission and at Day 4 or discharge (whichever occurred first). Patients' cognitive function and frailty statuses were assessed using validated instruments. Twenty-seven (61%) patients had CI and 61% were frail. Prevalence of dehydration at admission was 29% (n = 12) and 19% (n = 6) at study exit, and dehydration status did not differ according to CI or frailty status. However, within the non-CI group, significantly more frail than fit patients were dehydrated at admission (p = 0.03). Findings indicate dehydration is common among older hospitalized patients and that frailty may increase the risk for dehydration in cognitively intact older adults. [Journal of Gerontological Nursing, 42(5), 19-27.].

  5. Patient satisfaction and ethnic identity among American Indian older adults.

    PubMed

    Garroutte, Eva Marie; Kunovich, Robert M; Jacobsen, Clemma; Goldberg, Jack

    2004-12-01

    Work in the field of culturally competent medical care draws on studies showing that minority Americans often report lower satisfaction with care than White Americans and recommends that providers should adapt care to patients' cultural needs. However, empirical evidence in support of cultural competence models is limited by reliance upon measurements of racial rather than ethnic identity and also by a near-total neglect of American Indians. This project explored the relationship between ethnic identity and satisfaction using survey data collected from 115 chronically ill American Indian patients >or=50 years at a Cherokee Nation clinic. Satisfaction scores were high overall and comparable to those found in the general population. Nevertheless, analysis using hierarchical linear modeling showed that patients' self-rated American Indian ethnic identity was significantly associated with satisfaction. Specifically, patients who rated themselves high on the measure of American Indian ethnic identity reported reduced scores on satisfaction with health care providers' social skill and attentiveness, as compared to those who rated themselves lower. Significant associations remained after controlling for patients' sex, age, education, marital status, self-reported health, wait time, and number of previous visits. There were no significant associations between patients' American Indian ethnic identity and satisfaction with provider's technical skill and shared decision-making. Likewise, there were no significant associations between satisfaction and a separate measure of White American ethnic identity, although a suggestive trend was observed for satisfaction with provider's social skill. Our findings demonstrate the importance of including measures of ethnic identity in studies of medical satisfaction in racial minority populations. They support the importance of adapting care to patient's cultural needs, and they highlight the particular significance of interpersonal

  6. Patient satisfaction and ethnic identity among American Indian older adults.

    PubMed

    Garroutte, Eva Marie; Kunovich, Robert M; Jacobsen, Clemma; Goldberg, Jack

    2004-12-01

    Work in the field of culturally competent medical care draws on studies showing that minority Americans often report lower satisfaction with care than White Americans and recommends that providers should adapt care to patients' cultural needs. However, empirical evidence in support of cultural competence models is limited by reliance upon measurements of racial rather than ethnic identity and also by a near-total neglect of American Indians. This project explored the relationship between ethnic identity and satisfaction using survey data collected from 115 chronically ill American Indian patients >or=50 years at a Cherokee Nation clinic. Satisfaction scores were high overall and comparable to those found in the general population. Nevertheless, analysis using hierarchical linear modeling showed that patients' self-rated American Indian ethnic identity was significantly associated with satisfaction. Specifically, patients who rated themselves high on the measure of American Indian ethnic identity reported reduced scores on satisfaction with health care providers' social skill and attentiveness, as compared to those who rated themselves lower. Significant associations remained after controlling for patients' sex, age, education, marital status, self-reported health, wait time, and number of previous visits. There were no significant associations between patients' American Indian ethnic identity and satisfaction with provider's technical skill and shared decision-making. Likewise, there were no significant associations between satisfaction and a separate measure of White American ethnic identity, although a suggestive trend was observed for satisfaction with provider's social skill. Our findings demonstrate the importance of including measures of ethnic identity in studies of medical satisfaction in racial minority populations. They support the importance of adapting care to patient's cultural needs, and they highlight the particular significance of interpersonal

  7. Older lesbians and work in the Australian health and aged care sector.

    PubMed

    Hughes, Mark; Kentlyn, Sujay

    2015-01-01

    While research has identified challenges lesbians face in the workplace, there is limited understanding of the particular experiences of older lesbians, especially those working in the health and aged care sector. This article draws on the stories of four women who participated in a narrative research project on lesbian and gay people's experiences of health and aged care. It highlights the need for future research to examine the complexity of identity expression and community affiliation, how people negotiate "coming out" in the workplace, the impact of discrimination, and the resources (such as friends) available to lesbians in the workplace. PMID:25575323

  8. Volunteering as reciprocity: beneficial and harmful effects of social policies to encourage contribution in older age.

    PubMed

    Stephens, Christine; Breheny, Mary; Mansvelt, Juliana

    2015-04-01

    Social policy applications of 'active ageing' ideals have recently focussed on volunteering as a beneficial and valuable contribution that older people can make to their communities. In this paper we draw attention to the positive and negative effects of a general imperative to contribute. Understanding the benefits of contribution in terms of the moral force of reciprocity recognises that older people do need and want to contribute to society and these contributions are beneficial for their sense of identity and wellbeing. However, older people vary greatly in their health, financial resources, and social networks and should not be seen as a homogenous group whose members must contribute in the same way. A policy focus on the imperative to contribute as a participating citizen can be oppressive and lead to withdrawal from social engagement by those who are the most in need of support to participate. Priorities for social and organisational policies must include support for the many ways older people are able to be involved in their communities and to provide structures necessary to support their preferences. A focus on individual responsibility for active engagement in society, which does not take account of individual circumstances or past contributions, can be harmful. PMID:25841726

  9. Volunteering as reciprocity: beneficial and harmful effects of social policies to encourage contribution in older age.

    PubMed

    Stephens, Christine; Breheny, Mary; Mansvelt, Juliana

    2015-04-01

    Social policy applications of 'active ageing' ideals have recently focussed on volunteering as a beneficial and valuable contribution that older people can make to their communities. In this paper we draw attention to the positive and negative effects of a general imperative to contribute. Understanding the benefits of contribution in terms of the moral force of reciprocity recognises that older people do need and want to contribute to society and these contributions are beneficial for their sense of identity and wellbeing. However, older people vary greatly in their health, financial resources, and social networks and should not be seen as a homogenous group whose members must contribute in the same way. A policy focus on the imperative to contribute as a participating citizen can be oppressive and lead to withdrawal from social engagement by those who are the most in need of support to participate. Priorities for social and organisational policies must include support for the many ways older people are able to be involved in their communities and to provide structures necessary to support their preferences. A focus on individual responsibility for active engagement in society, which does not take account of individual circumstances or past contributions, can be harmful.

  10. Circumstances and Contributing Causes of Fall Deaths among Persons Aged 65 and Older: United States, 2010

    PubMed Central

    Stevens, Judy A.; Rudd, Rose A.

    2015-01-01

    OBJECTIVES To determine whether the increasing fall death rate among people aged 65 and older is due in part to temporal changes in recording the underlying cause of death. DESIGN Analyses of multiple cause of death data using the online Centers for Disease Control and Prevention Wide-ranging ON-line Data for Epidemiologic Research system, which uses the National Center for Health Statistics’ Multiple Cause of Death data set. SETTING United States, 1999 to 2010. PARTICIPANTS People aged 65 and older with a fall listed on their death record as the underlying or a contributing cause of death. MEASUREMENTS Circumstances and contributing causes off all deaths—records listing International Classification of Diseases, Tenth Revision, codes W00 to W19 as the underlying cause of death—and underlying causes for records with falls as a contributing cause were examined. Joinpoint regression analysis was used to assess trends in the proportion of fall and fall-associated deaths to total deaths for 1999 to 2010. RESULTS In 2010, there were 21,649 fall deaths and 5,402 fall-associated deaths among people aged 65 and older; 48.7% of fall deaths involved a head injury. Approximately half the fall death records included diseases of the circulatory system as contributing causes. From 1999 to 2010, there was a trend toward more-specific reporting of falls circumstances, although total deaths remained unchanged. The proportion of fall deaths to total deaths increased 114.3%, and that of fall-associated deaths to total deaths increased 43.1%. CONCLUSION The reasons behind the increasing older adult fall death rate deserve further investigation. Possible contributing factors include changing trends in underlying chronic diseases and better reporting of falls as the underlying cause of death. PMID:24617970

  11. Mobile and Wearable Technology Needs for Aging in Place: Perspectives from Older Adults and Their Caregivers and Providers.

    PubMed

    Wang, Jing; Carroll, Deidra; Peck, Michelle; Myneni, Sahiti; Gong, Yang

    2016-01-01

    There is an increasing number of wearable trackers and mobile devices in the burgeoning world of digital health, the purpose of the study is to explore the role of these mobile and wearable tools among older adults aging in place. We conducted a cross sectional study using individual interviews with older adults and surveys with their caregivers or providers. We interviewed 29 residents living in a retirement community, and surveyed 6 caregivers or providers. The older adults had an average age of 88 years, most did not express interests on technology and heavily relied on providers for health tracking, while their professional caregivers or providers saw a great need to access older adults' health information collected from these mobile and wearable tools. Educating the older old on the benefits of mobile and wearable tools may address such discrepancy on needs of adopting mobile and wearable tools for aging in place.

  12. Financial capability, asset ownership, and later-age immigration: evidence from a sample of low-income older Asian immigrants.

    PubMed

    Nam, Yunju; Lee, Eun Jeong; Huang, Jin; Kim, Junpyo

    2015-01-01

    We examined financial capability and asset ownership among low-income older Asian immigrants with special attention given to later-age immigrants who came to the United States when they were 55 years old or older. Survey data collected from supported employment program participants (N = 150) were used. The analyses demonstrated a low level of financial knowledge and asset ownership in the sample. The findings also indicated that later-age immigrants' financial-management skills, knowledge of social programs, and asset ownership were significantly lower than those of young-age immigrants. These findings call for active interventions to enhance economic security among low-income older Asian immigrants.

  13. Income of People Aged 65 and Older: Overview From 1968 Survey of the Aged.

    ERIC Educational Resources Information Center

    Bixby, Lenore E.

    1970-01-01

    In a 1968 survey of the income of the aged, 8,248 persons were interviewed out of a population of 19.3 million persons aged 65 or over, excluding approximately 95,000 federal annuitants, 30,000 aliens, and a small number of persons not enrolled. The Current Medicare Survey was utilized to obtain certain selected characteristics of aged persons.…

  14. Creative Music Therapy in an Acute Care Setting for Older Patients with Delirium and Dementia

    PubMed Central

    Cheong, Chin Yee; Tan, Jane An Qi; Foong, Yi-Lin; Koh, Hui Mien; Chen, Denise Zhen Yue; Tan, Jessie Joon Chen; Ng, Chong Jin; Yap, Philip

    2016-01-01

    Background/Aims The acute hospital ward can be unfamiliar and stressful for older patients with impaired cognition, rendering them prone to agitation and resistive to care. Extant literature shows that music therapy can enhance engagement and mood, thereby ameliorating agitated behaviours. This pilot study evaluates the impact of a creative music therapy (CMT) programme on mood and engagement in older patients with delirium and/or dementia (PtDD) in an acute care setting. We hypothesize that CMT improves engagement and pleasure in these patients. Methods Twenty-five PtDD (age 86.5 ± 5.7 years, MMSE 6/30 ± 5.4) were observed for 90 min (30 min before, 30 min during, and 30 min after music therapy) on 3 consecutive days: day 1 (control condition without music) and days 2 and 3 (with CMT). Music interventions included music improvisation such as spontaneous music making and playing familiar songs of patient's choice. The main outcome measures were mood and engagement assessed with the Menorah Park Engagement Scale (MPES) and Observed Emotion Rating Scale (OERS). Results Wilcoxon signed-rank test showed a statistically significant positive change in constructive and passive engagement (Z = 3.383, p = 0.01) in MPES and pleasure and general alertness (Z = 3.188,p = 0.01) in OERS during CMT. The average pleasure ratings of days 2 and 3 were higher than those of day 1 (Z = 2.466, p = 0.014). Negative engagement (Z = 2.582, p = 0.01) and affect (Z = 2.004, p = 0.045) were both lower during CMT compared to no music. Conclusion These results suggest that CMT holds much promise to improve mood and engagement of PtDD in an acute hospital setting. CMT can also be scheduled into the patients' daily routines or incorporated into other areas of care to increase patient compliance and cooperation. PMID:27489560

  15. Anthropometric characteristics and body composition in Mexican older adults: age and sex differences.

    PubMed

    López-Ortega, Mariana; Arroyo, Pedro

    2016-02-14

    Anthropometric reference data for older adults, particularly for the oldest old, are still limited, especially in developing countries. The aim of the present study was to describe sex- and age-specific distributions of anthropometric measurements and body composition in Mexican older adults. The methods included in the present study were assessment of height, weight, BMI, calf circumference (CC), waist circumference (WC) and hip circumference (HC) as well as knee height in a sample of 8883 Mexican adults aged 60 years and above and the estimation of sex- and age-specific differences in these measures. Results of the study (n 7865, 54% women) showed that men are taller, have higher BMI, and larger WC than women, whereas women presented higher prevalence of obesity and adiposity. Overall prevalence of underweight was 2·3% in men and 4·0% in women, with increasing prevalence with advancing age. Significant differences were found by age group for weight, height, WC, HC, CC, BMI and knee height (P<0·001), but no significant differences in waist-hip circumference were observed. Significant differences between men and women were found in height, weight, circumferences, BMI and knee height (P<0·001). These results, which are consistent with studies of older adults in other countries, can be used for comparison with other Mexican samples including populations living in the USA and other countries with similar developmental and socio-economic conditions. This information can also be used as reference in clinical settings as a tool for detection of individuals at risk of either underweight or overweight and obesity.

  16. The interplay of subjective social status and essentialist beliefs about cognitive aging on cortisol reactivity to challenge in older adults.

    PubMed

    Weiss, David; Weiss, Mona

    2016-08-01

    Older adults are more likely than younger adults to experience stress when confronted with cognitive challenges. However, little is known about individual differences that might explain why some older adults exhibit stronger stress responses than others. We examined the interplay of two social-cognitive factors to explain older adults' cortisol reactivity: (1) subjective social status, and (2) essentialist beliefs about cognitive aging. We hypothesized that, depending on whether older adults believe that aging-related cognitive decline is inevitable versus modifiable, low subjective social status should lead to stronger or weaker cortisol reactivity. Using longitudinal data, we assessed the impact of cognitive challenges on stress reactivity in a sample of older adults (N = 389; 61-86 years). As predicted, regression analyses confirmed that 44 min after cognitively challenging tasks, older adults exhibited a significantly different cortisol reactivity depending on their subjective social status and their essentialist beliefs about cognitive aging. Specifically, older adults with low subjective social status and high essentialist beliefs showed a significantly elevated cortisol reactivity. We discuss the role of essentialist beliefs about cognitive aging to predict when and why high versus low subjective social status leads to stress responses in older adults.

  17. An Educational Intervention for Reducing the Intake of Dietary Fats and Cholesterol among Middle-Aged and Older Women.

    ERIC Educational Resources Information Center

    Gorman, Charlotte

    2001-01-01

    Middle aged and older women (n=14) attended a seminar on reducing saturated fat and cholesterol intake. Their 4-month follow-up reflections showed they adopted an average of 14.5 of 34 dietary practices. Those with higher adoption scores tended to be older and had less education and lower income. (SK)

  18. The Psychological Niche of Older Japanese and Americans Through Auto-Photography: Aging and the Search for Peace.

    ERIC Educational Resources Information Center

    Okura, Yutaka; And Others

    1986-01-01

    To understand aging cross-culturally, used photography to perceive the perceiver. Asked persons averaging seventy-three years old from Japan and the United States to describe "Who are you?" by taking six photographs. Content analysis showed older Japanese to be inward and aesthetically oriented, while older Americans were more oriented toward…

  19. Age differences in learning emerge from an insufficient representation of uncertainty in older adults.

    PubMed

    Nassar, Matthew R; Bruckner, Rasmus; Gold, Joshua I; Li, Shu-Chen; Heekeren, Hauke R; Eppinger, Ben

    2016-01-01

    Healthy aging can lead to impairments in learning that affect many laboratory and real-life tasks. These tasks often involve the acquisition of dynamic contingencies, which requires adjusting the rate of learning to environmental statistics. For example, learning rate should increase when expectations are uncertain (uncertainty), outcomes are surprising (surprise) or contingencies are more likely to change (hazard rate). In this study, we combine computational modelling with an age-comparative behavioural study to test whether age-related learning deficits emerge from a failure to optimize learning according to the three factors mentioned above. Our results suggest that learning deficits observed in healthy older adults are driven by a diminished capacity to represent and use uncertainty to guide learning. These findings provide insight into age-related cognitive changes and demonstrate how learning deficits can emerge from a failure to accurately assess how much should be learned. PMID:27282467

  20. Attributing heart attack and stroke to "Old Age": Implications for subsequent health outcomes among older adults.

    PubMed

    Stewart, Tara L; Chipperfield, Judith G; Perry, Raymond P; Hamm, Jeremy M

    2016-01-01

    This study assessed the extent to which older adults attribute a recent heart attack/stroke to "old age," and examined consequences for subsequent lifestyle behavior and health-care service utilization. Community-dwelling adults (N = 57, ages 73-98 years) were interviewed about their heart attack/stroke, and an objective health registry provided data on health-care utilization over a 3-year period. Endorsement of "old age" as a cause of heart attack/stroke negatively predicted lifestyle behavior change, and positively predicted frequency of physician visits and likelihood of hospitalization over the subsequent 3 years. Findings suggest the importance of considering "old age" attributions in the context of cardiovascular health events.

  1. Age differences in learning emerge from an insufficient representation of uncertainty in older adults

    PubMed Central

    Nassar, Matthew R.; Bruckner, Rasmus; Gold, Joshua I.; Li, Shu-Chen; Heekeren, Hauke R.; Eppinger, Ben

    2016-01-01

    Healthy aging can lead to impairments in learning that affect many laboratory and real-life tasks. These tasks often involve the acquisition of dynamic contingencies, which requires adjusting the rate of learning to environmental statistics. For example, learning rate should increase when expectations are uncertain (uncertainty), outcomes are surprising (surprise) or contingencies are more likely to change (hazard rate). In this study, we combine computational modelling with an age-comparative behavioural study to test whether age-related learning deficits emerge from a failure to optimize learning according to the three factors mentioned above. Our results suggest that learning deficits observed in healthy older adults are driven by a diminished capacity to represent and use uncertainty to guide learning. These findings provide insight into age-related cognitive changes and demonstrate how learning deficits can emerge from a failure to accurately assess how much should be learned. PMID:27282467

  2. Healthy ageing in Isan-Thai culture—A phenomenographic study based on older persons’ lived experiences

    PubMed Central

    Manasatchakun, Pornpun; Chotiga, Pleumjit; Roxberg, Åsa; Asp, Margareta

    2016-01-01

    Healthy ageing is a concept that concerns older persons’ quality of life and is a key factor in promoting well-being. The older population in Thailand is growing. Isan (a region of north-eastern Thailand) has been reported as having one of the most rapidly increasing older populations in the country. In order to care for and promote the health of older people, healthcare providers should understand how healthy ageing is perceived by this target group. Although healthy ageing has been studied in different contexts as well as perspectives, no studies have previously focused on older persons’ experiences of healthy ageing from a lifeworld perspective in Isan-Thai. Therefore, the aim of this study is to describe older persons’ qualitatively different conceptions of healthy ageing in Isan-Thai culture. A phenomenographic approach with an epistemological base in lifeworld theory was used to disclose the various ways to conceptualize healthy ageing. Individual, qualitative interviews were conducted with 17 people aged 60 and above who live in Isan-Thai. The findings of this study revealed three categories of descriptions: “being independent in dependence,” “being at peace,” and “being a valuable person.” This study also found family members, friends, healthcare providers, and religion important to healthy ageing in the Isan-Thai culture. Understanding how older people conceptualize healthy ageing is valuable for healthcare providers. They can apply these findings regarding healthy ageing in their fieldwork when caring for older people. PMID:26960686

  3. Variations in Community Prevalence and Determinants of Recreational and Utilitarian Walking in Older Age

    PubMed Central

    Procter-Gray, Elizabeth; Leveille, Suzanne G.; Hannan, Marian T.; Cheng, Jie; Kane, Kevin; Li, Wenjun

    2015-01-01

    Background. Regular walking is critical to maintaining health in older age. We examined influences of individual and community factors on walking habits in older adults. Methods. We analyzed walking habits among participants of a prospective cohort study of 745 community-dwelling men and women, mainly aged 70 years or older. We estimated community variations in utilitarian and recreational walking, and examined whether the variations were attributable to community differences in individual and environmental factors. Results. Prevalence of recreational walking was relatively uniform while prevalence of utilitarian walking varied across the 16 communities in the study area. Both types of walking were associated with individual health and physical abilities. However, utilitarian walking was also strongly associated with several measures of neighborhood socioeconomic status and access to amenities while recreational walking was not. Conclusions. Utilitarian walking is strongly influenced by neighborhood environment, but intrinsic factors may be more important for recreational walking. Communities with the highest overall walking prevalence were those with the most utilitarian walkers. Public health promotion of regular walking should take this into account. PMID:26339507

  4. Variations in Community Prevalence and Determinants of Recreational and Utilitarian Walking in Older Age.

    PubMed

    Procter-Gray, Elizabeth; Leveille, Suzanne G; Hannan, Marian T; Cheng, Jie; Kane, Kevin; Li, Wenjun

    2015-01-01

    Background. Regular walking is critical to maintaining health in older age. We examined influences of individual and community factors on walking habits in older adults. Methods. We analyzed walking habits among participants of a prospective cohort study of 745 community-dwelling men and women, mainly aged 70 years or older. We estimated community variations in utilitarian and recreational walking, and examined whether the variations were attributable to community differences in individual and environmental factors. Results. Prevalence of recreational walking was relatively uniform while prevalence of utilitarian walking varied across the 16 communities in the study area. Both types of walking were associated with individual health and physical abilities. However, utilitarian walking was also strongly associated with several measures of neighborhood socioeconomic status and access to amenities while recreational walking was not. Conclusions. Utilitarian walking is strongly influenced by neighborhood environment, but intrinsic factors may be more important for recreational walking. Communities with the highest overall walking prevalence were those with the most utilitarian walkers. Public health promotion of regular walking should take this into account. PMID:26339507

  5. Impact of pharmacist interventions in older patients: a prospective study in a tertiary hospital in Germany

    PubMed Central

    Cortejoso, L; Dietz, RA; Hofmann, G; Gosch, M; Sattler, A

    2016-01-01

    Background Inappropriate pharmacotherapy among older adults remains a critical issue in our health care systems. Besides polypharmacy and multiple comorbidities, the age-related pharmacokinetic and pharmacodynamic changes may increase the risk of adverse drug reactions and medication errors. Objective The main target of this study was to describe the characteristics of pharmaceutical interventions in two geriatric wards (orthogeriatric ward and geriatric day unit) of a general teaching hospital and to evaluate the clinical significance of the detected medication errors. Materials and methods The study was conducted between August 2014 and October 2015 and was based on a triple approach that included validation of medical orders, medication reconciliation at patients’ admission, and a predischarge planning appointment with the patient. The validation of medical orders was based on analyzing the suitability of the drugs prescribed, the drug dose depending on the patient’s characteristics, the presence of contraindications and interactions between drugs, and the proposal of alternative drugs included in the hospital formulary. Results A total of 2,307 interventions associated to a medication error in 15,282 medical orders for 1,859 older patients were recorded. The greater part of the interventions carried out on the orthogeriatric ward at admission and at discharge were due to omission of a drug in the medical order (20.0%) and clinically significant interactions requiring monitoring (30.4%), respectively. The main factor triggering pharmacist’s recommendations on the geriatric day unit was clinically significant interactions (21.1%). With regard to the clinical severity of the detected errors, 68.1% were considered significant, 24.8% were of minor significance, and 7.2% were clinically serious. Conclusion Our findings show the importance of clinical pharmacist involvement in the optimization of pharmacotherapy in older adults, ensuring that they receive

  6. Social influences on smoking in middle-aged and older women.

    PubMed

    Holahan, Charles J; North, Rebecca J; Holahan, Carole K; Hayes, Rashelle B; Powers, Daniel A; Ockene, Judith K

    2012-09-01

    The purpose of this study was to examine the role of 2 types of social influence--general social support and living with a smoker--on smoking behavior among middle-aged and older women in the Women's Health Initiative (WHI) Observational Study. Participants were postmenopausal women who reported smoking at some time in their lives (N=37,027), who were an average age of 63.3 years at baseline. Analyses used multiple logistic regression and controlled for age, educational level, and ethnicity. In cross-sectional analyses, social support was associated with a lower likelihood and living with a smoker was associated with a higher likelihood of being a current smoker and, among smokers, of being a heavier smoker. Moreover, in prospective analyses among baseline smokers, social support predicted a higher likelihood and living with a smoker predicted a lower likelihood of smoking cessation 1-year later. Further, in prospective analyses among former smokers who were not smoking at baseline, social support predicted a lower likelihood and living with a smoker predicted a higher likelihood of smoking relapse 1-year later. Overall, the present results indicate that social influences are important correlates of smoking status, smoking level, smoking cessation, and smoking relapse among middle-aged and older women.

  7. Cross-national comparison of disability in Latin American and Caribbean persons aged 75 and older.

    PubMed

    Reyes-Ortiz, Carlos A; Ostir, Glenn V; Pelaez, Martha; Ottenbacher, Kenneth J

    2006-01-01

    The objectives of this study were to compare rates of instrumental activity of daily living (IADL) and activity of daily living (ADL) difficulties and examine sociodemographic and health correlates of IADL and ADL difficulties. Data were extracted from the first interview of Health, Well-Being and Aging in Latin America and the Caribbean Study (abbreviated from Spanish name as: SABE = salud, bienestar y envejecimiento en America Latina y el Caribe). This analysis included 3225 subjects aged 75 and older living in seven capital cities during 1999-2000. Reporting either IADL or ADL difficulties were the outcomes. Bivariate and multiple logistic regression analyses were used to examine the associations between IADL or ADL difficulties and sociodemographics, and health characteristics. The highest prevalence of IADL difficulties was reported in Sao Paulo (33.8%) and the lowest in Montevideo (12.0%). The highest prevalence of ADL difficulties was reported in Santiago (34.7%) and the lowest in Bridgetown (16.9%). In a combined analysis across cities, increased age, fewer years of education, lower body mass index (BMI) (<20), and high number of medical conditions were independently significantly associated with IADL and ADL difficulties. In conclusion, about a third of persons aged 75 and older reported difficulty in at least one IADL or ADL. There was a wide variation on disability rates and correlates across cities. PMID:16126289

  8. Patient experiences and health system responsiveness among older adults in South Africa

    PubMed Central

    Peltzer, Karl; Phaswana-Mafuya, Nancy

    2012-01-01

    Background As populations age, health systems must adapt and develop approaches that meet the needs of older patients with increasing multiple chronic conditions. Understanding older populations’ perceptions of quality of care is critical to developing measures to increase the utilization of primary healthcare services. Using the data from the Global Study on Ageing and Adult Health (SAGE) survey, the current study aims to evaluate the degree of perceived responsiveness with outpatient and inpatient healthcare in South Africa. Methods We conducted a national population-based cross-sectional study with a sample of 3,840 individuals aged 50 years or older in South Africa in 2008. The questionnaire included sociodemographic characteristics, healthcare utilization and responsiveness, and other health variables. Results Healthcare utilization was 9% inpatient care in the past 3 years and 50% outpatient care in the past 12 months. The overall mean perceived responsiveness score for inpatient care was 71 and for outpatient care 69. According to the evaluation of inpatient care, autonomy and prompt attention showed the lowest while quality, confidentiality, and dignity showed the highest degree of perceived responsiveness among all the areas analyzed. Regarding outpatient care, prompt attention showed the lowest while quality, confidentiality, and dignity the highest degree of perceived responsiveness scores. Overall, perceived healthcare responsiveness was higher in private than in public inpatient and outpatient healthcare facilities. Multivariate analysis found that being from the White population group (OR=3.96, CI=1.54–19.19), not a public health facility (OR=0.34, CI=0.17–0.69), poor subjective health status (OR=0.53, CI=0.38–0.75) and having health insurance paying for the outpatient care visit (OR=3.39, CI=1.24–9.27) were associated with outpatient perceived healthcare responsiveness, whereas male gender (OR=0.36, CI=0.14–0.89), 80 years or older (OR=5

  9. Effectiveness of Chemoradiation for Head and Neck Cancer in an Older Patient Population

    SciTech Connect

    VanderWalde, Noam A.; Meyer, Anne Marie; Deal, Allison M.; Layton, J. Bradley; Liu, Huan; Carpenter, William R.; Weissler, Mark C.; Fleming, Mary E.; and others

    2014-05-01

    Purpose: The purpose of this study was to compare chemoradiation therapy (CRT) with radiation therapy (RT) only in an older patient population with head and neck squamous cell carcinoma (HNSCC). Methods and Materials: Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database (1992-2007), we identified a retrospective cohort of nonmetastatic HNSCC patients and divided them into treatment groups. Comparisons were made between CRT and RT cohorts. Propensity scores for CRT were estimated from covariates associated with receipt of treatment using multivariable logistic regression. Standardized mortality ratio weights (SMRW) were created from the propensity scores and used to balance groups on measured confounders. Multivariable and SMR-weighted Cox proportional hazard models were used to estimate the hazard ratio (HR) of death for receipt of CRT versus RT among the whole group and for separate patient and tumor categories. Results: The final cohort of 10,599 patients was 68% male and 89% white. Median age was 74 years. Seventy-four percent were treated with RT, 26% were treated with CRT. Median follow-up points for CRT and RT survivors were 4.6 and 6.3 years, respectively. On multivariable analysis, HR for death with CRT was 1.13 (95% confidence interval [CI]: 1.07-1.20; P<.01). Using the SMRW model, the HR for death with CRT was 1.08 (95% CI: 1.02-1.15; P=.01). Conclusions: Although the addition of chemotherapy to radiation has proven efficacious in many randomized controlled trials, it may be less effective in an older patient population treated outside of a controlled trial setting.

  10. Validity of the gait variability index in older adults: effect of aging and mobility impairments.

    PubMed

    Balasubramanian, Chitralakshmi K; Clark, David J; Gouelle, Arnaud

    2015-05-01

    Gait variability, defined as the fluctuation in spatiotemporal characteristics between steps, is suggested to be a sensitive indicator of mobility deficits with aging and pathological processes. A challenge in quantifying gait variability is the decision of which spatiotemporal parameters to assess because gait parameters may exhibit different amounts of variability and may differentially relate to mobility performance. The Gait Variability Index (GVI), a composite measure of variability across several gait parameters, was previously developed to overcome this challenge. The present study seeks to validate the use of GVI in the older adult population. A retrospective analysis of gait and clinical data was conducted using data pooled from five prior studies. The final data set included 105 younger adults (YA, age<65) and 81 older adults (OA, age≥65). The GVI of OA (91.92±8.75) was significantly lower compared to the GVI of YA (100.79±7.99). Within OA, the GVI was significantly lower (p<0.0001) in individuals with mobility deficits (84.35±9.03) compared to those with high mobility function (96.35±8.86). Furthermore, GVI was associated with mobility function, including walking speed and performance on the Berg Balance Scale. Our findings imply that the GVI is a valid assessment for gauging spatiotemporal gait variability in older adults, is sensitive to differentiate between high-functioning older adults and those with mild to moderate mobility deficits and is associated with some clinical measures of functional mobility and balance.

  11. Serum folate, vitamin B-12 and cognitive function in middle and older age: The HAPIEE study

    PubMed Central

    Horvat, Pia; Gardiner, Julian; Kubinova, Ruzena; Pajak, Andrzej; Tamosiunas, Abdonas; Schöttker, Ben; Pikhart, Hynek; Peasey, Anne; Jansen, Eugene; Bobak, Martin

    2016-01-01

    Background Nutrient status of B vitamins, particularly folate and vitamin B-12, may be related to cognitive ageing but epidemiological evidence remains inconclusive. Objective The aim of this study was to estimate the association of serum folate and vitamin B-12 concentrations with cognitive function in middle-aged and older adults from three Central and Eastern European populations. Methods Men and women aged 45–69 at baseline participating in the Health, Alcohol and Psychosocial factors in Eastern Europe (HAPIEE) study were recruited in Krakow (Poland), Kaunas (Lithuania) and six urban centres in the Czech Republic. Tests of immediate and delayed recall, verbal fluency and letter search were administered at baseline and repeated in 2006–2008. Serum concentrations of biomarkers at baseline were measured in a sub-sample of participants. Associations of vitamin quartiles with baseline (n = 4166) and follow-up (n = 2739) cognitive domain-specific z-scores were estimated using multiple linear regression. Results After adjusting for confounders, folate was positively associated with letter search and vitamin B-12 with word recall in cross-sectional analyses. In prospective analyses, participants in the highest quartile of folate had higher verbal fluency (p < 0.01) and immediate recall (p < 0.05) scores compared to those in the bottom quartile. In addition, participants in the highest quartile of vitamin B-12 had significantly higher verbal fluency scores (β = 0.12; 95% CI = 0.02, 0.21). Conclusions Folate and vitamin B-12 were positively associated with performance in some but not all cognitive domains in older Central and Eastern Europeans. These findings do not lend unequivocal support to potential importance of folate and vitamin B-12 status for cognitive function in older age. Long-term longitudinal studies and randomised trials are required before drawing conclusions on the role of these vitamins in cognitive decline. PMID:26808046

  12. Rules for improving pharmacotherapy in older adult patients: part 2 (rules 6-10).

    PubMed

    Wooten, James M

    2015-03-01

    The population of older adult patients in the United States is growing each year. Appropriate pharmacotherapy has allowed many older patients to live longer and maintain healthy lives. Unfortunately, the inappropriate utilization of medications can be harmful to older adult patients. Inappropriate pharmacotherapy may lead to overusing medications and polypharmacy. Polypharmacy can contribute to a higher incidence of adverse effects, increase the risk of dangerous drug interactions, cause noncompliance with appropriate medication use, and significantly increase the cost of health care. The polypharmacy issue with geriatric patients has been described as an epidemic and this issue must be addressed. This review provides objective rules that may help prevent polypharmacy. Consideration of these rules when prescribing, dispensing, and caring for older adult patients will improve the overall pharmacotherapy regimens instituted by healthcare providers. PMID:25772047

  13. Risk factors for depressed mood amongst a community dwelling older age population in England: cross-sectional survey data from the PRO-AGE study

    PubMed Central

    2014-01-01

    Background The Quality and Outcomes Framework in the United Kingdom (UK) National Health Service previously highlighted case finding of depression amongst patients with diabetes or coronary heart disease. However, depression in older people remains under-recognized. Comprehensive data for analyses of the association of depression in older age with other health and functional measures, and demographic factors from community populations within England, are lacking. Methods Secondary analyses of cross-sectional baseline survey data from the England arm of a randomised controlled trial of health risk appraisal for older people in Europe; PRO-AGE study. Data from 1085 community-dwelling non-disabled people aged 65 years or more from three group practices in suburban London contributed to this study. Depressed mood was ascertained from the 5-item Mental Health Inventory Screening test. Exploratory multivariable logistic regression was used to identify the strongest associations of depressed mood with a previous diagnosis of a specified physical/mental health condition, health and functional measures, and demographic factors. Results Depressed mood occurred in 14% (155/1085) of participants. A previous diagnoses of depression (OR 3.39; P < 0.001) and poor vision as determined from a Visual Function Questionnaire (OR 2.37; P = 0.001) were amongst the strongest factors associated with depressed mood that were independent of functional impairment, other co-morbidities, and demographic factors. A subgroup analyses on those without a previous diagnosis of depression also indicated that within this group, poor vision (OR 2.51; P = 0.002) was amongst the strongest independent factors associated with depressed mood. Conclusions Previous case-finding strategies in primary care focussed on heart disease and diabetes but health-related conditions other than coronary heart disease and diabetes are also associated with an increased risk for depression. Complex issues of

  14. Age-friendly primary health care: an assessment of current service provision for older adults in Hong Kong.

    PubMed

    Woo, Jean; Mak, Benise; Yeung, Fannie

    2013-01-01

    There has been no study evaluating whether primary care services are sufficiently oriented towards the older population in Hong Kong, particularly those with increasing frailty. Since primary care is a key first interface in promotion and maintenance of health in older people, an assessment of the age-friendliness of service provisions is of critical importance in optimizing the health of aging populations. The age-friendliness of primary care services for older people was assessed using focus groups of elderly people and also of service providers who care for them. Discussion content was based on the WHO guidelines for age-friendly primary care in the following areas: Information, education and training, community-based health care management systems, and the physical environment. Desirable improvements were identified in all domains. The findings underscore the need for wider dissemination of health care needs of older people in the primary care setting.

  15. Evaluation of the safety and efficacy of pregabalin in older patients with neuropathic pain: results from a pooled analysis of 11 clinical studies

    PubMed Central

    2010-01-01

    Background Older patients are typically underrepresented in clinical trials of medications for chronic pain. A post hoc analysis of multiple clinical studies of pregabalin in patients with painful diabetic peripheral neuropathy (DPN) or postherpetic neuralgia (PHN) was conducted to evaluate the efficacy and safety of pregabalin in older patients. Methods Data from 11 double-blind, randomized, placebo-controlled clinical studies of pregabalin in patients with DPN or PHN were pooled. Efficacy outcomes included change in Daily Pain Rating Scale score, ≥30% and ≥50% responders, and endpoint pain score ≤3. Safety was based on adverse events (AEs). Primary efficacy was analyzed by analysis of covariance with terms for treatment, age category, protocol, baseline pain, and treatment-by-age category interaction. Results 2516 patients (white, n = 2344 [93.2%]; men, n = 1347 [53.5%]; PHN, n = 1003 [39.9%]; pregabalin, n = 1595) were included in the analysis. Patients were grouped by age: 18 to 64 years (n = 1236), 65 to 74 years (n = 766), and ≥75 years (n = 514). Baseline mean pain and sleep interference scores were comparable across treatment and age groups. Significant improvements in endpoint mean pain were observed for all pregabalin dosages versus placebo in all age groups (p ≤ 0.0009), except for the lowest dosage (150 mg/day) in the youngest age group. Clinically meaningful pain relief, defined as ≥30% and ≥50% pain response, was observed in all age groups. The most common AEs were dizziness, somnolence, peripheral edema, asthenia, dry mouth, weight gain, and infections. The relative risks for these AEs increased with pregabalin dose, but did not appear related to older age or type of neuropathic pain. Conclusions Pregabalin (150-600 mg/day) significantly reduced pain in older patients (age ≥65 years) with neuropathic pain and improvements in pain were comparable to those observed in younger patients. Titration of pregabalin to the lowest effective

  16. Theory of mind through the ages: older and middle-aged adults exhibit more errors than do younger adults on a continuous false belief task.

    PubMed

    Bernstein, Daniel M; Thornton, Wendy Loken; Sommerville, Jessica A

    2011-10-01

    Theory of mind (ToM), or the ability to understand mental states, is a fundamental aspect of social cognition. Previous research has documented marked advances in ToM in preschoolers, and declines in ToM in older-aged adults. In the present study, younger (n=37), middle-aged (n=20), and older (n=37) adults completed a continuous false belief task measuring ToM. Middle-aged and older adults exhibited more false belief bias than did younger adults, irrespective of language ability, executive function, processing speed, and memory. The authors conclude that ToM declines from younger to older adulthood, independent of age-related changes to domain-general cognitive functioning.

  17. Aging and selective engagement: the moderating impact of motivation on older adults' resource utilization.

    PubMed

    Hess, Thomas M; Germain, Cassandra M; Swaim, Elizabeth L; Osowski, Nicole L

    2009-06-01

    Two studies were conducted to examine age differences in the impact of motivation in a social cognitive task. We tested the hypothesis that aging is associated with an increase in the selective engagement of cognitive resources in support of performance. Different-aged adults read descriptions of 2 people in order to determine which was better suited for a particular job. These descriptions contained behaviors that were either consistent or inconsistent with the job, and participants performed the task under conditions of high versus low accountability. Examination of memory for behavioral information revealed that accountability disproportionately affected older adults' performance, with the locus of this effect being in conscious recollection processes. This supports the aforementioned selective engagement hypothesis by demonstrating that the differential impact of the motivational manipulation was based in deliberative memory processes.

  18. A multi-organisation aged care emergency service for acute care management of older residents in aged care facilities.

    PubMed

    Conway, Jane; Dilworth, Sophie; Hullick, Carolyn; Hewitt, Jacqueline; Turner, Catherine; Higgins, Isabel

    2015-11-01

    This case study describes a multi-organisation aged care emergency (ACE) service. The service was designed to enable point-of-care assessment and management for older people in residential aged care facilities (RACFs). Design of the ACE service involved consultation and engagement of multiple key stakeholders. The ACE service was implemented in a large geographical region of a single Medicare Local (ML) in New South Wales, Australia. The service was developed over several phases. A case control pilot evaluation of one emergency department (ED) and four RACFs revealed a 16% reduction in presentations to the ED as well as reductions in admission to the hospital following ED presentation. Following initial pilot work, the ACE service transitioned across another five EDs and 85 RACFs in the local health district. The service has now been implemented in a further 10 sites (six metropolitan and four rural EDs) across New South Wales. Ongoing evaluation of the implementation continues to show positive outcomes. The ACE service offers a model shown to reduce ED presentations and admissions from RACFs, and provide quality care with a focus on the needs of the older person. PMID:25981903

  19. Unsatisfied basic needs of older patients in emergency care environments - obstacles to an active role in decision making.

    PubMed

    Nydén, Kristoffer; Petersson, Martin; Nyström, Maria

    2003-03-01

    Little attention is paid in Emergency Care Units (ECUs) in Sweden to the special needs of older people. The aim of this study was thus to analyse older people's basic needs in the emergency care environment. The study was carried out with a life-world interpretative approach, and the theoretical framework for interpretation was Abraham Maslow's theory of motivation and personality. Seven informants aged between 65 and 88 years, with various experiences of being patients with urgent as well as non-urgent health-related problems, were interviewed about their experiences of ECU care. Their basic needs at the lower levels of Maslow's hierarchy were well-represented in the data. Higher needs, such as desire to know and understand, appeared to be totally neglected. Safety needs dominated the whole situation. Our conclusion is that standards of care must be developed in Sweden to make older patients feel safer and more secure in ECUs. Furthermore, the principles of nursing care for older patients need to be defined in order to encourage them to take an active part in their own health process.

  20. Use of Patient Portals: Personal Health Information Management in Older Adults.

    PubMed

    Turner, Anne; Osterhage, Katie; Joe, Jonathan; Hartzler, Andrea; Lin, Lorelei; Demiris, George

    2015-01-01

    The personal health information management (PHIM) of older adults is poorly understood. We describe initial results from the SOARING (Studying Older Adults & Researching Information Needs and Goals) study at the University of Washington, a participatory design investigation of PHIM in older adults. We conducted in-depth interviews with older adults (n=71) living in a variety of residential settings. A surprising 21% of participants reported using patient portals. Another 17% of participants reported prior use or anticipated use of portals in the future. We identified preferences and needs as well as barriers and facilitators to portal use. Our findings indicate that patient portals designed to target the specific needs for older adults can suport PHIM. We offer recommendations for expanded research. PMID:26262280

  1. Leg strength declines with advancing age despite habitual endurance exercise in active older adults.

    PubMed

    Marcell, Taylor J; Hawkins, Steven A; Wiswell, Robert A

    2014-02-01

    Age-associated loss of muscle mass (sarcopenia) and strength (dynapenia) is associated with a loss of independence that contributes to falls, fractures, and nursing home admissions, whereas regular physical activity has been suggested to offset these losses. The purpose of this study was to evaluate the effect of habitual endurance exercise on muscle mass and strength in active older adults. A longitudinal analysis of muscle strength (≈4.8 years apart) was performed on 59 men (age at start of study: 58.6 ± 7.3 years) and 35 women (56.9 ± 8.2 years) who used endurance running as their primary mode of exercise. There were no changes in fat-free mass although body fat increased minimally (1.0-1.5%). Training volume (km·wk, d·wk) decreased in both the men and women. There was a significant loss of both isometric knee extension (≈5% per year) and knee flexion (≈3.6% per year) strength in both the men and women. However, there was no significant change in either isokinetic concentric or eccentric torque of the knee extensors. Our data demonstrated a significant decline in isometric knee extensor and knee flexor strength although there were no changes in body mass in this group of very active older men and women. Our data support newer exercise guidelines for older Americans suggesting resistance training be an integral component of a fitness program and that running alone was not sufficient to prevent the loss in muscle strength (dynapenia) with aging.

  2. Blood Glucose, Diet-Based Glycemic Load and Cognitive Aging Among Dementia-Free Older Adults

    PubMed Central

    Andel, Ross; McEvoy, Cathy; Dahl Aslan, Anna K.; Finkel, Deborah; Pedersen, Nancy L.

    2015-01-01

    Background. Although evidence indicates that Type II Diabetes is related to abnormal brain aging, the influence of elevated blood glucose on long-term cognitive change is unclear. In addition, the relationship between diet-based glycemic load and cognitive aging has not been extensively studied. The focus of this study was to investigate the influence of diet-based glycemic load and blood glucose on cognitive aging in older adults followed for up to 16 years. Methods. Eight-hundred and thirty-eight cognitively healthy adults aged ≥50 years (M = 63.1, SD = 8.3) from the Swedish Adoption/Twin Study of Aging were studied. Mixed effects growth models were utilized to assess overall performance and change in general cognitive functioning, perceptual speed, memory, verbal ability, and spatial ability as a function of baseline blood glucose and diet-based glycemic load. Results. High blood glucose was related to poorer overall performance on perceptual speed as well as greater rates of decline in general cognitive ability, perceptual speed, verbal ability, and spatial ability. Diet-based glycemic load was related to poorer overall performance in perceptual speed and spatial ability. Conclusion. Diet-based glycemic load and, in particular, elevated blood glucose appear important for cognitive performance/cognitive aging. Blood glucose control (perhaps through low glycemic load diets) may be an important target in the detection and prevention of age-related cognitive decline. PMID:25149688

  3. Speech Recognition Across the Life Span: Longitudinal Changes From Middle-Age to Older Adults

    PubMed Central

    2015-01-01

    Purpose The purpose of this article is to provide an overview of evidence of age-related declines in speech recognition in middle age to older adulthood; to review contributions of pure-tone thresholds, age, and gender; and to report preliminary results from a longitudinal study. Method Pure-tone thresholds and word recognition in quiet and babble are being measured in a large sample of adults yearly or every 2 to 3 years. Analyses included >16,000 audiograms and speech recognition scores from >1,200 adults whose ages ranged from the 40s to the 90s. A multivariable generalized linear repeated mixed model assessed changes in thresholds and speech recognition over time. Results Word recognition in quiet declined significantly while controlling for threshold increases, and declines appeared to accelerate near ages 65 to 70 years. Scores for men were poorer than those for women even after controlling for gender differences in thresholds, but rates of decline did not differ by gender. Smaller declines in key word recognition in babble were observed, and declines appeared to accelerate near ages 75 to 80 years. Conclusions Additional evidence is needed from large-scale longitudinal cohort studies to determine rates of change of auditory function across the life span. These studies can identify associations with modifiable risk factors and potential mechanisms to reduce, to prevent, or to delay the onset of age-related hearing loss. PMID:25767998

  4. Barriers to cardiac rehabilitation access of older heart failure patients and strategies for better implementation.

    PubMed

    Pulignano, Giovanni; Tinti, Maria Denitza; Del Sindaco, Donatella; Tolone, Stefano; Minardi, Giovanni; Lax, Antonio; Uguccioni, Massimo

    2016-01-01

    In heart failure (HF), cardiac rehabilitation (CR) may reduce decompensations, hospitalization, and ultimately mortality in long term. Many studies over the past decade have demonstrated that aerobic exercise training is effective and safe in stable patients with HF. Exercise CR resulted in a clinically important improvement in the QOL. Several clinical and psychosocial factors are associated with decreased participation in CR programs of elderly HF patients, such as perception of exercise as tiring or painful, comorbidities, lack of physician encouragement, and opinion that CR will not improve their health status. Besides low functional capacity, and chronic deconditioning may also deter patients from participating in CR programs. Recent data suggest that current smoking, a BMI ≥30 kg/m2, diabetes mellitus, and cognitive dysfunction are associated with failure to enroll in outpatient CR in older age group. Moreover the lack of availability of CR facilities or the absence of financial refunds for enrolment of CHF patients in cardiac rehabilitation programs can play a crucial role. Many of this factors are modifiable through patient education and self care strategy instruction, health providers sensibilization, and implementing economic measures in order to make CR affordable.

  5. Readmission of older patients after hospital discharge for hip fracture: a multilevel approach

    PubMed Central

    Paula, Fátima de Lima; da Cunha, Geraldo Marcelo; Leite, Iúri da Costa; Pinheiro, Rejane Sobrino; Valente, Joaquim Gonçalves

    2016-01-01

    ABSTRACT OBJECTIVE To identify individual and hospital characteristics associated with the risk of readmission in older inpatients for proximal femoral fracture in the period of 90 days after discharge. METHODS Deaths and readmissions were obtained by a linkage of databases of the Hospital Information System of the Unified Health System and the System of Information on Mortality of the city of Rio de Janeiro from 2008 to 2011. The population of 3,405 individuals aged 60 or older, with non-elective hospitalization for proximal femoral fracture was followed for 90 days after discharge. Cox multilevel model was used for discharge time until readmission, and the characteristics of the patients were used on the first level and the characteristics of the hospitals on the second level. RESULTS The risk of readmission was higher for men (hazard ratio [HR] = 1.37; 95%CI 1.08–1.73), individuals more than 79 years old (HR = 1.45; 95%CI 1.06–1.98), patients who were hospitalized for more than two weeks (HR = 1.33; 95%CI 1.06-1.67), and for those who underwent arthroplasty when compared with the ones who underwent osteosynthesis (HR = 0.57; 95%CI 0.41–0.79). Besides, patients admitted to state hospitals had lower risk for readmission when compared with inpatients in municipal (HR = 1.71; 95%CI 1.09–2.68) and federal hospitals (HR = 1.81; 95%CI 1.00–3.27). The random effect of the hospitals in the adjusted model remained statistically significant (p < 0.05). CONCLUSIONS Hospitals have complex structures that reflect in the quality of care. Thus, we propose that future studies may include these complexities and the severity of the patients in the analysis of the data, also considering the correlation between readmission and mortality to reduce biases. PMID:27143616

  6. Daily activity level buffers stress-glycemia associations in older sedentary NIDDM patients.

    PubMed

    Aikens, K S; Aikens, J E; Wallander, J L; Hunt, S

    1997-08-01

    Examined glycemic associations with medical variables, activity, daily stress, and mood state in 72 older patients with non-insulin-dependent diabetes mellitus (NIDDM). On three occasions over a 2-week observation period, subjects provided measures of everyday life stress, negative mood state, and daily activities. At the end of this period, fructosamine was assayed to measure glycemic control throughout the assessment period. After controlling for medical variables (age, illness duration, body mass index, caloric intake, and activity) and the main effects of psychological factors (stress; anxious, angry, and depressed mood states), stress interacted with activity such that glycemic elevation was positively associated with stress for subjects below the activity median but not for those above the median. This was unattributable to any overall activity-related differences in fructosamine, stress, or mood. None of the mood states interacted with activity. The findings suggest that extremely low levels of activity may strengthen life stress-glycemia associations in NIDDM. PMID:9298436

  7. Gender stereotypes across the ages: On-line processing in school-age children, young and older adults.

    PubMed

    Siyanova-Chanturia, Anna; Warren, Paul; Pesciarelli, Francesca; Cacciari, Cristina

    2015-01-01

    Most research to date on implicit gender stereotyping has been conducted with one age group - young adults. The mechanisms that underlie the on-line processing of stereotypical information in other age groups have received very little attention. This is the first study to investigate real time processing of gender stereotypes at different age levels. We investigated the activation of gender stereotypes in Italian in four groups of participants: third- and fifth-graders, young and older adults. Participants heard a noun that was stereotypically associated with masculine (preside "headmaster") or feminine roles (badante "social care worker"), followed by a male (padre "father") or female kinship term (madre "mother"). The task was to decide if the two words - the role noun and the kinship term - could describe the same person. Across all age groups, participants were significantly faster to respond, and significantly more likely to press 'yes,' when the gender of the target was congruent with the stereotypical gender use of the preceding prime. These findings suggest that information about the stereotypical gender associated with a role noun is incorporated into the mental representation of this word and is activated as soon as the word is heard. In addition, our results show differences between male and female participants of the various age groups, and between male- and female-oriented stereotypes, pointing to important gender asymmetries. PMID:26441763

  8. Gender stereotypes across the ages: On-line processing in school-age children, young and older adults

    PubMed Central

    Siyanova-Chanturia, Anna; Warren, Paul; Pesciarelli, Francesca; Cacciari, Cristina

    2015-01-01

    Most research to date on implicit gender stereotyping has been conducted with one age group – young adults. The mechanisms that underlie the on-line processing of stereotypical information in other age groups have received very little attention. This is the first study to investigate real time processing of gender stereotypes at different age levels. We investigated the activation of gender stereotypes in Italian in four groups of participants: third- and fifth-graders, young and older adults. Participants heard a noun that was stereotypically associated with masculine (preside “headmaster”) or feminine roles (badante “social care worker”), followed by a male (padre “father”) or female kinship term (madre “mother”). The task was to decide if the two words – the role noun and the kinship term – could describe the same person. Across all age groups, participants were significantly faster to respond, and significantly more likely to press ‘yes,’ when the gender of the target was congruent with the stereotypical gender use of the preceding prime. These findings suggest that information about the stereotypical gender associated with a role noun is incorporated into the mental representation of this word and is activated as soon as the word is heard. In addition, our results show differences between male and female participants of the various age groups, and between male- and female-oriented stereotypes, pointing to important gender asymmetries. PMID:26441763

  9. Digital Inclusion for Older Adults based on Physical Activities: an Age Concern.

    PubMed

    Gusmão, Cristine; Menezes, Júlio; Pina, Carmelo; Lima, Juliana; Barbosa Neto, João

    2015-01-01

    Nowadays, we are living in an interdependent and interconnected world during an age that is driven by technological progress. It has extraordinary potential to improve the quality of later life: creating social networks to tackle isolation and loneliness; transforming services to help people live independently at home for longer; empowering consumers; and enabling civil participation. In light of this, this poster aims to present the development process of a digital booklet for mobile devices--smartphones and tablets that illustrate the benefits of doing physical exercises for older adults aiming to improve life quality and minimizing digital exclusion.

  10. Digital Inclusion for Older Adults based on Physical Activities: an Age Concern.

    PubMed

    Gusmão, Cristine; Menezes, Júlio; Pina, Carmelo; Lima, Juliana; Barbosa Neto, João

    2015-01-01

    Nowadays, we are living in an interdependent and interconnected world during an age that is driven by technological progress. It has extraordinary potential to improve the quality of later life: creating social networks to tackle isolation and loneliness; transforming services to help people live independently at home for longer; empowering consumers; and enabling civil participation. In light of this, this poster aims to present the development process of a digital booklet for mobile devices--smartphones and tablets that illustrate the benefits of doing physical exercises for older adults aiming to improve life quality and minimizing digital exclusion. PMID:26262272

  11. A comparison of attitudes about cremation among Black and White middle-aged and older adults.

    PubMed

    Glass, Anne P; Samuel, Linda F

    2011-05-01

    Social workers must be instrumental in educating elders and their families to make informed decisions about death and dying. As part of a larger qualitative study, we explored attitudes about cremation of 25 older and 25 middle-aged adults, evenly split between Black and White respondents. Major themes emerged about disposition of the body after death. Costs and land conservation influenced support for cremation; reasons against cremation include religious beliefs, lack of closure, and sense of place. Additionally, some respondents were against cremation primarily because of lack of exposure, as it was not their family tradition, suggesting a role for education.

  12. A comparison of attitudes about cremation among Black and White middle-aged and older adults.

    PubMed

    Glass, Anne P; Samuel, Linda F

    2011-05-01

    Social workers must be instrumental in educating elders and their families to make informed decisions about death and dying. As part of a larger qualitative study, we explored attitudes about cremation of 25 older and 25 middle-aged adults, evenly split between Black and White respondents. Major themes emerged about disposition of the body after death. Costs and land conservation influenced support for cremation; reasons against cremation include religious beliefs, lack of closure, and sense of place. Additionally, some respondents were against cremation primarily because of lack of exposure, as it was not their family tradition, suggesting a role for education. PMID:21547828

  13. An Examination of the Perceptions of Older Americans on Successful Aging and Adult Education Programs to Meet Their Aging Needs in Southeast Alabama

    ERIC Educational Resources Information Center

    Cobb, Ileeia Anjale

    2011-01-01

    The purpose of this study was to examine the personal perceptions of older Americans in regards to the aging process and the characteristics of successful aging. In addition, the study aimed to determine individual perceptions of adult education programs and resources necessary in aging successfully. The study examined current resources, services…

  14. Habitually exercising older men do not demonstrate age-associated vascular endothelial oxidative stress.

    PubMed

    Pierce, Gary L; Donato, Anthony J; LaRocca, Thomas J; Eskurza, Iratxe; Silver, Annemarie E; Seals, Douglas R

    2011-12-01

    We tested the hypothesis that older men who perform habitual aerobic exercise do not demonstrate age-associated vascular endothelial oxidative stress compared with their sedentary peers. Older exercising men (n=13, 62±2 years) had higher (P<0.05) physical activity (79±7 vs. 30±6 MET hours per week) and maximal exercise oxygen consumption (42±1 vs. 29±1 mL kg(-1) per minute) vs. sedentary men (n=28, 63±1 years). Brachial artery flow-mediated dilation (FMD), a measure of vascular endothelial function, was greater (P<0.05) in the exercising vs. sedentary older men (6.3±0.5 vs. 4.9±0.4%Δ) and not different than young controls (n=20, 25±1 years, 7.1±0.5%Δ). In vascular endothelial cells sampled from the brachial artery, nitrotyrosine, a marker of oxidative stress, was 51% lower in the exercising vs. sedentary older men (0.38±0.06 vs. 0.77±0.10 AU). This was associated with lower endothelial expression of the oxidant enzyme nicotinamide adenine dinucleotide phosphate (NADPH) oxidase (p47(phox) subunit, 0.33±0.05 vs. 0.61±0.09 AU) and the redox-sensitive transcription factor nuclear factor kappa B (NFκB) (p65 subunit, 0.36±0.05 vs. 0.72±0.09 AU). Expression of the antioxidant enzyme manganese superoxide dismutase (SOD) (0.57±0.13 vs. 0.30±0.04 AU) and activity of endothelium-bound extracellular SOD were greater (6.4±0.5 vs. 5.0±0.6 U mL(-1) per minute) in the exercising men (both P<0.05), but differences no longer were significant after correcting for adiposity and circulating metabolic factors. Overall, values for the young controls differed with those for the sedentary, but not the exercising older men. Older men who exercise regularly do not demonstrate vascular endothelial oxidative stress, and this may be a key molecular mechanism underlying their reduced risk of cardiovascular diseases.

  15. Effect of systematic relaxation techniques on anxiety and pain in older patients undergoing abdominal surgery.

    PubMed

    Rejeh, Nahid; Heravi-Karimooi, Majideh; Vaismoradi, Mojtaba; Jasper, Melanie

    2013-10-01

    Inadequate pain control in older patients who have undergone abdominal surgery can lead to many complications. This study investigates the effect of systematic relaxation techniques on pain and anxiety in older patients undergoing abdominal surgery. One hundred twenty-four patients were randomly assigned into the experimental and control groups. The systematic relaxation techniques consisted of older patients in the experimental group slowly reading relaxing sentences during recovery in ambulation after the surgery. Patients' satisfaction with pain and anxiety relief was recorded, as was their use of opioid analgesia. Statistically significant differences in pain and anxiety, and in analgesic use, were reported between the patients in experimental and control groups after the intervention. These relaxation techniques can be incorporated into the care plan to reduce pain and anxiety after surgery as well as offering a measure for increasing the patients' independence in pain management control.

  16. Modern Attitudes Toward Older Adults in the Aging World: A Cross-Cultural Meta-Analysis.

    PubMed

    North, Michael S; Fiske, Susan T

    2015-09-01

    Prevailing beliefs suggest that Eastern cultures hold older adults in higher esteem than Western cultures do, due to stronger collectivist traditions of filial piety. However, in modern, industrialized societies, the strain presented by dramatic rises in population aging potentially threatens traditional cultural expectations. Addressing these competing hypotheses, a literature search located 37 eligible papers, comprising samples from 23 countries and 21,093 total participants, directly comparing Easterners and Westerners (as classified per U.N. conventions) in their attitudes toward aging and the aged. Contradicting conventional wisdom, a random-effects meta-analysis on these articles found such evaluations to be more negative in the East overall (standardized mean difference = -0.31). High heterogeneity in study comparisons suggested the presence of moderators; indeed, geographical region emerged as a significant moderating factor, with the strongest levels of senior derogation emerging in East Asia (compared with South and Southeast Asia) and non-Anglophone Europe (compared with North American and Anglophone Western regions). At the country level, multiple-moderator meta-regression analysis confirmed recent rises in population aging to significantly predict negative elder attitudes, controlling for industrialization per se over the same time period. Unexpectedly, these analyses also found that cultural individualism significantly predicted relative positivity-suggesting that, for generating elder respect within rapidly aging societies, collectivist traditions may backfire. The findings suggest the importance of demographic challenges in shaping modern attitudes toward elders-presenting considerations for future research in ageism, cross-cultural psychology, and even economic development, as societies across the globe accommodate unprecedented numbers of older citizens. PMID:26191955

  17. Modern Attitudes Toward Older Adults in the Aging World: A Cross-Cultural Meta-Analysis.

    PubMed

    North, Michael S; Fiske, Susan T

    2015-09-01

    Prevailing beliefs suggest that Eastern cultures hold older adults in higher esteem than Western cultures do, due to stronger collectivist traditions of filial piety. However, in modern, industrialized societies, the strain presented by dramatic rises in population aging potentially threatens traditional cultural expectations. Addressing these competing hypotheses, a literature search located 37 eligible papers, comprising samples from 23 countries and 21,093 total participants, directly comparing Easterners and Westerners (as classified per U.N. conventions) in their attitudes toward aging and the aged. Contradicting conventional wisdom, a random-effects meta-analysis on these articles found such evaluations to be more negative in the East overall (standardized mean difference = -0.31). High heterogeneity in study comparisons suggested the presence of moderators; indeed, geographical region emerged as a significant moderating factor, with the strongest levels of senior derogation emerging in East Asia (compared with South and Southeast Asia) and non-Anglophone Europe (compared with North American and Anglophone Western regions). At the country level, multiple-moderator meta-regression analysis confirmed recent rises in population aging to significantly predict negative elder attitudes, controlling for industrialization per se over the same time period. Unexpectedly, these analyses also found that cultural individualism significantly predicted relative positivity-suggesting that, for generating elder respect within rapidly aging societies, collectivist traditions may backfire. The findings suggest the importance of demographic challenges in shaping modern attitudes toward elders-presenting considerations for future research in ageism, cross-cultural psychology, and even economic development, as societies across the globe accommodate unprecedented numbers of older citizens.

  18. Prediction of endurance running performance for middle-aged and older runners.

    PubMed Central

    Takeshima, N; Tanaka, K

    1995-01-01

    The purpose of this study was to develop regression equations that would sufficiently predict the endurance running performance (ERP) of middle-aged and older runners (n = 55, 43-79 years). Among many independent variables which were selected as possible predictors of the ERP, oxygen uptake corresponding to the lactate threshold (VO2@LT), or age was found to be the single best predictor. Some variables representing training habits correlated significantly but only moderately with the ERP. Linear multiple regression equations developed in this study were: V5km = 4.203 + 0.054X1 - 0.028X2 (r = 0.87) V5km = 4.436 + 0.045X1 - 0.033X2 + 0.005X3 (r = 0.89) V10km = 4.252 + 0.042X1 - 0.026X2 (r = 0.79) V10km = 4.371 + 0.037X1 - 0.031X2 + 0.005X3 (r = 0.82) VM = 3.207 + 0.048X1 - 0.022X2 (r = 0.91) VM = 3.707 + 0.038X1 - 0.031X2 + 0.005X3 (r = 0.93) where V5km, V10km and VM are the mean running velocity at 5 km, 10 km and marathon races, respectively, and X1 = VO2@LT (ml kg-1 min-1), X2 = age (year), and X3 = average running duration per workout (min). We suggest that the ERP of middle-aged and older runners can be predicted from a linear combination of VO2@LT and age or a combination of these variables plus average running duration per workout. PMID:7788211

  19. HIV/AIDS prevention and care services and services for the aging: bridging the gap between service systems to assist older people.

    PubMed

    Linsk, Nathan L; Fowler, Jane P; Klein, Susan J

    2003-06-01

    The service systems for patients with or at risk for HIV infection/AIDS and for the aging must work together to address the needs of older adults who engage in HIV risk behaviors or who are HIV infected. Health and human service organizations miss opportunities for service integration in prevention, care, and supportive services. The authors illustrate critical issues and offer strategies to address these missed opportunities.

  20. Why is toilet training occurring at older ages? A study of factors associated with later training.

    PubMed

    Blum, Nathan J; Taubman, Bruce; Nemeth, Nicole

    2004-07-01

    Recent studies suggest that children are completing toilet training much later than the preceding generation. Our objective was to identify factors associated with later toilet training. Children between 17 and 19 months of age (n=406) were enrolled in the study. At enrollment, parents completed the Parenting Stress Index and the Receptive-Expressive Emergent Language Scale. Follow-up parent interviews were conducted every 2 to 3 months until children completed daytime toilet training. Information obtained at follow-up interviews included steps parents were taking to toilet train their child, child toilet training behaviors, presence and frequency of constipation, birth of a sibling, and child care arrangements. In a stepwise linear regression model predicting age at completion of toilet training, 3 factors were consistently associated with later training: initiation of toilet training at an older age, presence of stool toileting refusal, and presence of frequent constipation. Models including these variables explained 25% to 39% of the variance in age at completion of toilet training. In conclusion, a later age at initiation of toilet training, stool toileting refusal, and constipation may explain some of the trend toward completion of toilet training at later ages.

  1. Religion, spirituality, and older adults with HIV: critical personal and social resources for an aging epidemic

    PubMed Central

    Vance, David E; Brennan, Mark; Enah, Comfort; Smith, Glenda L; Kaur, Jaspreet

    2011-01-01

    By 2015, approximately half of adults with HIV in the United States will be 50 and older. The demographic changes in this population due to successful treatment represent a unique challenge, not only in assisting these individuals to cope with their illness, but also in helping them to age successfully with this disease. Religious involvement and spirituality have been observed to promote successful aging in the general population and help those with HIV cope with their disease, yet little is known about how these resources may affect aging with HIV. Also, inherent barriers such as HIV stigma and ageism may prevent people from benefitting from religious and spiritual sources of solace as they age with HIV. In this paper, we present a model of barriers to successful aging with HIV, along with a discussion of how spirituality and religiousness may help people overcome these barriers. From this synthesis, implications for practice and research to improve the quality of life of this aging population are provided. PMID:21753865

  2. Computer-aided bone age assessment for ethnically diverse older children using integrated fuzzy logic system

    NASA Astrophysics Data System (ADS)

    Ma, Kevin; Moin, Paymann; Zhang, Aifeng; Liu, Brent

    2010-03-01

    Bone Age Assessment (BAA) of children is a clinical procedure frequently performed in pediatric radiology to evaluate the stage of skeletal maturation based on the left hand x-ray radiograph. The current BAA standard in the US is using the Greulich & Pyle (G&P) Hand Atlas, which was developed fifty years ago and was only based on Caucasian population from the Midwest US. To bring the BAA procedure up-to-date with today's population, a Digital Hand Atlas (DHA) consisting of 1400 hand images of normal children of different ethnicities, age, and gender. Based on the DHA and to solve inter- and intra-observer reading discrepancies, an automatic computer-aided bone age assessment system has been developed and tested in clinical environments. The algorithm utilizes features extracted from three regions of interests: phalanges, carpal, and radius. The features are aggregated into a fuzzy logic system, which outputs the calculated bone age. The previous BAA system only uses features from phalanges and carpal, thus BAA result for children over age of 15 is less accurate. In this project, the new radius features are incorporated into the overall BAA system. The bone age results, calculated from the new fuzzy logic system, are compared against radiologists' readings based on G&P atlas, and exhibits an improvement in reading accuracy for older children.

  3. Adverse outcomes following hospitalization in acutely ill older patients

    PubMed Central

    Wong, Roger Y; Miller, William C

    2008-01-01

    Background The longitudinal outcomes of patients admitted to acute care for elders units (ACE) are mixed. We studied the associations between socio-demographic and functional measures with hospital length of stay (LOS), and which variables predicted adverse events (non-independent living, readmission, death) 3 and 6 months later. Methods Prospective cohort study of community-living, medical patients age 75 or over admitted to ACE at a teaching hospital. Results The population included 147 subjects, median LOS of 9 days (interquartile range 5–15 days). All returned home/community after hospitalization. Just prior to discharge, baseline timed up and go test (TUG, P < 0.001), bipedal stance balance (P = 0.001), and clinical frailty scale scores (P = 0.02) predicted LOS, with TUG as the only independent predictor (P < 0.001) in multiple regression analysis. By 3 months, 59.9% of subjects remained free of an adverse event, and by 6 months, 49.0% were event free. The 3 and 6-month mortality was 10.2% and 12.9% respectively. Almost one-third of subjects had developed an adverse event by 6 months, with the highest risk within the first 3 months post discharge. An abnormal TUG score was associated with increased adjusted hazard ratio [HR] 1.28, 95% confidence interval [CI] 1.03 to 1.59, P = 0.03. A higher FMMSE score (adjusted HR 0.89, 95% CI 0.82 to 0.96, P = 0.003) and independent living before hospitalization (adjusted HR 0.42, 95% CI 0.21 to 0.84, P = 0.01) were associated with reduced risk of adverse outcome. Conclusion Some ACE patients demonstrate further functional decline following hospitalization, resulting in loss of independence, repeat hospitalization, or death. Abnormal TUG is associated with prolonged LOS and future adverse outcomes. PMID:18479512

  4. Characteristics of problem gamblers 56 years of age or older: a statewide study of casino self-excluders.

    PubMed

    Nower, Lia; Blaszczynski, Alex

    2008-09-01

    Gambling among older adults appears to be increasing, though little is known about the characteristics of older adult problem gamblers. The purpose of this study was to compare older adults to younger and middle-aged adults in a cohort of problem gamblers participating in a state-administered casino self-exclusion program. Self-reported problem gamblers (N = 1,601) who voluntary banned themselves from Missouri casinos from 2001 to 2003 were categorized by age as younger adults (ages 21 to 35; n = 490), middle-aged adults (ages 36 to 55; n = 950), and older adults (ages 56 to 79; n = 161), and were compared with respect to demographic variables, gambling participation, and reasons for self-exclusion. Older adult self-excluders typically began gambling in midlife, experienced gambling problems around age 60, reported preferences for nonstrategic forms of gambling, and identified fear of suicide as the primary reason for self-excluding. Implications for intervention, prevention and treatment are discussed.

  5. Self-objectification, habitual body monitoring, and body dissatisfaction in older European American women: exploring age and feminism as moderators.

    PubMed

    Grippo, Karen P; Hill, Melanie S

    2008-06-01

    This study examined the influence of feminist attitudes on self-objectification, habitual body monitoring, and body dissatisfaction in middle age and older women. The participants were 138 European American heterosexual women ranging in age from 40 to 87 years old. Consistent with previous research, self-objectification and habitual body monitoring were positively correlated with body dissatisfaction and, self-objectification and habitual body monitoring remained stable across the lifespan. While age did not moderate the relationship between self-objectification and body dissatisfaction, age was found to moderate the relationship between habitual body monitoring and body dissatisfaction such that the relationship was smaller for older women than for middle-aged women. Interestingly, feminist attitudes were not significantly correlated with body dissatisfaction, self-objectification, or habitual body monitoring, and endorsement of feminist attitudes was not found to moderate the relationship between self-objectification or habitual body monitoring and body dissatisfaction. Potential implications for older women are discussed.

  6. Exercise improves cognitive function in aging patients

    PubMed Central

    Hu, Jian-Ping; Guo, Yan-Hua; Wang, Feng; Zhao, Xin-Ping; Zhang, Quan-Hai; Song, Qing-Hua

    2014-01-01

    A decline in cognitive ability commonly occurs among older individuals. This study sought to explore the restorative effects of exercise in older patients with existing cognitive disabilities. Ninety-six patients with mild cognitive impairment were placed in an exercise program for six months. Following completion of the program, participants were assessed via the Chinese Mini Mental Status Examination (MMSE), Activity of Daily Living (ADL) assessment, and body movement testing and compared to a control group of patients with mild cognitive impairment who did not participate in the exercise program (N = 102). Statistical analyses were performed using the Student’s t-test and chi-square test to compare results between groups. Compared with control group, patients who exercised showed improved cognitive function in immediate memory (p < 0.001) and delayed recall (p = 0.004) function. In addition, activities associated with daily living showed improvement (p < 0.001), as did body movement (p < 0.05), arm stability (p < 0.001), and the appearance of rotation (p < 0.05). Based on these results, we conclude that participation in an exercise program can improve patients’ cognitive function, physical abilities, and body movement capacity. PMID:25419345

  7. The PRO-AGE study: an international randomised controlled study of health risk appraisal for older persons based in general practice

    PubMed Central

    Stuck, Andreas E; Kharicha, Kalpa; Dapp, Ulrike; Anders, Jennifer; von Renteln-Kruse, Wolfgang; Meier-Baumgartner, Hans Peter; Iliffe, Steve; Harari, Danielle; Bachmann, Martin D; Egger, Matthias; Gillmann, Gerhard; Beck, John C; Swift, Cameron G

    2007-01-01

    Background This paper describes the study protocol, the recruitment, and base-line data for evaluating the success of randomisation of the PRO-AGE (PRevention in Older people – Assessment in GEneralists' practices) project. Methods/Design A group of general practitioners (GPs) in London (U.K.), Hamburg (Germany) and Solothurn (Switzerland) were trained in risk identification, health promotion, and prevention in older people. Their non-disabled older patients were invited to participate in a randomised controlled study. Participants allocated to the intervention group were offered the Health Risk Appraisal for Older Persons (HRA-O) instrument with a site-specific method for reinforcement (London: physician reminders in electronic medical record; Hamburg: one group session or two preventive home visits; Solothurn: six-monthly preventive home visits over a two-year period). Participants allocated to the control group received usual care. At each site, an additional group of GPs did not receive the training, and their eligible patients were invited to participate in a concurrent comparison group. Primary outcomes are self-reported health behaviour and preventative care use at one-year follow-up. In Solothurn, an additional follow-up was conducted at two years. The number of older persons agreeing to participate (% of eligible persons) in the randomised controlled study was 2503 (66.0%) in London, 2580 (53.6%) in Hamburg, and 2284 (67.5%) in Solothurn. Base-line findings confirm that randomisation of participants was successful, with comparable characteristics between intervention and control groups. The number of persons (% of eligible) enrolled in the concurrent comparison group was 636 (48.8%) in London, 746 (35.7%) in Hamburg, and 1171 (63.0%) in Solothurn. Discussion PRO-AGE is the first large-scale randomised controlled trial of health risk appraisal for older people in Europe. Its results will inform about the effects of implementing HRA-O with different

  8. Age-related differences in suicidality between young people and older adults with depression: data from a nationwide depression cohort study in Korea (the CRESCEND study).

    PubMed

    Seo, Ho-Jun; Song, Hoo Rim; Yim, Hyeon-Woo; Kim, Jung-Bum; Lee, Min-Soo; Kim, Jae-Min; Jun, Tae-Youn

    2015-01-01

    This study compared young people and older adults with depression to identify differences in suicidality between these groups. A total of 1003 patients with moderate to severe depression (Hamilton Depression Rating Scale [HDRS] score ≥14) were recruited from a national sample of 18 hospitals. Of the patients included in this study, 103 (10.3%) were placed in the younger group (age <25years) and 900 (89.7%) were placed in the older group (age ≥25years). Suicide-related variables and predictive factors associated with significant suicidal ideation were compared between the two groups. Regardless of the severity of depression, subjects in the younger group were more likely than were those in the older group to report significant suicidal ideation (scores ≥6 on the Beck Scale for Suicide Ideation [SSI-B], 79.6 vs. 53.7%, respectively; p<0.001), have had a suicide attempt at the current episode (4.9 vs. 1.6%, respectively; p=0.037), and have a history of suicide attempts (43.7 vs. 19.4%, respectively; p<0.001). Logistic regression models revealed that, in contrast to the predictive factors in the older group, subjects in the younger group were more affected by their history of suicide attempts (OR [95% CI]: 12.4, [1.5-99.1]; p=0.018) and depressive episodes (OR [95% CI]: 13.0, [1.6-104.0]; p=0.016). Also in contrast to the older group, an increase in HDRS score was not identified as a possible precipitating factor of significant suicidal ideation in younger subjects. The present findings demonstrate that suicidality in depressed young people was more severe than in older adults, but that suicidality was not correlated with the severity of depression. These data suggest that close attention should be paid to young people even in mild or moderate depression.

  9. Assessment of Solid Cancer Treatment Feasibility in Older Patients: A Prospective Cohort Study

    PubMed Central

    Laurent, Marie; Paillaud, Elena; Tournigand, Christophe; Caillet, Philippe; Le Thuaut, Aurélie; Lagrange, Jean-Léon; Beauchet, Olivier; Vincent, Hélène; Carvahlo-Verlinde, Muriel; Culine, Stéphane; Bastuji-Garin, Sylvie

    2014-01-01

    Purpose. To assess solid cancer treatment feasibility in older patients Methods. Between 2007 and 2010, 385 consecutive elderly patients (mean age: 78.9 ± 5.4 years; 47.8% males) with solid malignancies referred to two geriatric oncology clinics were included prospectively. We recorded feasibility of first-line chemotherapy (planned number of cycles in patients without metastases and three to six cycles depending on tumor site in patients with metastases), surgery (patient alive 30 days after successfully performed planned surgical procedure), radiotherapy (planned dose delivered), and hormonal therapy (planned drug dose given), and we recorded overall 1-year survival. Results. Main tumor sites were colorectal (28.6%), breast (23.1%), and prostate (10.9%), and 47% of patients had metastases. Planned cancer treatment was feasible in 65.7% of patients with metastases; this proportion was 59.0% for chemotherapy, 82.6% for surgery, 100% for radiotherapy, and 85.2% for hormonal therapy. In the group without metastases, feasibility proportions were 86.8% overall, 72.4% for chemotherapy, 95.7% for surgery, 96.4% for radiotherapy, and 97.9% for hormonal therapy. Factors independently associated with chemotherapy feasibility were good functional status defined as Eastern Cooperative Oncology Group performance status <2 (p < .0001) or activities of daily living >5 (p = .01), normal mobility defined as no difficulty walking (p = .01) or no fall risk (p = .007), and higher creatinine clearance (p = .04). Conclusion. Feasibility rates were considerably lower for chemotherapy than for surgery, radiotherapy, and hormonal therapy. Therefore, utilization of limited geriatric oncology resources may be optimized by preferential referral of elderly cancer patients initially considered for chemotherapy to geriatric oncology clinics. PMID:24569945

  10. Communicating with Assistive Listening Devices and Age-Related Hearing Loss: Perceptions of Older Australians.

    PubMed

    Aberdeen, Lucinda; Fereiro, David

    2014-01-31

    Abstract Age-related hearing loss can impact adversely on the delivery of primary care and cannot necessarily be remedied by hearing aid technology. A study of 20 older Australians living in a Queensland retirement village and residential hostel complex was undertaken to investigate how communication might be advanced through an assistive listening device (ALD). Most participants were women aged over 85 years; almost all had hearing loss and wore hearing aids. Tests with an ALD found very high levels of satisfaction with understanding speech and sound quality amongst participants. However, few had heard previously of ALDs, all required individualised assistance to fit and use the device and rated ease of use less highly. The findings affirm those of previous studies that ALD technology has a role in communication for older hearing-impaired people and for hearing rehabilitation. Its potential to enhance quality of life can be facilitated and promoted through nursing practice, but requires professional and consumer education so that it