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Sample records for at-risk older people

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

    PubMed

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

    2008-01-01

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

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

    PubMed

    Smith, Alison; Gray, Juliet

    2016-06-01

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

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

    PubMed

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

    2015-10-01

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

  4. Measuring Appetite with the Simplified Nutritional Appetite Questionnaire Identifies Hospitalised Older People at Risk of Worse Health Outcomes

    PubMed Central

    PILGRIM, A.L.; BAYLIS, D.; JAMESON, K.A.; COOPER, C.; SAYER, A.A.; ROBINSON, S.M.; ROBERTS, H.C.

    2016-01-01

    Objectives Poor appetite is commonly reported by older people but is rarely measured. The Simplified Nutritional Appetite Questionnaire (SNAQ) was validated to predict weight loss in community dwelling older adults but has been little used in hospitals. We evaluated it in older women on admission to hospital and examined associations with healthcare outcomes. Design Longitudinal observational with follow-up at six months. Setting Female acute Medicine for Older People wards at a University hospital in England. Participants 179 female inpatients. Measurements Age, weight, Body Mass Index (BMI), grip strength, SNAQ, Barthel Index Score, Mini Mental State Examination (MMSE), Geriatric Depression Scale: Short Form (GDS-SF), Malnutrition Universal Screening Tool (MUST), category of domicile and receipt of care were measured soon after admission and repeated at six month follow-up. The length of hospital stay (LOS), hospital acquired infection, readmissions and deaths by follow-up were recorded. Results 179 female participants mean age 87 (SD 4.7) years were recruited. 42% of participants had a low SNAQ score (<14, indicating poor appetite). A low SNAQ score was associated with an increased risk of hospital acquired infection (OR 3.53; 95% CI: 1.48, 8.41; p=0.004) and with risk of death (HR 2.29; 95% CI: 1.12, 4.68; p = 0.023) by follow-up. Conclusion Poor appetite was common among the older hospitalised women studied, and was associated with higher risk of poor healthcare outcomes. PMID:26728926

  5. Feasibility and effects of preventive home visits for at-risk older people: Design of a randomized controlled trial

    PubMed Central

    2009-01-01

    Background The search for preventive methods to mitigate functional decline and unwanted relocation by older adults living in the community is important. Preventive home visit (PHV) models use infrequent but regular visits to older adults by trained practitioners with the goal of maintaining function and quality of life. Evidence about PHV efficacy is mixed but generally supportive. Yet interventions have rarely combined a comprehensive (biopsychosocial) occupational therapy intervention protocol with a home visit to older adults. There is a particular need in the USA to create and examine such a protocol. Methods/Design The study is a single-blind randomized controlled pilot trial designed to assess the feasibility, and to obtain preliminary efficacy estimates, of an intervention consisting of preventive home visits to community-dwelling older adults. An occupational therapy-based preventive home visit (PHV) intervention was developed and is being implemented and evaluated using a repeated measures design. We recruited a sample of 110 from a population of older adults (75+) who were screened and found to be at-risk for functional decline. Participants are currently living in the community (not in assisted living or a skilled nursing facility) in one of three central North Carolina counties. After consent, participants were randomly assigned into experimental and comparison groups. The experimental group receives the intervention 4 times over a 12 month follow-up period while the comparison group receives a minimal intervention of mailed printed materials. Pre- and post-intervention measures are being gathered by questionnaires administered face-to-face by a treatment-blinded research associate. Key outcome measures include functional ability, participation, life satisfaction, self-rated health, and depression. Additional information is collected from participants in the experimental group during the intervention to assess the feasibility of the intervention and

  6. Effects of vertical and side-alternating vibration training on fall risk factors and bone turnover in older people at risk of falls.

    PubMed

    Corrie, Heather; Brooke-Wavell, Katherine; Mansfield, Neil J; Cowley, Alison; Morris, Robert; Masud, Tahir

    2015-01-01

    whole-body vibration training may improve neuromuscular function, falls risk and bone density, but previous studies have had conflicting findings. this study aimed to evaluate the influence of vertical vibration (VV) and side-alternating vibration (SV) on musculoskeletal health in older people at risk of falls. single-blind, randomised, controlled trial comparing vibration training to sham vibration (Sham) in addition to usual care. participants were 61 older people (37 women and 24 men), aged 80.2 + 6.5 years, referred to an outpatient falls prevention service. participants were randomly assigned to VV, SV or Sham in addition to the usual falls prevention programme. Participants were requested to attend three vibration sessions per week for 12 weeks, with sessions increasing to six, 1 min bouts of vibration. Falls risk factors and neuromuscular tests were assessed, and blood samples collected for determination of bone turnover, at baseline and following the intervention. chair stand time, timed-up-and-go time, fear of falling, NEADL index and postural sway with eyes open improved in the Sham group. There were significantly greater gains in leg power in the VV than in the Sham group and in bone formation in SV and VV compared with the Sham group. Conversely, body sway improved less in the VV than in the Sham group. Changes in falls risk factors did not differ between the groups. whole-body vibration increased leg power and bone formation, but it did not provide any additional benefits to balance or fall risk factors beyond a falls prevention programme in older people at risk of falls. © The Author 2014. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  7. The Identification of Seniors at Risk (ISAR) score to predict clinical outcomes and health service costs in older people discharged from UK acute medical units.

    PubMed

    Edmans, Judi; Bradshaw, Lucy; Gladman, John R F; Franklin, Matthew; Berdunov, Vladislav; Elliott, Rachel; Conroy, Simon P

    2013-11-01

    tools are required to identify high-risk older people in acute emergency settings so that appropriate services can be directed towards them. to evaluate whether the Identification of Seniors At Risk (ISAR) predicts the clinical outcomes and health and social services costs of older people discharged from acute medical units. an observational cohort study using receiver-operator curve analysis to compare baseline ISAR to an adverse clinical outcome at 90 days (where an adverse outcome was any of death, institutionalisation, hospital readmission, increased dependency in activities of daily living (decrease of 2 or more points on the Barthel ADL Index), reduced mental well-being (increase of 2 or more points on the 12-point General Health Questionnaire) or reduced quality of life (reduction in the EuroQol-5D) and high health and social services costs over 90 days estimated from routine electronic service records. two acute medical units in the East Midlands, UK. a total of 667 patients aged ≥70 discharged from acute medical units. an adverse outcome at 90 days was observed in 76% of participants. The ISAR was poor at predicting adverse outcomes (AUC: 0.60, 95% CI: 0.54-0.65) and fair for health and social care costs (AUC: 0.70, 95% CI: 0.59-0.81). adverse outcomes are common in older people discharged from acute medical units in the UK; the poor predictive ability of the ISAR in older people discharged from acute medical units makes it unsuitable as a sole tool in clinical decision-making.

  8. The Identification of Seniors at Risk (ISAR) score to predict clinical outcomes and health service costs in older people discharged from UK acute medical units

    PubMed Central

    Edmans, Judi; Bradshaw, Lucy; Gladman, John R. F.; Franklin, Matthew; Berdunov, Vladislav; Elliott, Rachel; Conroy, Simon P.

    2013-01-01

    Background: tools are required to identify high-risk older people in acute emergency settings so that appropriate services can be directed towards them. Objective: to evaluate whether the Identification of Seniors At Risk (ISAR) predicts the clinical outcomes and health and social services costs of older people discharged from acute medical units. Design: an observational cohort study using receiver–operator curve analysis to compare baseline ISAR to an adverse clinical outcome at 90 days (where an adverse outcome was any of death, institutionalisation, hospital readmission, increased dependency in activities of daily living (decrease of 2 or more points on the Barthel ADL Index), reduced mental well-being (increase of 2 or more points on the 12-point General Health Questionnaire) or reduced quality of life (reduction in the EuroQol-5D) and high health and social services costs over 90 days estimated from routine electronic service records. Setting: two acute medical units in the East Midlands, UK. Participants: a total of 667 patients aged ≥70 discharged from acute medical units. Results: an adverse outcome at 90 days was observed in 76% of participants. The ISAR was poor at predicting adverse outcomes (AUC: 0.60, 95% CI: 0.54–0.65) and fair for health and social care costs (AUC: 0.70, 95% CI: 0.59–0.81). Conclusions: adverse outcomes are common in older people discharged from acute medical units in the UK; the poor predictive ability of the ISAR in older people discharged from acute medical units makes it unsuitable as a sole tool in clinical decision-making. PMID:23666405

  9. Three 15-min bouts of moderate postmeal walking significantly improves 24-h glycemic control in older people at risk for impaired glucose tolerance

    USDA-ARS?s Scientific Manuscript database

    The purpose of this study was to compare the effectiveness of three 15-min bouts of postmeal walking with 45 min of sustained walking on 24-h glycemic control in older persons at risk for glucose intolerance. Inactive older (=60 years of age) participants (N = 10) were recruited from the community a...

  10. Three 15-min bouts of moderate postmeal walking significantly improves 24-h glycemic control in older people at risk for impaired glucose tolerance.

    PubMed

    DiPietro, Loretta; Gribok, Andrei; Stevens, Michelle S; Hamm, Larry F; Rumpler, William

    2013-10-01

    The purpose of this study was to compare the effectiveness of three 15-min bouts of postmeal walking with 45 min of sustained walking on 24-h glycemic control in older persons at risk for glucose intolerance. Inactive older (≥60 years of age) participants (N=10) were recruited from the community and were nonsmoking, with a BMI<35 kg/m2 and a fasting blood glucose concentration between 105 and 125 mg dL(-1). Participants completed three randomly ordered exercise protocols spaced 4 weeks apart. Each protocol comprised a 48-h stay in a whole-room calorimeter, with the first day serving as the control day. On the second day, participants engaged in either 1) postmeal walking for 15 min or 45 min of sustained walking performed at 2) 10:30 a.m. or 3) 4:30 p.m. All walking was on a treadmill at an absolute intensity of 3 METs. Interstitial glucose concentrations were determined over 48 h with a continuous glucose monitor. Substrate utilization was measured continuously by respiratory exchange (VCO2/VO2). Both sustained morning walking (127±23 vs. 118±14 mg dL(-1)) and postmeal walking (129±24 vs. 116±13 mg dL(-1)) significantly improved 24-h glycemic control relative to the control day (P<0.05). Moreover, postmeal walking was significantly (P<0.01) more effective than 45 min of sustained morning or afternoon walking in lowering 3-h postdinner glucose between the control and experimental day. Short, intermittent bouts of postmeal walking appear to be an effective way to control postprandial hyperglycemia in older people.

  11. Specifying the content of home-based health behaviour change interventions for older people with frailty or at risk of frailty: an exploratory systematic review

    PubMed Central

    Jovicic, Ana; Belk, Celia; Kharicha, Kalpa; Iliffe, Steve; Manthorpe, Jill; Goodman, Claire; Drennan, Vari M

    2017-01-01

    Objectives To identify trials of home-based health behaviour change interventions for frail older people, describe intervention content and explore its potential contribution to intervention effects. Design 15 bibliographic databases, and reference lists and citations of key papers, were searched for randomised controlled trials of home-based behavioural interventions reporting behavioural or health outcomes. Setting Participants' homes. Participants Community-dwelling adults aged ≥65 years with frailty or at risk of frailty. Primary and secondary outcome measures Trials were coded for effects on thematically clustered behavioural, health and well-being outcomes. Intervention content was described using 96 behaviour change techniques, and 9 functions (eg, education, environmental restructuring). Results 19 eligible trials reported 22 interventions. Physical functioning was most commonly assessed (19 interventions). Behavioural outcomes were assessed for only 4 interventions. Effectiveness on most outcomes was limited, with at most 50% of interventions showing potential positive effects on behaviour, and 42% on physical functioning. 3 techniques (instruction on how to perform behaviour, adding objects to environment, restructuring physical environment) and 2 functions (education and enablement) were more commonly found in interventions showing potential than those showing no potential to improve physical function. Intervention content was not linked to effectiveness on other outcomes. Conclusions Interventions appeared to have greatest impact on physical function where they included behavioural instructions, environmental modification and practical social support. Yet, mechanisms of effects are unclear, because impact on behavioural outcomes has rarely been considered. Moreover, the robustness of our findings is also unclear, because interventions have been poorly reported. Greater engagement with behavioural science is needed when developing and evaluating home

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

    PubMed Central

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

    2016-01-01

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

  13. Can an e-learning course improve nursing care for older people at risk of delirium: a stepped wedge cluster randomised trial

    PubMed Central

    2014-01-01

    Background Delirium occurs frequently in older hospitalised patients and is associated with several adverse outcomes. Ignorance among healthcare professionals and a failure to recognise patients suffering from delirium have been identified as the possible causes of poor care. The objective of the study was to determine whether e-learning can be an effective means of improving implementation of a quality improvement project in delirium care. This project aims primarily at improving the early recognition of older patients who are at risk of delirium. Methods In a stepped wedge cluster randomised trial an e-learning course on delirium was introduced, aimed at nursing staff. The trial was conducted on general medical and surgical wards from 18 Dutch hospitals. The primary outcome measure was the delirium risk screening conducted by nursing staff, measured through monthly patient record reviews. Patient records from patients aged 70 and over admitted onto wards participating in the study were used for data collection. Data was also collected on the level of delirium knowledge of these wards’ nursing staff. Results Records from 1,862 older patients were included during the control phase and from 1,411 patients during the intervention phase. The e-learning course on delirium had a significant positive effect on the risk screening of older patients by nursing staff (OR 1.8, p-value <0.01), as well as on other aspects of delirium care. The number of patients diagnosed with delirium was reduced from 11.2% in the control phase to 8.7% in the intervention phase (p = 0.04). The e-learning course also showed a significant positive effect on nurses’ knowledge of delirium. Conclusions Nurses who undertook a delirium e-learning course showed a greater adherence to the quality improvement project in delirium care. This improved the recognition of patients at risk and demonstrated that e-learning can be a valuable instrument for hospitals when implementing improvements in

  14. Can an e-learning course improve nursing care for older people at risk of delirium: a stepped wedge cluster randomised trial.

    PubMed

    van de Steeg, Lotte; IJkema, Roelie; Langelaan, Maaike; Wagner, Cordula

    2014-05-27

    Delirium occurs frequently in older hospitalised patients and is associated with several adverse outcomes. Ignorance among healthcare professionals and a failure to recognise patients suffering from delirium have been identified as the possible causes of poor care. The objective of the study was to determine whether e-learning can be an effective means of improving implementation of a quality improvement project in delirium care. This project aims primarily at improving the early recognition of older patients who are at risk of delirium. In a stepped wedge cluster randomised trial an e-learning course on delirium was introduced, aimed at nursing staff. The trial was conducted on general medical and surgical wards from 18 Dutch hospitals. The primary outcome measure was the delirium risk screening conducted by nursing staff, measured through monthly patient record reviews. Patient records from patients aged 70 and over admitted onto wards participating in the study were used for data collection. Data was also collected on the level of delirium knowledge of these wards' nursing staff. Records from 1,862 older patients were included during the control phase and from 1,411 patients during the intervention phase. The e-learning course on delirium had a significant positive effect on the risk screening of older patients by nursing staff (OR 1.8, p-value <0.01), as well as on other aspects of delirium care. The number of patients diagnosed with delirium was reduced from 11.2% in the control phase to 8.7% in the intervention phase (p = 0.04). The e-learning course also showed a significant positive effect on nurses' knowledge of delirium. Nurses who undertook a delirium e-learning course showed a greater adherence to the quality improvement project in delirium care. This improved the recognition of patients at risk and demonstrated that e-learning can be a valuable instrument for hospitals when implementing improvements in delirium care. The Netherlands National Trial

  15. Screening of older community-dwelling people at risk for death and hospitalization: the Assistenza Socio-Sanitaria in Italia project.

    PubMed

    Mazzaglia, Giampiero; Roti, Lorenzo; Corsini, Giacomo; Colombini, Angela; Maciocco, Gavino; Marchionni, Niccolò; Buiatti, Eva; Ferrucci, Luigi; Di Bari, Mauro

    2007-12-01

    To develop and validate mortality and hospitalization prognostic tools based upon information readily available to primary care physicians (PCPs). Population-based cohort study. Baseline predictors were patient demographics, a seven-item questionnaire on functional status and general health, use of five or more drugs, and previous hospitalization. Community-based study. Prognostic indexes were developed in 2,470 subjects and validated in 2,926 subjects, all community-dwelling, aged 65 and older, and randomly sampled from the rosters of 98 PCPs in Florence, Italy. Fifteen-month mortality and hospitalization. Two scores were derived from logistic regression models and used to stratify participants into four groups. With Model 1, based upon the seven-item questionnaire, mortality rate ranged from 0.8% in the lowest-risk group (0-1 point) to 9.4% in the highest risk group (> or = 3 points), and hospitalization rate ranged from 12.4% to 29.3%; area under the receiver operating characteristic curves (AUC) was 0.75 and 0.60, respectively. With Model 2, considering also drug use and previous hospitalization, mortality and hospitalization rates ranged from 0.3% to 8.2% and from 8.1% to 29.7%, for the lowest-risk to the highest-risk group; the AUC increased significantly only for hospitalization (0.67). Prediction of death and hospitalization in older community-dwelling people can be easily obtained with two indexes using information promptly available to PCPs. These tools might be useful for guiding clinical care and targeting interventions to reduce the need for hospital care in older persons.

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

    ERIC Educational Resources Information Center

    Wisniewski, Wendy; Cohen, Donna

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

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

    ERIC Educational Resources Information Center

    Wisniewski, Wendy; Cohen, Donna

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

  18. Could more than three million older people in England be at risk of alcohol-related harm? A cross-sectional analysis of proposed age-specific drinking limits.

    PubMed

    Knott, Craig S; Scholes, Shaun; Shelton, Nicola J

    2013-09-01

    to determine the impact of recently proposed age-specific alcohol consumption limits on the proportion and number of older people classified at risk of alcohol-related harm. nationally representative cross-sectional population data from the Health Survey for England (HSE). adults with valid alcohol consumption data, comprising 14,718 participants from 2003 and 14,939 from 2008. the prevalence of alcohol consumption in excess of existing and recently proposed consumption limits, plus associated population estimates. the number of individuals aged 65 or over and drinking in excess of daily recommended limits would have increased 2.5-fold to over 3 million in 2008 under age-specific recommendations proposed in a report from the Royal College of Psychiatrists, equating to an at-risk population 809,000 individuals greater than found within the 16-24 age group during the same year. Suggested revisions to existing binge drinking classifications would have defined almost 1,200,000 people aged 65 or over as hazardous consumers of alcohol in 2008-a 3.6-fold increase over existing definitions. age-specific drinking recommendations proposed in the Royal College of Psychiatrists Report would increase the number of older drinkers classified as hazardous alcohol consumers to a level greater than found among young adults aged 16-24.

  19. Suicide among older people.

    PubMed

    Manthorpe, Jill; Iliffe, Steve

    2006-01-01

    Overall, the number of people who kill themselves across all ages is falling but suicide rates among older people remain comparatively high. This article considers possible risk factors and suggests ways of reducing and containing potential harm. It also explores ways of responding when prevention of suicide fails.

  20. Adapting Interpersonal Psychotherapy for Older Adults at Risk for Suicide

    PubMed Central

    Heisel, Marnin J.; Talbot, Nancy L.; King, Deborah A.; Tu, Xin M.; Duberstein, Paul R.

    2014-01-01

    Objective To pilot a psychological intervention adapted for older adults at-risk for suicide. Design A focused, uncontrolled, pre-to-post-treatment psychotherapy trial. All eligible participants were offered the study intervention. Setting Outpatient mental healthcare provided in the psychiatry department of an academic medical center in a mid-sized Canadian city. Participants Seventeen English-speaking adults 60 years or older, at- risk for suicide by virtue of current suicide ideation, death ideation, and/or recent self-injury. Intervention A 16-session course of Interpersonal Psychotherapy (IPT) adapted for older adults at-risk for suicide who were receiving medication and/or other standard psychiatric treatment for underlying mood disorders. Measurements Participants completed a demographics form, screens for cognitive impairment and alcohol misuse, a semi-structured diagnostic interview, and measures of primary (suicide ideation and death ideation), and secondary study outcomes (depressive symptom severity; social adjustment and support; psychological well-being), and psychotherapy process measures. Results Participants experienced significant reductions in suicide ideation, death ideation, and depressive symptom severity, and significant improvement in perceived meaning in life, social adjustment, perceived social support, and other psychological well-being variables. Conclusions Study participants experienced enhanced psychological well-being and reduced symptoms of depression and suicide ideation over the course of IPT adapted for older adults at-risk for suicide. Larger, controlled trials are needed to further evaluate the impact of this novel intervention and to test methods for translating and integrating focused interventions into standard clinical care with at-risk older adults. PMID:24840611

  1. Learning Opportunities for Older People.

    ERIC Educational Resources Information Center

    MacKeracher, Dorothy

    1980-01-01

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

  2. Frailty in Older People

    PubMed Central

    2014-01-01

    Summary Frailty is the most problematic expression of population ageing. It is a state of vulnerability to poor resolution of homeostasis following a stress and is a consequence of cumulative decline in multiple physiological systems over a lifespan. This cumulative decline erodes homeostatic reserve until relatively minor stressor events trigger disproportionate changes in health status, typically a fall or delirium. Landmark studies have developed valid models for frailty and these have allowed epidemiological studies that demonstrate the association of frailty with adverse health outcomes. New research is needed to develop more efficient methods to detect and severity grade frailty as part of routine clinical practice, particularly methods with utility for primary care. This would greatly inform the appropriate selection of older people for invasive procedures or medications and would be the basis for a paradigm shift in the care of frail older people towards a more appropriate goal-directed care. PMID:23395245

  3. Screening older adults at risk of falling with the Tinetti balance scale.

    PubMed

    Raîche, M; Hébert, R; Prince, F; Corriveau, H

    2000-09-16

    In a prospective study of 225 community dwelling people 75 years and older, we tested the validity of the Tinetti balance scale to predict individuals who will fall at least once during the following year. A score of 36 or less identified 7 of 10 fallers with 70% sensitivity and 52% specificity. With this cut-off score, 53% of the individuals were screened positive and presented a two-fold risk of falling. These characteristics support the use of this test to screen older people at risk of falling in order to include them in a preventive intervention.

  4. Identifying older diabetic patients at risk of poor glycemic control

    PubMed Central

    Incalzi, Raffaele Antonelli; Corsonello, Andrea; Pedone, Claudio; Corica, Francesco; Carosella, Luciana; Mazzei, Bruno; Perticone, Francesco; Carbonin, PierUgo

    2002-01-01

    Background Optimal glycemic control prevents the onset of diabetes complications. Identifying diabetic patients at risk of poor glycemic control could help promoting dedicated interventions. The purpose of this study was to identify predictors of poor short-term and long-term glycemic control in older diabetic in-patients. Methods A total of 1354 older diabetic in-patients consecutively enrolled in a multicenter study formed the training population (retrospective arm); 264 patients consecutively admitted to a ward of general medicine formed the testing population (prospective arm). Glycated hemoglobin (HbA1c) was measured on admission and one year after the discharge in the testing population. Independent correlates of a discharge glycemia ≥ 140 mg/dl in the training population were assessed by logistic regression analysis and a clinical prediction rule was developed. The ability of the prediction rule and that of admission HbA1c to predict discharge glycemia ≥ 140 mg/dl and HbA1c > 7% one year after discharge was assessed in the testing population. Results Selected admission variables (diastolic arterial pressure < 80 mmHg, glycemia = 143–218 mg/dl, glycemia > 218 mg/dl, history of insulinic or combined hypoglycemic therapy, Charlson's index > 2) were combined to obtain a score predicting a discharge fasting glycemia ≥ 140 mg/dl in the training population. A modified score was obtained by adding 1 if admission HbA1c exceeded 7.8%. The modified score was the best predictor of both discharge glycemia ≥ 140 mg/dl (sensitivity = 79%, specificity = 63%) and 1 year HbA1c > 7% (sensitivity = 72%, specificity = 71%) in the testing population. Conclusion A simple clinical prediction rule might help identify older diabetic in-patients at risk of both short and long term poor glycemic control. PMID:12194701

  5. Improving Medication Management among At-risk Older Adults

    PubMed Central

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

    2013-01-01

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

  6. Preventing abuse of older people.

    PubMed

    Fraser, Aileen

    2010-10-01

    The author travelled to the United States on a Florence Nightingale Travel Scholarship to study the systems in place to respond to and prevent elder abuse. She visited centres in Orange County, California, and New York City that are involved in dealing with the issue. This article provides a summary of her findings, with emphasis on education and training strategies for healthcare professionals working with older people, and provides recommendations for developments in safeguarding older people in the UK. The author also reviews models of service, models of evaluation and approaches to older people who self-neglect.

  7. Intermediate care for older people.

    PubMed

    Logan, Pip; Stoner-Hobbs, Val; McCloughry, Helen; Foster, Carol; Fitzsimmons, Dwane; Williams, Jo; Spencer, Pamela; Robertson, Kate; Gladman, John

    2007-06-01

    Up to 40 per cent of older people do not go to hospital after calling an emergency ambulance and until recently were not referred on to any other community services. This article describes how a multidisciplinary working group developed and evaluated a protocol to enable older people to be referred to intermediate care services after calling an emergency ambulance. A total of 54 patients were monitored after referral to intermediate care to assess adherence to the protocol and outcomes.

  8. Improving the Gastrointestinal Tolerability of Aspirin in Older People

    PubMed Central

    Newton, Julia L

    2006-01-01

    Interventions to reduce mortality and disability in older people are vital. Aspirin is cheap and effective and known to prevent cardiovascular and cerebrovascular disease, many cancers, and Alzheimer dementia. The widespread use of aspirin in older people is limited by its gastrointestinal side effects. Understanding age-related changes in gastrointestinal physiology that could put older people at risk of the side effects of aspirin may direct strategies to improve tolerance and hence lead to greater numbers of older people being able to take this effective intervention. PMID:18047255

  9. Sarcopenia in older people.

    PubMed

    Yu, Solomon; Umapathysivam, Kandiah; Visvanathan, Renuka

    2014-12-01

    Sarcopenia is the age-related loss of muscle mass and strength. It has been receiving international attention because of its increased prevalence in western societies, such as Australia, which have large and growing older populations. Adverse health consequences of sarcopenia are falls and loss of independence, increased health costs and reduced quality of life. Recently, there have been international attempts to come to a consensus with regards to a definition of the condition, and, increasingly, clinicians are being encouraged to screen and assess for sarcopenia. Screening pathways are being investigated and some are discussed in this review. There is an emphasis on early screening, as it is believed that early detection will allow early intervention. As with most conditions in older age, there are many environmental and medical factors that can contribute to the development and worsening of sarcopenia, and it is important that, when possible, these contributing factors be addressed. Pharmaceutical treatment strategies are under development with some early promise and there is the possibility of clinical trials in the near future. Currently, nutritional supplementation and physical therapy are the strategies advocated for the management of sarcopenia once it is diagnosed.

  10. Association of Anterior Cingulate Glutathione with Sleep Apnea in Older Adults At-Risk for Dementia

    PubMed Central

    Duffy, Shantel L.; Lagopoulos, Jim; Terpening, Zoe; Lewis, Simon J.G.; Grunstein, Ron; Mowszowski, Loren; Cross, Nathan; Hermens, Daniel F.; Hickie, Ian B.; Naismith, Sharon L.

    2016-01-01

    Study Objectives: Sleep disordered breathing (SDB) is common in older adults and is strongly associated with cognitive decline, with increasing evidence suggesting that it may represent a risk factor for dementia. Given that SDB is characterized by intermittent episodes of hypoxemia during sleep, it is possible that cognitive impairment may relate to cerebral oxidative stress. This study aimed to examine the relationship between nocturnal markers of hypoxemia and proton magnetic resonance spectroscopy (1H-MRS) markers of oxidative stress within the anterior cingulate cortex (ACC) of the brain. Methods: Twenty-four older adults (mean age = 67.9 y) at-risk for dementia were recruited from our Healthy Brain Ageing Research Clinic. At-risk was defined as participants seeking help for assessment and/or intervention for cognitive decline, including those with subjective and/or objective cognitive complaints. This could occur in the context of prior depression or risk factors (e.g., vascular) for dementia. All participants underwent psychiatric, medical and neuropsychological assessment followed by overnight polysomnography. In addition, participants underwent 1H-MRS to derive levels of ACC metabolite glutathione (GSH) reported as a ratio to creatine (GSH/Cr). Results: Increased levels of GSH/Cr were associated with lower oxygen desaturation (r = −0.54, P = 0.007) and more severe apnea-hypopnea index scores during rapid eye movement sleep (r = 0.42, P = 0.050). In addition, ACC GSH/Cr correlated with poorer executive functioning (i.e., response inhibition: r = −0.49, P = 0.015; set shifting: r = −0.43, P = 0.037). Conclusions: Markers of nocturnal hypoxemia and SDB are associated with cerebral oxidative stress in older people at-risk for dementia, suggesting a potential mechanism by which SDB may contribute to brain degeneration, cognitive decline, and dementia. Further work focused on utilizing this biomarker for the early identification and treatment of this

  11. Homicide perpetrated by older people.

    PubMed

    Overshott, Ross; Rodway, Cathryn; Roscoe, Alison; Flynn, Sandra; Hunt, Isabelle M; Swinson, Nicola; Appleby, Louis; Shaw, Jenny

    2012-11-01

    This study aims to describe the circumstances in which older people commit homicide, the form of assessment they undergo and to examine the proportion of those who suffer from mental illness. The study was carried out as part of the England and Wales National Confidential Inquiry into Suicide and Homicide by People with Mental Illness based on a five-year sample. The Inquiry was notified of the names of those over the age of 60 years convicted of homicide and also the details of the offence, sentencing and outcome in court by the Home Office. The Inquiry collected clinical data of those known to have had contact with mental health services from the responsible service and also retrieved psychiatric reports of those convicted. Homicide incidents perpetrated by older people typically involve a man killing his partner in an impulsive manner. The most common method was by using a sharp instrument (34%), followed by the use of a blunt instrument (26%). The use of firearms was rare (11%). Perpetrators aged 65 years and older were significantly more likely to kill a current or former spouse/partner and less likely to kill an acquaintance. Forty-four per cent of perpetrators over 65 years old suffered from depression at the time of the offence, whereas rates of schizophrenia and alcohol dependence were low. The information used in the study was extracted from a unique national database of homicide perpetrators. The characteristics and the circumstances of homicides perpetrated by older people are different to other age groups. An older-people homicide may be preventable if depression is identified early in older people. Copyright © 2012 John Wiley & Sons, Ltd.

  12. Children's Views of Older People

    ERIC Educational Resources Information Center

    Robinson, Sally; Howatson-Jones, Lioba

    2014-01-01

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

  13. Theme: Pharmacology and Older People.

    ERIC Educational Resources Information Center

    Simonson, William; And Others

    1994-01-01

    This theme issue discusses maximizing the benefits and minimizing the risks of drug therapy for older people. It includes articles on psychoactive drugs, drug-related problems, medication compliance, geriatric psychopharmacotherapy, consumer guidelines, and outpatient prescriptions drug coverage as it relates to health care reform. (JOW)

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

    PubMed Central

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

    2012-01-01

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

  15. Promoting mobility in older people.

    PubMed

    Rantanen, Taina

    2013-01-01

    Out-of-home mobility is necessary for accessing commodities, making use of neighborhood facilities, and participation in meaningful social, cultural, and physical activities. Mobility also promotes healthy aging as it relates to the basic human need of physical movement. Mobility is typically assessed either with standardized performance-based tests or with self-reports of perceived difficulty in carrying out specific mobility tasks. Mobility declines with increasing age, and the most complex and demanding tasks are affected first. Sometimes people cope with declining functional capacity by making changes in their way or frequency of doing these tasks, thus avoiding facing manifest difficulties. From the physiological point of view, walking is an integrated result of the functioning of the musculoskeletal, cardio-respiratory, sensory and neural systems. Studies have shown that interventions aiming to increase muscle strength will also improve mobility. Physical activity counseling, an educational intervention aiming to increase physical activity, may also prevent mobility decline among older people. Sensory deficits, such as poor vision and hearing may increase the risk of mobility decline. Consequently, rehabilitation of sensory functions may prevent falls and decline in mobility. To promote mobility, it is not enough to target only individuals because environmental barriers to mobility may also accelerate mobility decline among older people. Communities need to promote the accessibility of physical environments while also trying to minimize negative or stereotypic attitudes toward the physical activity of older people.

  16. Interface Design and Engagement with Older People

    ERIC Educational Resources Information Center

    Hawthorn, D.

    2007-01-01

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

  17. Interface Design and Engagement with Older People

    ERIC Educational Resources Information Center

    Hawthorn, D.

    2007-01-01

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

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

    ERIC Educational Resources Information Center

    Powell, Anastasia

    2007-01-01

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

  19. Seniors at Risk: The Association between the Six-Month Use of Publicly Funded Home Support Services and Quality of Life and Use of Health Services for Older People

    ERIC Educational Resources Information Center

    Markle-Reid, M.; Browne, G.; Weir, R.; Gafni, A.; Roberts, J.; Henderson, S.

    2008-01-01

    This study examines the baseline characteristics and changes in health status and cost of use of health services associated with use of publicly funded home support services. The analysis includes 122 people 75 years of age or more who were eligible for home support services. Over a 6-month period, one third of the sample used home support…

  20. Problems of the Social Development of Young People at Risk

    ERIC Educational Resources Information Center

    Zubok, Iuliia Al'bertovna

    2005-01-01

    In this article, the researchers examine a number of methodological problems involved in the study of risk among young people as a social demographic group, and they analyze the tendencies of social-development of the younger generation of Russians under conditions of risk. The analysis is based on data from a national sociological monitoring…

  1. Antipsychotic prescribing in older people.

    PubMed

    Neil, Wendy; Curran, Stephen; Wattis, John

    2003-09-01

    older people. There is a need to redress this balance to ensure that the prescribing of antipsychotics in older people is evidence based.

  2. [Functional decline in older people].

    PubMed

    Wada, Taizo

    2013-10-01

    World Health Organization(WHO) proposed to be used as an index of the health of elderly independence of functioning. Basic activities of daily living (BADL), such as bathing, dressing, toileting, transferring, continence, and feeding are well known as the functioning of the elderly. However, not only BADL, there are a variety of levels, such as the ability to play a social role, intellectual activities and instrumental activities of daily living (IADL), which are components of the Tokyo Metropolitan Institute of Gerontology Index of Competence(TMIG-IC). Functional decline in older people is associated with age, gender, depression, up and go test and manual dexterity. Smoking, body-mass index, and exercise patterns in midlife and late adulthood are predictors of subsequent disability.

  3. Hand-grip strength cut points to screen older persons at risk for mobility limitation.

    PubMed

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

    2010-09-01

    To determine optimal hand-grip strength cut points for likelihood of mobility limitation in older people and to study whether these cut points differ according to body mass index (BMI). Cross-sectional analysis of data. Data collected in the Finnish population-based Health 2000 Survey. One thousand eighty-four men and 1,562 women aged 55 and older with complete data on anthropometry, hand-grip strength and self-reported mobility. Mobility limitation was defined as difficulty walking 0.5 km or climbing stairs. Receiver operating characteristic analysis was used to estimate hand-grip strength cut points for likelihood of mobility limitation. The overall hand-grip strength cut points for likelihood of mobility limitation were 37 kg (sensitivity 62%; specificity 76%) for men and 21 kg (sensitivity 67%; specificity 73%) for women. The effect of the interaction between hand-grip strength and BMI on mobility limitation was significant in men (P=.02), but no such interaction was observed in women (P=.16). In men, the most-optimal cutoff points were 33 kg (sensitivity 73%; specificity 79%) for normal-weight men, 39 kg (sensitivity 67%; specificity 71%) for overweight men, and 40 kg (sensitivity 57%; specificity 68%) for obese men. In women, BMI-specific hand-grip strength cutoff values was not markedly more accurate than the overall cutoff value. The hand-grip strength test is a useful tool to identify persons at risk of mobility limitation. In men, hand-grip strength cut points for mobility increased with BMI, whereas in women, only one hand-grip strength threshold was identified. © 2010, Copyright the Authors. Journal compilation © 2010, The American Geriatrics Society.

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

    ERIC Educational Resources Information Center

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

    2013-01-01

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

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

    ERIC Educational Resources Information Center

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

    2013-01-01

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

  6. Biological markers in older people at risk of mobility limitations.

    PubMed

    Lippi, Giuseppe; Sanchis-Gomar, Fabian; Montagnana, Martina

    2014-01-01

    Due to the progressive ageing of the worldwide population, prevention and treatment of late-life dysfunctions, including functional decline and mobility limitations, represent leading targets of scientists and clinicians, but are also receiving growing attention from governments and healthcare systems. The early identification of elderly patients more prone to physical decline represents a crucial step for establishing preventive measures. Although functional capacity can easily be assessed, the use of additional criteria that anticipate the onset of mobility limitations seems much more advantageous. The most challenging issues in the identification of biological markers for assessing the risk of functional decline in the elderly originates from the complex and multifaceted pathogenesis of sarcopenia and the resulting physiological decrement, so that bridging the gap between basic research and clinical practice may appear intricate. Nevertheless, several lines of evidence now confirm the existence of negative associations between functional mobility and values of hemoglobin, total and HDL-cholesterol, vitamin D, testosterone, adiponectin and antioxidants such carotenoids, vitamin C and E, selenium and magnesium, whereas positive associations have been reported with the values of uric acid, white blood cells, plasma and blood viscosity, erythrocyte sedimentation rate (ESR), triglycerides, homocysteine, plasma glucose, glycated hemoglobin (HbA1c), markers of renal functions (i.e., creatine and cystatin C), insulin-like growth factor-1 (IGF-1), as well as several inflammatory (e.g., C reactive protein, Intereleukin-6, Interleukin- 1 receptor antagonist), hemostatic (e.g., fibrinogen, Von Willebrand Factor, factors VIII and IX) and oxidative (oxidized lipoproteins, 8-oxo-7,8-2'-deoxyguanosine, protein carbonylation) biomarkers. In the foreseeable future, proteomic studies might predictably help identify novel associations between putative biomarkers and functional decline.

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

    ERIC Educational Resources Information Center

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

    2006-01-01

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

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

    ERIC Educational Resources Information Center

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

    2006-01-01

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

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

    MedlinePlus

    ... Research Information Clinical Trials Resources and Publications How many people are affected by or at risk for endometriosis? Skip sharing on social media links Share this: Page Content Because some women ...

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

    MedlinePlus

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

  11. Food intake and nutritional status of hospitalised older people.

    PubMed

    de Oliveira, Maria Rita Marques; Leandro-Merhi, Vânia Aparecida

    2011-09-01

    Disease is influenced by the nutritional status of the individual. We have assessed the relationship between nutritional status and food intake among recently hospitalised older people. A cross-sectional study was undertaken with 240 older people in a hospital that provides care for the public and private healthcare systems. Nutritional status was classified by the MNA (Mini Nutritional Assessment) into: malnourished, risk of malnutrition and without malnutrition. Food intake was estimated by the reported food intake during a typical day. The Kruskal-Wallis test was used to compare the medians and the correlation coefficient of Spearman to verify the relationship between the consumption of energy, protein and vitamin C and MNA scores. 33.8% were classified as adequate regarding nutritional status; 37.1% were classified as being at risk of malnutrition and 29.1% were classified as malnourished. The malnourished individuals reported significantly less energy and nutrient intake than those at risk of malnutrition or those without malnutrition (P = 0.001). Not all nutrient intake, just some (iron, cholesterol and fibre), were lower in malnourished people. Deterioration of the nutritional status of older people is accompanied by a reduction in energy and some nutrient intake. The investigation of food intake in older people could provide important information about nutritional risk. © 2010 Blackwell Publishing Ltd.

  12. Minimising barriers to dental care in older people

    PubMed Central

    Borreani, Elena; Wright, Desmond; Scambler, Sasha; Gallagher, Jennifer E

    2008-01-01

    Background Older people are increasingly retaining their natural teeth but at higher risk of oral disease with resultant impact on their quality of life. Socially deprived people are more at risk of oral disease and yet less likely to take up care. Health organisations in England and Wales are exploring new ways to commission and provide dental care services in general and for vulnerable groups in particular. This study was undertaken to investigate barriers to dental care perceived by older people in socially deprived inner city area where uptake of care was low and identify methods for minimising barriers in older people in support of oral health. Methods A qualitative dual-methodological approach, utilising both focus groups and individual interviews, was used in this research. Participants, older people and carers of older people, were recruited using purposive sampling through day centres and community groups in the inner city boroughs of Lambeth, Southwark and Lewisham in South London. A topic guide was utilised to guide qualitative data collection. Informants' views were recorded on tape and in field notes. The data were transcribed and analysed using Framework Methodology. Results Thirty-nine older people and/or their carers participated in focus groups. Active barriers to dental care in older people fell into five main categories: cost, fear, availability, accessibility and characteristics of the dentist. Lack of perception of a need for dental care was a common 'passive barrier' amongst denture wearers in particular. The cost of dental treatment, fear of care and perceived availability of dental services emerged to influence significantly dental attendance. Minimising barriers involves three levels of action to be taken: individual actions (such as persistence in finding available care following identification of need), system changes (including reducing costs, improving information, ensuring appropriate timing and location of care, and good patient

  13. Power resources of older people in Iran.

    PubMed

    Ravanipour, Maryam; Salehi, Shayesteh; Taleghani, Fariba; Abedi, Heidar Ali; Ishaghi, Sayed Reza; Schuurmans, Marieke J; de Jong, Anneke

    2013-03-01

    Maximising the client's power resources facilitates their ability to cope with chronic illness. Nurses must be well informed about power resources and feelings of empowerment among older people. This article reports on a study exploring power resources in daily life from the perspective of older people in Iran. A qualitative content analysis study was conducted. The participants were selected from older community dwellers in Iran using in-depth, semi-structured interviews to understand their experiences with power resources. Power in older people in Iran is represented by four dimensions: spiritual, intellectual, social and physical. Each power dimension can be divided into intrinsic and extrinsic modes. By maximising older people's power in intellectual, social and especially in spiritual resources, the effect of the loss of physical power, with its deteriorative or depressogenic effect on older people's sense of power and well-being can be compensated for. It is recommended that nurses should plan their interventions to enhance older people's power, especially their spiritual power. Different models of empowering older people should be explored in Iranian nursing care delivery. © 2012 Blackwell Publishing Ltd.

  14. Can routine clinical data identify older patients at risk of poor healthcare outcomes on admission to hospital?

    PubMed

    Ibrahim, Kinda; Owen, Charlotte; Patel, Harnish P; May, Carl; Baxter, Mark; Sayer, Avan A; Roberts, Helen C

    2017-08-10

    Older patients who are at risk of poor healthcare outcomes should be recognised early during hospital admission to allow appropriate interventions. It is unclear whether routinely collected data can identify high-risk patients. The aim of this study was to define current practice with regard to the identification of older patients at high risk of poor healthcare outcomes on admission to hospital. Interviews/focus groups were conducted to establish the views of 22 healthcare staff across five acute medicine for older people wards in one hospital including seven nurses, four dieticians, seven doctors, and four therapists. In addition, a random sample of 60 patients' clinical records were reviewed to characterise the older patients, identify risk assessments performed routinely on admission, and describe usual care. We found that staff relied on their clinical judgment to identify high risk patients which was influenced by a number of factors such as reasons for admission, staff familiarity with patients, patients' general condition, visible frailty, and patients' ability to manage at home. "Therapy assessment" and patients' engagement with therapy were also reported to be important in recognising high-risk patients. However, staff recognised that making clinical judgments was often difficult and that it might occur several days after admission potentially delaying specific interventions. Routine risk assessments carried out on admission to identify single healthcare needs included risk of malnutrition (completed for 85% patients), falls risk (95%), moving and handling assessments (85%), and pressure ulcer risk assessments (88%). These were not used collectively to highlight patients at risk of poor healthcare outcomes. Thus, patients at risk of poor healthcare outcomes were not explicitly identified on admission using routinely collected data. There is a need for an early identification of these patients using a valid measure alongside staff clinical judgment to

  15. "Sent Out" and "Stepping Back In": Stories from Young People "Placed at Risk"

    ERIC Educational Resources Information Center

    Robinson, Janean; Smyth, John

    2016-01-01

    This paper invokes the voices of young people who had been separated from mainstream schooling because they were positioned as "disengaged" and "at risk of failing". The authors argue that streaming students out of schooling needs serious questioning as an escalating number of young people are framed as non-performers within a…

  16. "Sent Out" and "Stepping Back In": Stories from Young People "Placed at Risk"

    ERIC Educational Resources Information Center

    Robinson, Janean; Smyth, John

    2016-01-01

    This paper invokes the voices of young people who had been separated from mainstream schooling because they were positioned as "disengaged" and "at risk of failing". The authors argue that streaming students out of schooling needs serious questioning as an escalating number of young people are framed as non-performers within a…

  17. Brief report: young people at risk for eating disorders in Southeast Brazil.

    PubMed

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

    2006-04-01

    A representative sample of 7-14-year-old young people in southeast Brazil (N=1251) was assessed using standardized parent and youth interviews, thereby identifying an 'at-risk' group of young people who met one or more DSM-IV criteria for anorexia and/or bulimia nervosa. These young people were compared with an age and gender matched comparison group for body mass index (BMI) and socio-economic status (SES). The prevalence of young people at risk for eating disorders was 1.4% (higher in females and rising with age). 'At-risk' individuals did not differ from controls in BMI but were of higher SES. In Brazil, the link between symptoms of eating disorders and higher SES is not just a referral artefact but is evident in a representative community sample. This might reflect a stronger preference for thinness among more westernized social groups.

  18. Group Music Therapy as a Preventive Intervention for Young People at Risk: Cluster-Randomized Trial.

    PubMed

    Gold, Christian; Saarikallio, Suvi; Crooke, Alexander Hew Dale; McFerran, Katrina Skewes

    2017-07-01

    Music forms an important part of the lives and identities of adolescents and may have positive or negative mental health implications. Music therapy can be effective for mental disorders such as depression, but its preventive potential is unknown. The aim of this study was to examine whether group music therapy (GMT) is an effective intervention for young people who may be at risk of developing mental health problems, as indicated via unhealthy music use. The main question was whether GMT can reduce unhealthy uses of music and increase potentials for healthy uses of music, compared to self-directed music listening (SDML). We were also interested in effects of GMT on depressive symptoms, psychosocial well-being, rumination, and reflection. In an exploratory cluster-randomized trial in Australian schools, 100 students with self-reported unhealthy music use were invited to GMT (weekly sessions over 8 weeks) or SDML. Changes in the Healthy-Unhealthy Music Scale (HUMS) and mental health outcomes were measured over 3 months. Both interventions were well accepted. No effects were found between GMT and SDML (all p > 0.05); both groups tended to show small improvements over time. Younger participants benefited more from GMT, and older ones more from SDML (p = 0.018). GMT was associated with similar changes as SDML. Further research is needed to improve the processes of selecting participants for targeted interventions; to determine optimal dosage; and to provide more reliable evidence of effects of music-based interventions for adolescents.

  19. Exploring attitudes towards older people's sexuality.

    PubMed

    Price, B

    2009-07-01

    Sexuality is an important part of life, for older people as well as for others. Sexual attitudes, beliefs and lifestyles may be as diverse among older people as they are among younger age groups. But for nurses to plan care with patients in ways that take issues of sexuality into account, they need to feel more comfortable talking about sexuality with older people. This article uses case studies to help readers explore their own attitudes and those of colleagues towards sexuality in later years, and prompts discussions on what this might signify for future nursing care so that staff are better equipped to assist patients with this subject.

  20. Technologies in older people's care.

    PubMed

    Andersson Marchesoni, Maria; Axelsson, Karin; Fältholm, Ylva; Lindberg, Inger

    2017-03-01

    The tension between care-based and technology-based rationalities motivates studies concerning how technology can be used in the care sector to support the relational foundation of care. This study interprets values related to care and technologies connected to the practice of good care. This research study was part of a development project aimed at developing innovative work practices through information and communication technology. Participants and research context: All staff (n = 18) working at two wards in a care facility for older people were asked to participate in interviews, and 12 accepted. We analysed the data using latent content analysis in combination with normative analysis. Ethical considerations: The caregivers were informed that participation was voluntary and that they could drop out at any time without providing any explanation. Four values were identified: 'presence', 'appreciation', 'competence' and 'trust'. Caregivers wanted to focus on care receivers as unique persons, a view that they thought was compromised by time-consuming and beeping electronic devices. Appraising from next-of-kin and been seen as someone who can contribute together with knowledge to handle different situations were other desires. The caregivers also desired positive feedback from next-of-kin, as they wanted to be seen as professionals who have the knowledge and skills to handle difficult situations. In addition, the caregivers wanted their employer to trust them, and they wanted to work in a calm environment. Caregivers' desire for disturbance-free interactions, being valued for their skills and working in a trustful working environment were interpreted as their base for providing good care. The caregivers' arguments are based on caring rationality, and sometimes they felt the technological rationality interfered with their main mission, providing quality care. Introducing new technology in caring should support the caring relationship. Although society's overall

  1. Older people, personal hygiene, and skin care.

    PubMed

    Cowdell, Fiona

    2011-01-01

    Skin health is essential for well being in older people. Personal hygiene is fundamental to skin health, but a lack of evidence exists about effective practices. An evidence base, disseminated through nursing education and patient health promotion, must be developed.

  2. Older people and skin: challenging perceptions.

    PubMed

    Cowdell, Fiona; Garrett, Dawne

    In this article we set out to challenge perceptions about older people and skin. We examine current portrayals of older people and skin, both in the media and in the nursing literature. We describe the ‘normal’ process of skin ageing and highlight the importance of maintaining skin integrity and effective barrier function for health and wellbeing, particularly in older people. One element of maintaining skin integrity is ensuring that personal hygiene and emollient needs are met. Effective skin hygiene and emollient care will reduce the risk of breakdown, with all its burdensome and costly consequences. We therefore offer a summary of the current evidence base for skin-hygiene practice. We make a case for nurses considering skin health from a wider societal and human perspective, and identify opportunities to enhance nursing practice through skin-care advice and health education for all older people.

  3. Nutritional guidelines for older people in Finland.

    PubMed

    Suominen, M H; Jyvakorpi, S K; Pitkala, K H; Finne-Soveri, H; Hakala, P; Mannisto, S; Soini, H; Sarlio-Lahteenkorva, S

    2014-12-01

    Ageing is associated with an increased risk of malnutrition, decreased nutrient intake, unintentional weight loss and sarcopenia, which lead to frailty, functional disabilities and increased mortality. Nutrition combined with exercise is important in supporting older people's health, functional capacity and quality of life. To identify nutritional needs in various groups of older individuals and to present the nutritional guidelines for older people in Finland. A review of the existing literature on older people's nutritional needs and problems. The draft guidelines were written by a multidisciplinary expert panel; they were then revised, based on comments by expert organisations. The guidelines were approved by the National Nutritional Council in Finland. The heterogeneity of the older population is highlighted. The five key guidelines are: 1. The nutritional needs in different age and disability groups should be considered. 2. The nutritional status and food intake of older individuals should be assessed regularly. 3. An adequate intake of energy, protein, fiber, other nutrients and fluids should be guaranteed. 4. The use of a vitamin D supplement (20 μg per day) recommended. 5. The importance of physical activity is highlighted. In addition, weight changes, oral health, constipation, obesity, implementing nutritional care are highlighted. Owing to the impact that good nutrition has on health and well-being in later life, nutrition among older people should be given more attention. These nutritional guidelines are intended to improve the nutrition and nutritional care of the older population.

  4. Crash characteristics of older pedestrian fatalities: dementia pathology may be related to 'at risk' traffic situations.

    PubMed

    Gorrie, Catherine A; Brown, Julie; Waite, Phil M E

    2008-05-01

    Older people are over represented among pedestrian casualties, and cognitive decline is an often cited possible contributory factor. Cognitive decline and dementia are intimately associated, however the role dementia might play in older pedestrian crashes has received little attention. This study describes crash characteristics for 52 fatally injured older pedestrians in the Sydney metropolitan area. It investigates the relationship between the extent of neurofibrillary tangles (NFT), a hallmark of Alzheimer's disease in the brain, and particular crash situations. The results demonstrate crash characteristics that are similar to that reported in other studies of older pedestrians. Furthermore, the results suggest that cognitive decline associated with dementia related neuropathology may be associated with specific crash situations. Compared to older pedestrians with no, or low NFT, those with moderate to high NFT were more likely to be: at least partially responsible for the incident; injured while in low complexity situations; involved in impacts with reversing vehicles; impacted in near lanes of traffic; and struck by a vehicle off road. While described as trends only (p<0.2), these findings highlight areas of concern for older pedestrians and suggest potential targets for engineering and behaviour-based countermeasures aimed at reducing casualty numbers among older pedestrians.

  5. Drug Misuse in Older People.

    ERIC Educational Resources Information Center

    Raffoul, Paul R.; And Others

    1981-01-01

    Drug misuse of prescription and OTC drugs was studied among 67 older subjects to determine the frequency of misuse and relationship to various psychosocial, medical and pharmacological factors. Drug misuse was found among 43 percent of subjects with number of prescribing physicians and number of pharmacies directly related to misuse. (Author)

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

    PubMed

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

    2016-04-01

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

  7. Internalized stigma, emotional dysfunction and unusual experiences in young people at risk of psychosis.

    PubMed

    Pyle, Melissa; Stewart, Suzanne L K; French, Paul; Byrne, Rory; Patterson, Paul; Gumley, Andrew; Birchwood, Max; Morrison, Anthony P

    2015-04-01

    To investigate the relationship between internalized stigma, depression, social anxiety and unusual experiences in young people considered to be at risk of developing psychosis. A total of 288 participants meeting criteria for an at-risk mental state were recruited as part of a multisite randomized controlled trial of cognitive behavioural therapy for people meeting criteria for an at risk mental state (ARMS). The sample was assessed at baseline and 6 months using measures of at risk mental states, internalized stigma, depression and social anxiety. The Personal Beliefs about Experiences Questionnaire was validated for use with an ARMS sample. Correlational analyses at baseline indicated significant relationships between internalized stigma and: (i) depression; (ii) social anxiety; (iii) distress associated with unusual psychological experiences; and (iv) suicidal thinking. Regression analysis indicates negative appraisals of unusual experiences contributed significantly to depression scores at 6-month follow up when controlling for baseline depression and unusual psychological experiences. These findings suggest that internalized stigma may contribute to the development and maintenance of depression in young people at risk of psychosis. © 2013 Wiley Publishing Asia Pty Ltd.

  8. Access to mobile communications by older people.

    PubMed

    Nguyen, Toan; Irizarry, Carol; Garrett, Rob; Downing, Andrew

    2015-06-01

    To investigate how older people effectively identify, select and learn to use mobile communications technologies to enhance communication and safety, and support independent living. One hundred and fifty-three older South Australians participated in a purpose-designed survey questionnaire. Older people relied on family and friends for information and advice (76%), and their children's assistance with buying (45%) and learning to use (48%) new technology. The most preferred learning method was face-to-face training (56%). Less than half (44%) were interested in trying out new designs/applications, functions and capabilities that could assist with independent living. The highest need was for personal security and emergencies (88%). Findings suggest that the family and friends of older people play an important role in identifying, selecting and learning to use mobile communication technologies. The safety and emergency capabilities of mobile communications technologies were more important than having functions that could assist with independent living. © 2014 ACOTA.

  9. Measurement of resilience in Chinese older people.

    PubMed

    Yang, F; Bao, J-M; Huang, X-H; Guo, Q; Smith, G D

    2015-03-01

    Resilience has been identified as a personal construct that may contribute to the process of healthy ageing in older people. To date, no measurement instrument has been tested to evaluate resilience in Chinese older people. To examine the psychometric testing and clinical application of the Chinese version of the Resilience Scale (RS) in Chinese older people. A descriptive cross-sectional study design was used. Forward and backward translation procedures were used to obtain semantic equivalence of the original English version of the RS. Content validity was examined by identified experts, followed by exploratory factor analysis, item-to-total correlation, Cronbach's α coefficients and test-retest reliability. The 25-item Chinese version of Resilience Scale (RS-CN) was fully completed by 461 Chinese older people. Cronbach's α for the total Chinese version of the Revised Resilience Scale was 0.95, with a range of 0.85-0.89 for the sub-scales. Item-to-total correlation coefficients ranged from 0.51 to 0.75 and items were excluded with item-to-total correlations coefficients lower than 0.4. The test-retest reliability of the total scale was 0.80, sub-scale test-retest reliability ranged from 0.61 to 0.620. The exploratory principal component analysis with varimax rotation revealed RS-CN to have a four-factor structure. The RS-CN is a valid and reliable instrument for the measurement of the concept of resilience in Chinese older people. The results of this study provide cross-cultural evidence for the potential application of this scale in Chinese older people. Greater insight into the psychological constructs of resilience in Chinese older people can lead to international comparisons and to the potential development of interventions for this population around the world. © 2015 International Council of Nurses.

  10. Exercise among urban-dwelling older adults at risk for health disparities.

    PubMed

    Sullivan-Marx, Eileen M; Cuesta, Cindy Lou; Ratcliffe, Sarah J

    2008-01-01

    This study assessed factors that contribute to exercise in older adults at risk for health disparities living in a predominantly African American urban community. A local health database was used to gain an understanding of these factors, which then could be used to develop programs to improve health within a specific urban community. The sample included 112 participants (mean age = 81); the majority were women and African American. Participants were more likely to exercise if not insured by Medicaid, compared with those who did receive Medicaid. Adults with two or more limitations in instrumental activities of daily living (IADLs) were less likely to exercise. Among those who exercised, those with two or more limitations in IADLs were more likely to exercise less than adults with no such limitations, and adults with high blood pressure were more likely to exercise less than those without high blood pressure. The findings of this study will help generate discussion in both the community and outreach programs to invigorate exercise among older adults at risk for health disparities. Copyright 2008, SLACK Incorporated.

  11. Older peoples' perspectives on time spent alone.

    PubMed

    Stanley, Mandy; Richard, Ashley; Williams, Shoshannah

    2017-06-01

    Large amounts of time spent alone by older people have been associated with loneliness and poor mental and physical health. There is a paucity of research, however, that examines time alone from an occupational perspective. In this exploratory study we explored the perspectives of older people on their time spent alone. A qualitative descriptive study design was selected. With the aim of maximising variation, five participants were recruited from retirement villages and seven participants who lived independently in the community. Participants recorded time spent alone in a time diary for three days as priming for a semi-structured in-depth interview. Transcripts were analysed thematically. Three key themes were identified: 'it is a matter of getting some balance'; 'keeping busy'; and 'the nights are the worst'. The study highlights the importance older people place on the need to manage time alone so that it is a positive and nourishing experience and to avoid experiencing extended periods of boredom potentially leading to loneliness. Older people utilise occupations to keep busy and achieve an individually acceptable level of time alone. Enabling older people to balance time spent alone by addressing barriers to participation in the community in addition to finding engaging occupations to occupy time has the potential to prevent boredom, loneliness and improve wellbeing. © 2016 Occupational Therapy Australia.

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

    PubMed

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

    2015-08-01

    A significant relationship exists between experiencing psychosis and both engaging in criminal offending and being a victim of crime. A substantial proportion of violence and offending occurs during the first episode of psychosis, but it is unclear whether such behaviour is also evident in the earlier pre-psychotic stage of illness. As part of a prospective study of young people who were seeking help for mental health problems, we enquired about participants' experiences of being charged and/or convicted of a criminal offence and being a victim of crime. This paper uses cross-sectional baseline data to compare the rates of these forensic outcomes in participants at-risk of psychosis (n=271) with those not at-risk (n=440). Univariate logistic regression showed that the at-risk for psychosis group was significantly more likely than the not at-risk participants to report having been charged by police (11.1% vs 5.9%; p=.015) and convicted by the courts (4.4% vs. 1.6%; p=0.028) with a non-violent offence, as well as to have been convicted of any criminal offence (6.3% vs. 3.0%; p=0.037). The at-risk were also more likely to report having been a victim of crime (23.7% vs 14.0%; p=.002), particularly violent victimization (16.5% vs 8.2%; p=.001). In multivariate logistic regression analyses, being at-risk for psychosis remained a significant predictor of three of the four outcome measures after controlling for other known covariates such as gender, age, substance misuse and unemployment. This is the first study to demonstrate that, relative to their non-psychotic help-seeking counterparts, young people at-risk for psychosis are at higher risk of forensic outcomes, particularly violent crime victimization. Copyright © 2015 Elsevier B.V. All rights reserved.

  13. Electronic Health Record Tools to Care for At-Risk Older Drivers: A Quality Improvement Project.

    PubMed

    Casey, Colleen M; Salinas, Katherine; Eckstrom, Elizabeth

    2015-06-01

    Evaluating driving safety of older adults is an important health topic, but primary care providers (PCP) face multiple barriers in addressing this issue. The study's objectives were to develop an electronic health record (EHR)-based Driving Clinical Support Tool, train PCPs to perform driving assessments utilizing the tool, and systematize documentation of assessment and management of driving safety issues via the tool. The intervention included development of an evidence-based Driving Clinical Support Tool within the EHR, followed by training of internal medicine providers in the tool's content and use. Pre- and postintervention provider surveys and chart review of driving-related patient visits were conducted. Surveys included self-report of preparedness and knowledge to evaluate at-risk older drivers and were analyzed using paired t-test. A chart review of driving-related office visits compared documentation pre- and postintervention including: completeness of appropriate focused history and exam, identification of deficits, patient education, and reporting to appropriate authorities when indicated. Data from 86 providers were analyzed. Pre- and postintervention surveys showed significantly increased self-assessed preparedness (p < .001) and increased driving-related knowledge (p < .001). Postintervention charts showed improved documentation of correct cognitive testing, more referrals/consults, increased patient education about community resources, and appropriate regulatory reporting when deficits were identified. Focused training and an EHR-based clinical support tool improved provider self-reported preparedness and knowledge of how to evaluate at-risk older drivers. The tool improved documentation of driving-related issues and led to improved access to interdisciplinary care coordination. Published by Oxford University Press on behalf of the Gerontological Society of America 2015.

  14. The Right to Health of Older People.

    PubMed

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

    2016-04-01

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

  15. Pressure ulcer prevention in frail older people.

    PubMed

    Barry, Maree; Nugent, Linda

    2015-12-16

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

  16. Caring for Older People. Public transport.

    PubMed Central

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

    1996-01-01

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

  17. Detecting dehydration in older people: useful tests.

    PubMed

    Hooper, Lee; Bunn, Diane

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

  18. Thyroid disease in older people.

    PubMed

    Mitrou, Panayota; Raptis, Sotirios A; Dimitriadis, George

    2011-09-01

    Several changes in thyroid hormone secretion, metabolism, and action occur with the increase in age. Aging is often associated with a decrease in serum thyroid stimulating hormone and T3 levels, whereas serum free T4 levels usually remain unchanged. The prevalence of thyroid dysfunction is higher in the elderly as compared to the younger population. In elderly individuals the non-specific clinical manifestations of thyroid hormone excess or deprivation can cause confusion in the clinical setup; while some of the symptoms of thyroid disease are similar to those in younger patients, it is not uncommon for both hyperthyroidism and hypothyroidism to be manifested in subtle ways in older patients, often mimicking symptoms of aging or masquerading as diseases of the cardiovascular, gastrointestinal, or nervous system. In addition, diagnosis of thyroid disorders is commonly complicated, due to chronic, non-thyroidal illness or medication therapy. Early diagnosis and treatment of overt thyroid disorders is crucial, since these disorders are associated with increased morbidity and mortality in the elderly, usually due to common coexistent diseases such as diminished cardiovascular reserve. Treatment of subclinical thyroid disease should also be considered, based on a combination of age, symptoms and risk factors in the individual patients. In addition, both prevalence and aggressiveness of thyroid cancer increase with age. This review summarizes the changes of thyroid function, as well as the clinical manifestations and treatment of thyroid disorders with advancing age. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  19. MYPLAN - A Mobile Phone Application for Supporting People at Risk of Suicide.

    PubMed

    Skovgaard Larsen, Jette L; Frandsen, Hanne; Erlangsen, Annette

    2016-05-01

    Safety plans have been suggested as an intervention for people at risk of suicide. Given the impulsive character of suicidal ideation, a safety plan in the format of a mobile phone application is likely to be more available and useful than traditional paper versions. The study describes MYPLAN, a mobile phone application designed to support people at risk of suicide by letting them create a safety plan. MYPLAN was developed in collaboration with clinical psychiatric staff at Danish suicide preventive clinics. The mobile application lets the user create an individualized safety plan by filling in templates with strategies, actions, and direct links to contact persons. MYPLAN was developed in 2013 and is freely available in Denmark and Norway. It is designed for iPhone and android platforms. As of December 2015, the application has been downloaded almost 8,000 times. Users at risk of suicide as well as clinical staff have provided positive feedback on the mobile application. Support via mobile phone applications might be particularly useful for younger age groups at risk of suicide as well as in areas or countries where support options are lacking. Yet, it is important to examine the effectiveness of this type of intervention.

  20. Attitudes towards help-seeking and stigma among young people at risk for psychosis.

    PubMed

    Rüsch, Nicolas; Heekeren, Karsten; Theodoridou, Anastasia; Dvorsky, Diane; Müller, Mario; Paust, Tobias; Corrigan, Patrick W; Walitza, Susanne; Rössler, Wulf

    2013-12-30

    The role of self-labeling as 'mentally ill' and of stigma-related stress for help-seeking among young people at risk for psychosis is unknown. Stronger self-labeling and less stigma stress predicted better attitudes towards psychiatric medication and psychotherapy, controlling for clinical and sociodemographic variables. Interventions could target stigma-related stress to increase help-seeking. © 2013 Elsevier Ireland Ltd. All rights reserved.

  1. Older People as Consumers of Education.

    ERIC Educational Resources Information Center

    Knox, Alan

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

  2. Older people's experiences of dream coaching.

    PubMed

    Wadensten, Barbro

    2009-12-01

    Recalling and talking about dreams could initiate dream work among older people and provide an opportunity for self-confrontation and personal growth, which could in turn promote gerotranscendental development. The present article describes older people's opinions about participating in a dream-coaching group; it also briefly describes the theoretical foundation of dream coaching. The study aim was to investigate older people's experience of participating in a dream-coaching group based on Jungian psychology. A descriptive design was used. Retrospective interviews were explored using qualitative content analysis. The participants were satisfied with the arrangement of the dream-coaching groups. All participants believed that they had recalled their dreams and thought much more about their dreams during the period in which the dream-coaching group met. Three diverse appraisals of participating in a dream-coaching group, which had different effects on the participants, were identified: "An activity like any other activity," "An activity that led to deeper thoughts about the meaning of dreams," and "An activity that led to deeper thoughts both about the meaning of dreams and about how dreams can improve one's understanding of the life situation." It is possible to arrange dream-coaching groups for older people and could be a way to promote personal development using this type of intervention. The study provides some guidance as to how such a group could be organized, thus facilitating use of dream-coaching groups in gerontological care.

  3. Frail Older People as Participants in Research

    ERIC Educational Resources Information Center

    Peel, Nancye M.; Wilson, Cecilia

    2008-01-01

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

  4. Frail Older People as Participants in Research

    ERIC Educational Resources Information Center

    Peel, Nancye M.; Wilson, Cecilia

    2008-01-01

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

  5. Education for Older People in Italy

    ERIC Educational Resources Information Center

    Principi, Andrea; Lamura, Giovanni

    2009-01-01

    This article provides information on trends in formal and informal adult education in Italy, with a particular focus on the older learners (over 65). Main providers, programs, objectives/motivations, and financial and legal framework are described. In general, over-65-year-old people were found to be underrepresented in participation. They were…

  6. Delirium and older people: repositioning nursing care.

    PubMed

    Neville, Stephen

    2006-06-01

    Aims.  To critically examine the nursing care offered to older people who have been delirious. Background.  Delirium occurs as a result of physiological imbalances resulting in an alteration in consciousness and cognitive impairment. Delirium is a prevalent and serious cognitive disorder experienced by older people. While there is a vast number of studies published utilizing quantitative methods, there remains a dearth of research relating to delirium in older people from a qualitative perspective. Design.  A qualitative research design that utilized a critical gerontological framework underpinned this study. This framework drew on aspects of postmodernism and Foucault's understanding of discourse. Methods.  Data sources included published documents on delirium, semi-structured taped interviews with people over the age of 65 years who had been delirious (as well as their clinical notes), family members, Registered Nurses and a hospital doctor. A postmodern discourse analytic approach was used to interrogate the 20 sets of data collected. Findings.  Textual analysis revealed the presence of two major discourses impacting on being an older person with delirium. These were identified as a nursing discourse of delirium and a personal discourse of delirium. A nursing discourse of delirium was largely focussed on the biomedical processes that resulted in a delirious episode. Conversely, a personal discourse of delirium highlights that there are other ways of 'knowing' about delirium through considering the narratives of older adults, and their families, when offering a nursing service to this group of people. Relevance to clinical practice.  Nursing needs to critically examine all aspects of nursing care as it applies to older people who have delirium to ensure the rhetorical claims of the profession become the reality for consumers of health services. The use of critical gerontology provides nurses with the tools to challenge the status quo and uncover the

  7. Assessing and managing depression in older people.

    PubMed

    Thomas, Hywel

    Depression is the most common mental health condition in people aged 65 and over. It can have a detrimental effect on quality of life and reduce patients' ability to manage their health. Nurses caring for older people with physical health problems are in an ideal position to identify depression; this article outlines how general receive the appropriate mental health care. nurses can do so and ensure their patientsepression can occur as a result of major life changes. It affects an estimated two million people over the age of 65 in the UK and is the most common mental illness

  8. Prevalence and clinical characteristics of metabolic syndrome for at-risk people in a rural community.

    PubMed

    Oh, Eui Geum; Bang, So Youn; Hyun, Sa Saeng

    2009-02-01

    Substantial socioeconomic and demographic changes have resulted in an increase in the incidence of metabolic syndrome in Korea, especially in aged, postmenopausal women and in rural populations. As rural populations age, metabolic syndrome is expected to be a significant health problem. The purpose of this study was to determine the prevalence and clinical characteristics of metabolic syndrome for an at-risk population in a rural community health-care center. Data were collected from 136 people who were defined as being at risk for metabolic syndrome by being over 40 years of age and being treated for hypertension, diabetes mellitus, dyslipidemia, or central obesity at a rural community health-care center in Korea. Prevalence and clinical characteristics were evaluated by the diagnostic guidelines of National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) and World Health Organization Asia-Pacific (WHO-AP). The prevalence of metabolic syndrome among this group was 64.7% and 74.3% according to the NCEP-ATP III and WHO-AP criteria, respectively. The prevalence of metabolic syndrome increased with age and was higher in women. Of the five risk factors, fasting blood sugar and central obesity in women were the most prevalent (81.6%), followed by systolic hypertension (80.1%). The prevalence of metabolic syndrome for at-risk people was high in the rural Korean health-care center used in this study. Population-wide management strategies are apparently needed.

  9. Helicobacter pylori infection in older people

    PubMed Central

    Pilotto, Alberto; Franceschi, Marilisa

    2014-01-01

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

  10. Creating the right light for older people.

    PubMed

    Gardner, Carl

    2014-09-01

    In last month's HEJ first we ran the first of a two-part focus, by Carl Gardner, former editor of the Institution of Lighting Professionals' Lighting Journal, on the issues surrounding lighting and the ageing population, which focused particularly on effective task lighting. In the second part of the article, the author considers the important psychological, physiological, and biological effects of lighting on older people--and how improved lighting design can benefit this group in a number of ways.

  11. Low cardiorespiratory fitness in people at risk for type 2 diabetes: early marker for insulin resistance

    PubMed Central

    2009-01-01

    Purpose There is a significant association between insulin resistance and low cardiorespiratory fitness in nondiabetic subjects. In a population with risk factors for type 2 diabetes (T2DM), before they are insulin resistant, we investigated low exercise capacity (VO2max) as an early marker of impaired insulin sensitivity in order to determine earlier interventions to prevent development of insulin resistance syndrome (IRS) and T2DM. Methods Cross-sectional analyses of data on 369 (78 men and 291 women) people at risk for IRS and T2DM, aged 45.6 +/- 10 years (20-65 years) old from the Community Diabetes Prevention Project in Minnesota were carried out. The cardiorespiratory fitness (VO2max) by respiratory gas exchange and bicycle ergometer were measured in our at risk non insulin resistant population and compared with a control group living in the same geographic area. Both groups were equally sedentary, matched for age, gender and BMI. Results The most prevalent abnormality in the study population was markedly low VO2max when compared with general work site screening control group, (n = 177; 137F; 40 M, mean age 40 ± 11 years; BMI = 27.8 ± 6.1 kg/m2). Individuals at risk for IRS and T2DM had a VO2max (22 ± 6 ml/kg/min) 15% lower than the control group VO2max (26 ± 9 ml/kg/min) (p < 0.001). It was foun that VO2max was inversely correlated with HOMA-IR (r = -0.30, p < 0.0001). Conclusions Decreased VO2max is correlated with impaired insulin sensitivity and was the most prevalent abnormality in a population at risk for IRS and T2DM but without overt disease. This raises the possibility that decreased VO2 max is among the earliest indicators of IRS and T2DM therefore, an important risk factor for disease progression. PMID:19825145

  12. Impact of cognitive therapy on internalised stigma in people with at-risk mental states.

    PubMed

    Morrison, Anthony P; Birchwood, Max; Pyle, Melissa; Flach, Clare; Stewart, Suzanne L K; Byrne, Rory; Patterson, Paul; Jones, Peter B; Fowler, David; Gumley, Andrew I; French, Paul

    2013-08-01

    Internalised stigma in young people meeting criteria for at-risk mental states (ARMS) has been highlighted as an important issue, and it has been suggested that provision of cognitive therapy may increase such stigma. To investigate the effects of cognitive therapy on internalised stigma using a secondary analysis of data from the EDIE-2 trial. Participants meeting criteria for ARMS were recruited as part of a multisite randomised controlled trial of cognitive therapy for prevention and amelioration of psychosis. Participants were assessed at baseline and at 6, 12, 18 and 24 months using measures of psychotic experiences, symptoms and internalised stigma. Negative appraisals of experiences were significantly reduced in the group assigned to cognitive therapy (estimated difference at 12 months was -1.36 (95% CI -2.69 to -0.02), P = 0.047). There was no difference in social acceptability of experiences (estimated difference at 12 months was 0.46, 95% CI -0.05 to 0.98, P = 0.079). These findings suggest that, rather than increasing internalised stigma, cognitive therapy decreases negative appraisals of unusual experiences in young people at risk of psychosis; as such, it is a non-stigmatising intervention for this population.

  13. Competence in advanced older people nursing: development of 'nursing older people--competence evaluation tool'.

    PubMed

    Bing-Jonsson, Pia Cecilie; Bjørk, Ida Torunn; Hofoss, Dag; Kirkevold, Marit; Foss, Christina

    2015-03-01

    Community care is characterised by a move from institutionalised to home-based care, a large patient population with comorbidities including cognitive failure, and nurses who struggle to keep up with their many competence demands. No study has examined the competence of nurses based on present demands, and an instrument for this purpose is lacking. We conducted a Delphi study based in Norway to develop the substantial content of a new competence measurement instrument. We sought to reach consensus regarding which nursing staff competence is most relevant to meet the current needs of older patients. A total of 42 experts participated in three consecutive panel investigations. Snowball sampling was used. The experts were clinicians, leaders, teachers, researchers and relatives of older people who required nursing. In Round 1, all experts were interviewed individually. These data were analysed using meaning coding and categorisation. In Rounds 2 and 3, the data were collected using electronic questionnaires and analysed quantitatively with SPSS. The experts agreed that health promotion as well as disease prevention, treatment, palliative care, ethics and regulation, assessment and taking action, covering basic needs, communication and documentation, responsibility and activeness, cooperation, and attitudes towards older people were the most relevant categories of competence. The experts showed clear consensus regarding the most relevant and current competence for nurses of older people. Assuming that older people in need of health care have the same requirements across cultures, this study's findings could be used as a basis for international studies. Those who nurse older people require competence that is complex and comprehensive. One way to evaluate nursing competence is through evaluation tools such as the Nursing Older People--Competence Evaluation tool. © 2014 John Wiley & Sons Ltd.

  14. Challenges with cost-utility analyses of behavioural interventions among older adults at risk for dementia.

    PubMed

    Davis, Jennifer C; Bryan, Stirling; Marra, Carlo A; Hsiung, Ging-Yuek R; Liu-Ambrose, Teresa

    2015-10-01

    Cognitive decline is one of the most prominent healthcare issues of the 21st century. Within the context of combating cognitive decline through behavioural interventions, physical activity is a promising approach. There is a dearth of health economic data in the area of behavioural interventions for dementia prevention. Yet, economic evaluations are essential for providing information to policy makers for resource allocation. It is essential we first address population and intervention-specific methodological challenges prior to building a larger evidence base. We use a cost-utility analysis conducted alongside the exercise for cognition and everyday living (EXCEL) study to illustrate methodological challenges specific to assessing the cost-effectiveness of behavioural interventions aimed at older adults at risk of cognitive decline. A cost-utility analysis conducted concurrently with a 6-month, three-arm randomised controlled trial (ie, the EXCEL study) was used as an example to identify and discuss methodological challenges. Both the aerobic training and resistance training interventions were less costly than twice weekly balance and tone classes. In critically evaluating the economic evaluation of the EXCEL study we identified four category-specific challenges: (1) analysing costs; (2) assessing quality-adjusted life-years; (3) Incomplete data; and (4) 'Intervention' activities of the control group. Resistance training and aerobic training resulted in healthcare cost saving and were equally effective to balance and tone classes after only 6 months of intervention. To ensure this population is treated fairly in terms of claims on resources, we first need to identify areas for methodological improvement. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  15. Can older "at risk" adults benefit from psychoeducation targeting healthy brain aging?

    PubMed

    Norrie, Louisa M; Diamond, Keri; Hickie, Ian B; Rogers, Naomi L; Fearns, Samantha; Naismith, Sharon L

    2011-04-01

    Multifactorial strategies that prevent or delay the onset or progress of cognitive decline and dementia are needed, and should include education regarding recognized risk factors. The current study sought to investigate whether older adults "at risk" of cognitive decline benefit from psychoeducation targeting healthy brain aging. 65 participants (mean age 64.8 years, SD 9.6) with a lifetime history of major depression; vascular risk as evidenced by at least one vascular risk factor; and/or subjective or objective memory impairment were allocated to weekly psychoeducation sessions or a waitlist control group. The small group sessions were conducted over ten weeks by a team of medical and allied health professionals with expertise in late-life depression and cognition. Sessions focused on modifiable risk factors for cognitive decline including vascular risk, diet, exercise, depression, anxiety and sleep disturbance, as well as providing practical strategies for memory and cognition. Both the psychoeducation and waitlist group completed a 20-item knowledge test at baseline and follow-up. Participants in the psychoeducation group were asked to complete follow-up self-report satisfaction questionnaires. Repeated measures ANOVA showed a significant interaction effect depicting improvements in knowledge associated with psychoeducation, corresponding to an improvement of 15% from baseline. Satisfaction data additionally showed that 92.3% of participants rated the program as "good" to "excellent", and over 90% suggested they would recommend it to others. A group-based psychoeducation program targeting healthy brain aging is effective in improving knowledge. Additionally, it is acceptable and rated highly by participants.

  16. Are current labeling terms suitable for people who are at risk of psychosis?

    PubMed

    Kim, Sung-Wan; Polari, Andrea; Melville, Fritha; Moller, Bridget; Kim, Jae-Min; Amminger, Paul; Herrman, Helen; McGorry, Patrick; Nelson, Barnaby

    2017-10-01

    Inclusion of 'attenuated psychosis syndrome (APS)' in the DSM-5 has been hotly debated because of the concern about stigmatising young patients with a 'psychosis risk' label. This study aimed to investigate whether current labeling terms such as 'at risk mental state', 'ultra-high risk' (UHR) and 'APS' are suitable for people who are at risk of psychosis. This study included 105 subjects (55 patients aged 15-25years who used an early interventional service to prevent psychosis and 50 professionals who worked with them). A questionnaire regarding their opinions about the stigma associated with the above labels and the Mental Health Consumers' Experience of Stigma scale were administered. The patients were less likely than the professionals to agree that there was stigma associated with the terms 'UHR' and 'APS'. Significantly more patients with a family history of psychosis and those who had transitioned to psychosis agreed that there was stigma associated with the term 'UHR' and/or that this term should be changed. Patients who agreed with the negative attitude items for the three labeling terms and the need to change the terms 'UHR' and 'schizophrenia' showed significantly higher scores on the Stigma scale. In conclusion, patients at risk of psychosis may experience less stigma related to labels than expected by professionals, suggesting that mental health professionals may not be able to help patients unless they listen to their views on nosological and treatment issues rather than make assumptions. Previous stigmatising experiences may have strengthened the stigma attached to this label. Copyright © 2017 Elsevier B.V. All rights reserved.

  17. Providing comfort and support to older people.

    PubMed

    Triggle, Nick

    2012-10-01

    This article reports on a scheme run by Age UK at Hillingdon Hospital, Middlesex, to help support emergency department (ED) staff with the care of older people. The A&E support-worker team assists patients with non-clinical activities, such as going to the toilet, eating meals and finding out care-related information. The support-worker scheme has been running for nine years and its success has prompted Age UK to consider expanding it nationally. It comes at a time when there is a growing focus on the care Solder patients receive in hospitals.

  18. Screening for Malnutrition in Older People.

    PubMed

    Guyonnet, Sophie; Rolland, Yves

    2015-08-01

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

  19. Characteristics of older at-risk drinkers who drive after drinking and those who do not drive after drinking

    PubMed Central

    Sanna, Maija B.; Tuqan, Alia T.; Goldsmith, Jeff S.; Law, Malena S.; Ramirez, Karina D.; Liao, Diana H.; Moore, Alison A.

    2014-01-01

    Objective To describe and compare characteristics of older adults who drive after drinking and those who do not, whether an intervention addressing at-risk drinking reduces risk among those reporting driving after drinking, and reasons reported for driving after drinking. Methods Secondary data analysis of a randomized trial testing the efficacy of a multifaceted intervention to reduce at-risk drinking among adults with a mean age of 68 years in primary care (N=631). Results Almost a quarter of at-risk drinkers reported driving after drinking (N=154). Compared to those who did not drive after drinking, those who did were more likely to be younger, male and working. They consumed a higher average number of drinks per week, had more reasons they were considered at-risk drinkers, and were more likely to meet at-risk drinking criteria due to amount of drinking and binge drinking. Those driving after drinking at baseline reduced the frequency of this behavior at 3- and 12-months and there were no statistically significant differences in the proportions of persons still engaging in driving after drinking among those who were assigned to intervention or control groups. Reasons for driving after drinking included not thinking it was a problem and having to get home. Conclusions Driving after drinking is common in this population of older, at-risk drinkers recruited in primary care settings, and, like younger adults, men and those reporting binge drinking are more likely to engage in this behavior. Given this behavior is dangerous and the population of older adults is fast growing, interventions addressing driving after drinking are needed. PMID:24874549

  20. Psychotherapeutic treatments for older depressed people.

    PubMed

    Wilson, K C M; Mottram, P G; Vassilas, C A

    2008-01-23

    Despite a number of reviews advocating psychotherapy for the treatment of depression, there is relatively little evidence based on randomised controlled trials that specifically examines its efficacy in older people. To examine the efficacy of psychotherapeutic treatments for depression in older people. CCDANCTR-Studies and CCDANCTR-References were searched on 11/9/2006. The International Journal of Geriatric Psychiatry and Irish Journal of Psychiatry were handsearched. Reference lists of previous published systematic reviews, included/excluded trial articles and bibliographies were scrutinised. Experts in the field were contacted.. All randomised controlled trials that included older adults diagnosed as suffering from depression (ICD or DSM criteria) were included. All types of psychotherapeutic treatments were included, categorised into cognitive behavioural therapies (CBT), psychodynamic therapy, interpersonal therapy and supportive therapies. Meta-analysis was performed, using odds ratios for dichotomous outcomes and weighted mean differences (WMD) for continuous outcomes, with 95% confidence intervals. Primary outcomes were a reduction in severity of depression, usually measured by clinician rated rating scales. Secondary outcomes, including dropout and life satisfaction, were also analysed. The search identified nine trials of cognitive behavioural and psychodynamic therapy approaches, together with a small group of 'active control' interventions. No trials relating to other psychotherapeutic approaches and techniques were found. A total of seven trials provided sufficient data for inclusion in the comparison between CBT and controls. No trials compared psychodynamic psychotherapy with controls. Based on five trials (153 participants), cognitive behavioural therapy was more effective than waiting list controls (WMD -9.85, 95% CI -11.97 to -7.73). Only three small trials compared psychodynamic therapy with CBT, with no significant difference in treatment

  1. Research into ageing and older people.

    PubMed

    Watson, Roger

    2008-03-01

    The aim of this paper is to consider the process of ageing, the effects of ageing and research related to ageing. In most countries of the world, the UK being no exception, the population is ageing in terms of the absolute numbers of and relative proportion of older people. This has resulted from economic, scientific and medical progress. However, it poses challenges for health and social services. Selective review of the literature. Ageing is an inevitable part of life and, while not in itself debilitating, can be accompanied by a range of debilitating physical and mental conditions which lead to frailty and dependency. There is limited evidence that the ageing process can be alleviated, as such, but there is some evidence that choices and circumstances in early life can influence the extent to which we age successfully. Nurse managers have two responsibilities with regard to age: they are increasingly engaged in organizing care for older people in acute and long-term settings and in nursing homes and the more they need to understand the process of ageing. They also have responsibilities towards their workforce and can facilitate lifestyle choices which may help their workforce to age successfully.

  2. The Representation of Older People in East Asian Television Advertisements.

    PubMed

    Prieler, Michael; Ivanov, Alex; Hagiwara, Shigeru

    2016-11-15

    In this study, 432 television advertisements from Hong Kong, Japan, and South Korea were analyzed to determine their representations of older people. Findings demonstrate that in East Asian advertisements, older people are highly underrepresented, appear in major roles, mostly alongside younger people, and older men clearly outnumber older women. The other variables investigated (i.e., setting and product categories) led to no conclusive findings for the three societies. In short, our study, employing ethnolinguistic vitality theory to analyze television advertisements, demonstrates how East Asian societies greatly marginalize older people. Potential effects of such representations are discussed using social cognitive theory and cultivation theory.

  3. The Market for Community Services for Older People.

    ERIC Educational Resources Information Center

    Hereford, Russell W.

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

  4. Perception of vulnerability to HIV infection among older people in Nairobi, Kenya: a need for intervention.

    PubMed

    Chepngeno-Langat, Gloria

    2013-03-01

    It is evident that sexual activity tends to decrease with age. Nonetheless, it is still prevalent enough to be considered a risk factor for the spread of HIV among older people. This paper uses quantitative data for 2053 individuals to examine HIV risk perception and correlates of perceived risk among older people aged 50 years and older living in Nairobi slums. It emerged that a majority of older people did not consider themselves at risk of infection. Of those who felt at risk, a greater proportion sensed only a small chance of contracting HIV. Women cited 'no sexual activity' while men mentioned 'having only one and/or a faithful sexual partner' as the primary reasons for perceiving minimal risk of HIV infection. There were no differences by sex in the basis for perceiving moderate-to-great risk of infection. Religion is a key factor in risk perception with Muslims perceiving higher levels of risk and, conversely, devotees irrespective of faith perceiving lower levels of risk. Older people willing to be tested for HIV had a decreased likelihood of perceived risk compared with those unwilling to be tested. This paper recommends evaluation of older people's perception of risk in order to better inform interventions aimed at minimizing their vulnerability to HIV infection.

  5. Amyloid burden and neural function in people at risk for Alzheimer's Disease.

    PubMed

    Johnson, Sterling C; Christian, Bradley T; Okonkwo, Ozioma C; Oh, Jennifer M; Harding, Sandra; Xu, Guofan; Hillmer, Ansel T; Wooten, Dustin W; Murali, Dhanabalan; Barnhart, Todd E; Hall, Lance T; Racine, Annie M; Klunk, William E; Mathis, Chester A; Bendlin, Barbara B; Gallagher, Catherine L; Carlsson, Cynthia M; Rowley, Howard A; Hermann, Bruce P; Dowling, N Maritza; Asthana, Sanjay; Sager, Mark A

    2014-03-01

    To determine the relationship between amyloid burden and neural function in healthy adults at risk for Alzheimer's Disease (AD), we used multimodal imaging with [C-11]Pittsburgh compound B positron emission tomography, [F-18]fluorodeoxyglucose, positron emission tomography , and magnetic resonance imaging, together with cognitive measurement in 201 subjects (mean age, 60.1 years; range, 46-73 years) from the Wisconsin Registry for Alzheimer's Prevention. Using a qualitative rating, 18% of the samples were strongly positive Beta-amyloid (Aβ+), 41% indeterminate (Aβi), and 41% negative (Aβ-). Aβ+ was associated with older age, female sex, and showed trends for maternal family history of AD and APOE4. Relative to the Aβ- group, Aβ+ and Aβi participants had increased glucose metabolism in the bilateral thalamus; Aβ+ participants also had increased metabolism in the bilateral superior temporal gyrus. Aβ+ participants exhibited increased gray matter in the lateral parietal lobe bilaterally relative to the Aβ- group, and no areas of significant atrophy. Cognitive performance and self report cognitive and affective symptoms did not differ between groups. Amyloid burden can be identified in adults at a mean age of 60 years and is accompanied by glucometabolic increases in specific areas, but not atrophy or cognitive loss. This asymptomatic stage may be an opportune window for intervention to prevent progression to symptomatic AD. Published by Elsevier Inc.

  6. Primary Care Based Intervention to Reduce At-Risk Drinking in Older Adults: A Randomized Controlled Trial

    PubMed Central

    Moore, Alison A.; Blow, Fred C.; Hoffing, Marc; Welgreen, Sandra; Davis, James W.; Lin, James C.; Ramirez, Karina D.; Liao, Diana H.; Tang, Lingqi; Gould, Robert; Gill, Monica; Chen, Oriana; Barry, Kristen L.

    2010-01-01

    Aims To examine whether a multifaceted intervention among older at-risk drinking primary care patients reduced at-risk drinking and alcohol consumption at 3 and 12 months. Design Randomized controlled trial. Setting Three primary care sites in southern California. Participants Six hundred thirty-one adults aged ≥ 55 years who were at-risk drinkers identified by the Comorbidity Alcohol Risk Evaluation Tool (CARET) were randomly assigned between October 2004 and April 2007 during an office visit to receive a booklet on healthy behaviors or an intervention including a personalized report, booklet on alcohol and aging, drinking diary, advice from the primary care provider and telephone counseling from a health educator at 2, 4 and 8 weeks. Measurements The primary outcome was the proportion of participants meeting at-risk criteria, and secondary outcomes were number of drinks in past 7 days, heavy drinking (4 or more drinks in a day) in the past 7 days and risk score.. Findings At 3 months, relative to controls, fewer intervention group participants were at-risk drinkers (OR 0.41; 95% CI 0.22–0.75); they reported drinking fewer drinks in the past 7 days (rate ratio [RR] 0.79; 95% confidence interval [CI] 0.70–0.90), less heavy drinking (odds ratio [OR] 0.46; 95% CI 0.22–0.99), and had lower risk scores (RR 0.77 95% CI 0.63–0.94).. At 12 months, only the difference in number of drinks remained statistically significant (RR 0.87; 95% CI 0.76–0.99). Conclusions A multifaceted intervention among older at-risk drinkers in primary care does not reduce the proportions of at-risk or heavy drinkers, but does reduce amount of drinking at 12 months. PMID:21143686

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

    PubMed

    Yoo, Myoungran; Lee, Mijung; Tullmann, Dorothy

    2016-03-01

    Older people are a major vulnerable population. During disasters, given their physical frailty, lower social status, loss of medications and medical care, the vulnerability of older people increases. The purpose of this study was to examine the perceptions of older people in Korea on various aspects of disaster preparedness to better understand their special needs and to facilitate appropriate disaster planning. The study was qualitative and used focus group interviews with 12 older people in one major city and one rural area of South Korea. Four themes were identified by the analysis of the interviews: defenceless state, reality of accepting limitations, strong will to live, importance of disaster preparedness governmental efforts for the older people. Findings indicated that preparation of shelters and transportation was critical to help older people survive in times of disasters and suggested that there should be active involvement of the government in terms of disaster planning, managing and preparing older people for disasters. In addition, healthy older people can be assets to disaster relief efforts by providing practical and emotional support for the most fragile older people. Older people can also provide knowledge of their special needs to the government to improve their disaster response policy. © 2015 John Wiley & Sons Ltd.

  8. Causes of death in older people autopsied.

    PubMed

    de Oliveira, Flávia Aparecida; Teixeira, Vicente de Paula Antunes; Lino, Ruy de Souza; Guimarães, Janaina Valadares; dos Reis, Marlene Antônia

    2009-08-01

    Studies of causes of death in autopsied older people are not common in Brazil. The aims were to compare demographic data and causes of death in elderly people autopsied in the 1970s, 1980s, and 1990s and to relate causes of death to age, sex, color, and body mass index. Data survey of the autopsy reports came from the Hospital de Clínicas of the Universidade Federal do Triângulo Mineiro, Uberaba, Minas Gerais, Brazil. The data were obtained from the autopsied individuals 60 years or older. Median age was 69 years (60-120 years) and was higher in the 1990s than in the 1970s (70.5 vs 68.0, P < .05) and higher in women (70 vs 68 years, P < .05). Men (66.8%) and white people (70.0%) predominated during the period. The most frequent causes of death were cardiovascular (42%) and infectious (33.4%). The percentage of cardiovascular causes of death varied little over the 1970s (41.7%), 1980s (42.3%), and 1990s (42.9%), whereas that of infectious causes decreased (38.0%, 28.6%, and 28.6%, respectively) and that of neoplastic causes increased (10.3%, 12.6%, and 19.6%, respectively, P > .05). Most of the elderly (84.6%) presented a body mass index of less than 22 kg/m2 and malnutrition predominated in the 1980s (48%). Therefore, there was little percentage variation in cardiovascular-related deaths over the 3 decades while the percentage of neoplastic-related deaths increased. Infectious causes of death was associated with the lowest body mass index, and the greatest percentage of cardiovascular and neoplastic-related deaths were in women.

  9. Rural older people had lower mortality after accidental falls than non-rural older people

    PubMed Central

    Huang, Jen-Wu; Lin, Yi-Ying; Wu, Nai-Yuan; Chen, Yu-Chun

    2017-01-01

    Objective This study aimed to investigate the mortality rate after falls of rural and non-rural older people and to explore the risk factors of mortality after falls among older people. Patients and methods This population-based case–control study identified two groups from a nationwide claim database (National Health Insurance Research Database in Taiwan): a rural group and a non-rural group, which included 3,897 and 5,541 older people, respectively, who were hospitalized for accidental falls (The International Classification of Diseases, Ninth Revision, Clinical Modification: E880–E888) during 2006–2009. Both groups were followed up for 4 years after falls. Four-year cumulative all-cause mortality rate after falls was calculated, and the demographic factor, comorbidity, and medications were considered as the potential risk factors of mortality after falls. Results The rural group had a significantly higher frequency of fall-related hospitalizations (7.4% vs 4.3%, P<0.001), but a lower 4-year cumulative all-cause mortality rate after falls than the non-rural group (8.8% vs 23.4%, P<0.001). After adjusting for age, gender, comorbidity, and medication use, the rural group had a significantly lower risk of mortality after falls than the non-rural group (adjusted odds ratio =0.32, 95% confidence interval =0.28–0.37, P<0.001). Age, gender, place of residence, comorbidity, number of medications, and inappropriate medication use were independent risk factors of mortality after falls. Conclusion The rural older people had a higher frequency of fall-related hospitalizations but lower mortality after falls than the non-rural older people. Fall prevention programs should be adjusted for difference in place of residence. PMID:28123289

  10. Inflammation and frailty measures in older people

    PubMed Central

    Hubbard, Ruth E; O’Mahony, M Sinead; Savva, George M; Calver, Brian L; Woodhouse, Ken W

    2009-01-01

    Inflammation in patients defined as frail by Fried’s phenotypic definition may be related to sarcopenia. This study aimed to investigate inflammation in older patients across different frailty criteria. Frailty status was determined in 110 patients aged over 75 years (mean 83.9 years) according to function (dependent, intermediate, independent); Fried (three or more items of exhaustion, weight loss, slow walking speed, low handgrip strength, low physical activity) and Frailty Index (a measure of accumulated deficits). With increasing patient frailty as defined by function and by Fried phenotype, tumour necrosis factor-α (TNF-α), interleukin-6 (IL-6) and C-reactive protein (CRP) increased significantly. Albumin was lowest in the frailest subjects by each definition. The greatest differences were seen between intermediate and dependent groups and between the pre-frail and frail. Adjustment for multiple covariates (age, sex, BMI category, smoking status, number of co-morbidities and number of prescribed medications) did not account for any of the observed differences in levels of inflammatory markers. The Frailty Index correlated significantly with log-transformed CRP (r= 0.221, P < 0.05), log-transformed IL-6 (r= 0.369, P < 0.01), TNF-α (r= 0.379, P < 0.01) and inversely with albumin (r=– 0.545, P < 0.01). This study provides further evidence linking inflammation and frailty in older people, an association that seems consistent across different frailty measures. PMID:19438806

  11. Carotenoids and health in older people.

    PubMed

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

    2015-01-01

    As the proportion of older people increases, so will chronic disease incidence and the proportion of the population living with disability. Therefore, new approaches to maintain health for as long as possible in this age group are required. Carotenoids are a group of polyphenolic compounds found predominantly in fruit and vegetables that have been proposed to have anti-inflammatory and antioxidant effects. Such properties may impact on the risk diseases which predominate in older people, and also ageing-related physiological changes. Working out the effect of carotenoid intake versus fruit and vegetable intake is difficult, and the strong correlation between individual carotenoid intakes also complicates any attempt to examine individual carotenoid health effects. Similarly, research to determine whether carotenoids consumed as supplements have similar benefits to increased dietary intake through whole foods, is still required. However, reviewing the recent evidence suggests that carotenoid intake and status are relatively consistently associated with reduced CVD risk, although β-carotene supplementation does not reduce CVD risk and increases lung cancer risk. Increased lycopene intake may reduce prostate cancer progression, with a potential role for carotenoids at other cancer sites. Lutein and zeaxanthin have a plausible role in the maintenance of eye health, whilst an association between carotenoid intake and cognitive and physical health appears possible, although research is limited to date. Given this accruing evidence base to support a specific role for certain carotenoids and ageing, current dietary advice to consume a diet rich in fruit and vegetables would appear prudent, and efforts maintained to encourage increased intake. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  12. Longitudinal respiratory studies in older people

    PubMed Central

    Milne, J S

    1978-01-01

    Milne, J S (1978).Thorax, 33, 547-554. Longitudinal respiratory studies in older people. A random sample of older people in Edinburgh (215 men, 272 women aged 62-90 years) was examined with the MRC questionnaire on respiratory symptoms. The FEV1 and FVC were recorded. Spirograms were repeated after one and five years and the questions after five years, the sample by then having been reduced to 133 men and 148 women. After five years 7% of the surviving men and women had developed persistent cough and phlegm. This syndrome had disappeared in 12% of men and 2% of women. Dyspnoea had increased beyond grade 2 in 13% of men and 7% of women and had lessened only in 6% of women. One-quarter of male and one-seventh of female cigarette smokers had given up smoking, mostly in the first year. Nearly all who stopped were symptomless before and after. In those men who stopped smoking before the study began symptom prevalence was similar to that in those who continued smoking. Mean values of FEV1 and FVC declined as age increased, the decline being greater in FVC with resulting rise in FEV1%. Five-year differences in FEV1 and FVC were symmetrically distributed with mean differences increasing with age. Mean differences in FEV1 were 280-350 ml in men and 150-230 ml in women. Prediction equations from the first examinations remained usable for clinical work. Mean values of FEV1 and FVC at the first examination were smaller in those who died compared with survivors, whether symptoms were present or not. The prevalence of symptoms was greater in those who died. PMID:725823

  13. Getting help quickly: older people and community worker perspectives of contingency planning for falls management.

    PubMed

    Charlton, Kimberly; Murray, Carolyn M; Kumar, Saravana

    2016-11-10

    Older people living in the community need to plan for getting help quickly if they have a fall. In this paper planning for falls is referred to as contingency planning and is not a falls prevention strategy but rather a falls management strategy. This research explored the perspectives of older people and community workers (CWs) about contingency planning for a fall. Using a qualitative descriptive approach, participants were recruited through a community agency that supports older people. In-depth interviews were conducted with seven older people (67-89 years of age) and a focus group was held with seven workers of mixed disciplines from the same agency. Older people who hadn't fallen were included but were assumed to be at risk of falls because they were in receipt of services. Thematic analysis and concept mapping combined the data from the two participant groups. Four themes including preconceptions about planning ahead for falling, a fall changes perception, giving, and receiving advice about contingency plans and what to do about falling. Both CWs and older people agree contingency planning requires understanding of individual identity and circumstances. CWs have limited knowledge about contingency planning and may be directive, informative, or conservative. Implications for Rehabilitation Falls can result in serious consequences for older people. There is an evidence-practice gap as availability of and access to contingency planning does not necessarily mean older people will use it in a falls emergency. Older people prefer community workers to be directive or informative about contingency planning options but they do want choice and control. Increased community workers knowledge of, and collaborative decision-making about, contingency planning may promote patient-centered services and assist in closing the evidence-practice gap.

  14. Cognitive Reserve as a Protective Factor in Older HIV-Positive Patients at Risk for Cognitive Decline

    PubMed Central

    Foley, Jessica M.; Ettenhofer, Mark L.; Kim, Michelle S.; Behdin, Nina; Castellon, Steven A.; Hinkin, Charles H.

    2013-01-01

    The present study examined the impact of cognitive reserve in maintaining intact neuropsychological (NP) function among older HIV-positive individuals, a uniquely at-risk subgroup. Participants included 129 individuals classified by HIV serostatus, age group, and NP impairment. A three-way analysis of variance (ANOVA) followed by a series of within-group ANOVA and multiple regression analyses were conducted to investigate the pattern of cognitive reserve (vs. other protective) influence among groups with varying risks of NP impairment. Results indicated a significant age ×HIV status interaction, with older HIV-positive individuals demonstrating higher cognitive reserve than subgroups with less risk for NP compromise (younger age and/or HIV-negative). Results demonstrated higher cognitive reserve specific to NP-intact older HIV-positive individuals. Within this group, the interaction of younger age and higher cognitive reserve independently contributed to cognitive status when controlling for psychiatric, immunological, and psychosocial protective mechanisms, suggesting the importance of cognitive reserve beyond other protective mechanisms in maintaining optimal NP functioning in those individuals most at risk. Alongside younger age, factors contributing to cognitive reserve (i.e., education and estimated premorbid intelligence) may provide substantial benefit for older HIV-positive adults who are at high risk for NP compromise. PMID:22385375

  15. Physical and mental health of transgender older adults: an at-risk and underserved population.

    PubMed

    Fredriksen-Goldsen, Karen I; Cook-Daniels, Loree; Kim, Hyun-Jun; Erosheva, Elena A; Emlet, Charles A; Hoy-Ellis, Charles P; Goldsen, Jayn; Muraco, Anna

    2014-06-01

    This study is one of the first to examine the physical and mental health of transgender older adults and to identify modifiable factors that account for health risks in this underserved population. Utilizing data from a cross-sectional survey of lesbian, gay, bisexual, and transgender older adults aged 50 and older (N = 2,560), we assessed direct and indirect effects of gender identity on 4 health outcomes (physical health, disability, depressive symptomatology, and perceived stress) based on a resilience conceptual framework. Transgender older adults were at significantly higher risk of poor physical health, disability, depressive symptomatology, and perceived stress compared with nontransgender participants. We found significant indirect effects of gender identity on the health outcomes via fear of accessing health services, lack of physical activity, internalized stigma, victimization, and lack of social support; other mediators included obesity for physical health and disability, identity concealment for perceived stress, and community belonging for depressive symptomatology and perceived stress. Further analyses revealed that risk factors (victimization and stigma) explained the highest proportion of the total effect of gender identity on health outcomes. The study identifies important modifiable factors (stigma, victimization, health-related behaviors, and social support) associated with health among transgender older adults. Reducing stigma and victimization and including gender identity in nondiscrimination and hate crime statutes are important steps to reduce health risks. Attention to bolstering individual and community-level social support must be considered when developing tailored interventions to address transgender older adults' distinct health and aging needs.

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

    NASA Astrophysics Data System (ADS)

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

    2015-12-01

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

  17. Diagnosis, prevention and treatment of urinary tract infections in older people.

    PubMed

    Bardsley, Alison

    2017-02-28

    Urinary tract infections (UTIs) are common in older people, with the prevalence increasing with age in both sexes. UTI is a frequent reason for emergency admission to hospital. There are many conditions that contribute to older people being more at risk of UTI and the main preventive strategy is to avoid the use of indwelling urethral catheters. Where an indwelling catheter is inserted its continued use should be regularly reviewed and the catheter removed, especially if the reason for insertion is incontinence and the person becomes additionally incontinent of faeces. Diagnosis of UTI can be complex because older people do not always exhibit the signs and symptoms commonly associated with UTI. Diagnosis can be further complicated by a person's inability to provide a comprehensive history and by difficulties obtaining an uncontaminated, 'clean catch' urine specimen. Antibiotic therapy should not be used routinely for people with asymptomatic bacteriuria and, where antibiotics are required, healthcare professionals should follow local prescribing guidelines.

  18. Who Is at Risk for Arrhythmia?

    MedlinePlus

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

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

    PubMed Central

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

    2014-01-01

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

  20. Engaging older people with English as a second language and frail older people in physical activity.

    PubMed

    Stickney, Beth; Vilshanskaya, Olga

    2005-08-01

    Despite growing awareness of the benefits of physical activity for older people, some population subgroups remain particularly hard to engage, especially those with English as a second language (ESL) and frail older people. A qualitative investigation of an existing community-based physical activity provider - Active Involved Mature (AIM)--was undertaken, including in-depth, semi-structured interviews with 12 key partners and nine class instructors, and focus groups with 58 class participants. Health benefits and social factors were strong incentives for participation among both ESL and frail groups. Some differences were evident between these two groups in their needs and strategies reported as addressing these needs. Partners described AIM as a quality service with a commitment to working with groups in need, responsive to the local community and with a good track record of collaborative work. Specific strategies targeted engagement and long-term participation. Social and environmental strategies, in addition to cognitive and behavioural approaches, supported participation of ESL and frail older people in AIM's group-based physical activity classes. Development of community and organisational partnerships, targeting to group needs (for ESL groups) and tailoring to individual requirements (for frail participants) were also seen as key features for success. These program elements are supported by, and grounded in, current health promotion and behavioural theory.

  1. Physical and Mental Health of Transgender Older Adults: An At-Risk and Underserved Population

    PubMed Central

    Fredriksen-Goldsen, Karen I.

    2014-01-01

    Purpose: This study is one of the first to examine the physical and mental health of transgender older adults and to identify modifiable factors that account for health risks in this underserved population. Design and Methods: Utilizing data from a cross-sectional survey of lesbian, gay, bisexual, and transgender older adults aged 50 and older (N = 2,560), we assessed direct and indirect effects of gender identity on 4 health outcomes (physical health, disability, depressive symptomatology, and perceived stress) based on a resilience conceptual framework. Results: Transgender older adults were at significantly higher risk of poor physical health, disability, depressive symptomatology, and perceived stress compared with nontransgender participants. We found significant indirect effects of gender identity on the health outcomes via fear of accessing health services, lack of physical activity, internalized stigma, victimization, and lack of social support; other mediators included obesity for physical health and disability, identity concealment for perceived stress, and community belonging for depressive symptomatology and perceived stress. Further analyses revealed that risk factors (victimization and stigma) explained the highest proportion of the total effect of gender identity on health outcomes. Implications: The study identifies important modifiable factors (stigma, victimization, health-related behaviors, and social support) associated with health among transgender older adults. Reducing stigma and victimization and including gender identity in nondiscrimination and hate crime statutes are important steps to reduce health risks. Attention to bolstering individual and community-level social support must be considered when developing tailored interventions to address transgender older adults’ distinct health and aging needs. PMID:23535500

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

    PubMed Central

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

    2012-01-01

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

  3. Detection of people at risk of diabetes in community pharmacies of Pontevedra (Spain) (DEDIPO).

    PubMed

    Fornos-Pérez, José Antonio; Andrés-Rodríguez, N Floro; Andrés-Iglesias, J Carlos; Luna-Cano, Reyes; García-Soidán, Javier; Lorenzo-Veiga, Blanca; Mera-Gallego, Rocío; García-Riestra, Rosario

    2016-10-01

    The aim of this study was to detect people at risk of suffering diabetes or changes in carbohydrate metabolism and to refer them for possible diagnosis to health care centres. The number of diagnoses and costs for the pharmacy were recorded. A cross-sectional, observational study was conducted in community pharmacies in Pontevedra in September-October of 2014. The Findrisc questionnaire was completed by pharmacy users over 18 years old. If Findrisc score was ≥ 15, capillary blood glucose was measured, and the participant was referred to a physician if the value was ≥110mg/dL. The main variables included score in the Findrisc questionnaire, number of diabetes diagnosed, and cost of the service. Differences between the groups were calculated using a Chi-squared test, a Student's t test, and/or a Wilcoxon test. This study was conducted in 180 pharmacies on a sample of 4,222 users, including 992 (23.5%) with a high or very high risk of diabetes (F≥15). In the 1,060 basal capillary blood glucose tests performed, mean glucose level was 110.2 (SD=20.4)mg/dL (56-254). The Galician Health Service sent information about 83 of the 384 (9.1%) subjects referred to a physician: 28 (33.7%) of them were diagnosed with diabetes (3.1% of the sample), and 26 (31.3%) were diagnosed with prediabetes (2.8% of the sample). Cost per diagnosed subject was € 184.22 per subject with diabetes and € 96.86 per subject with prediabetes. The proportion of subjects with new diagnosis of diabetes (3.1%) shows the high efficiency of a screening program for hidden diabetics implemented at community pharmacies as the one presented here. Copyright © 2016 SEEN. Publicado por Elsevier España, S.L.U. All rights reserved.

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

    ERIC Educational Resources Information Center

    Sawyer, Patricia; Williams, Beverly Rosa

    2012-01-01

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

  5. Coaching in Healthy Dietary Practices in At-Risk Older Adults: A Case of Indicated Depression Prevention

    PubMed Central

    Stahl, Sarah T.; Albert, Steven M.; Dew, Mary Amanda; Lockovich, Michael H.; Reynolds, Charles F.

    2014-01-01

    Prevention of major depressive disorder is important because current treatments are only partially adequate in reducing symptom burden and promoting health-related quality of life. Lifestyle interventions may be a desirable prevention strategy for reasons of patient preference, particularly among older patients from minority groups. Using evidence from a randomized depression prevention trial for older adults, the authors found that coaching in healthy dietary practices was potentially effective in protecting at-risk older adults from developing incident episodes of major depression. The authors describe the dietary coaching program (highlighted in a case example) as well as the feasibility and potential efficacy of the program within the context of evidence-based interventions for preventing episodes of major depression and mitigating symptoms of depression. Older adults receiving dietary coaching experienced a low incidence of major depressive episodes and exhibited a 40%–50% decrease in depressive symptoms, as well as enhanced well-being, during the initial 6-week intervention; these gains were sustained over 2 years. The authors also describe why lifestyle interventions like coaching in healthy dietary practices may hold promise as effective, practical, nonstigmatizing interventions for preventing episodes of major depressive disorder in older adults with sub-syndromal depressive symptoms. PMID:24788282

  6. Older people in Canada: their victimization and fear of crime.

    PubMed

    Hayman, Stephanie

    2011-09-01

    Older people are more affected by fear of crime and the possibility of victimization, despite their being at lower risk of harm, than any other population group in Canada. Crime, victimization, and fear are not experienced uniformly among older Canadian citizens and residents, partly because older people do not form a homogeneous group. Being part of an ethnic, religious, or sexual minority, or being mentally frail, can have an impact on an individual's perceptions and experience of risk. This analysis explores older people's victimization and fear of crime, while it highlights the lack of consistency in the available data.

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

    PubMed Central

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

    2014-01-01

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

  8. Using Observation for Reflective Practice with Older People

    ERIC Educational Resources Information Center

    Hughes, Mark; Heycox, Karen

    2008-01-01

    This article discusses the use of observation for reflective practice with older people, particularly the benefits and challenges of this learning tool. It outlines a study with 26 third-year Bachelor of Social Work students who undertook an elective course on reflective practice with older people. Using qualitative document analysis, the authors…

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

    ERIC Educational Resources Information Center

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

    2015-01-01

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

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

    ERIC Educational Resources Information Center

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

    2015-01-01

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

  11. [Quality of life of older people living in Antofagasta, Chile].

    PubMed

    Urzúa, Alfonso; Bravo, Miguel; Ogalde, Mario; Vargas, Carolina

    2011-08-01

    As basic needs of older people are covered, the concern about the determinants of their quality of life becomes preeminent. To evaluate the relationship between self-reported quality of life and related variables. The Quality of Life Survey for older people developed by the World Health Organization (WHOQOL-Old), the reduced scale of Ryff Psychological Well Being, the Functional Social Support Questionnaire, the SF-12 and GHQ12 general health surveys were applied to 406 older adults aged 71 ± 7 years (83% women), that were members of older people organizations and lived in Antofagasta, Chile. Older people that perceived themselves as sick had significantly lower quality of life scores. Self-acceptance, social support, autonomy and having a purpose in life also influenced the perception of quality of life. Health issues and the sense of self efficacy are determinants of the quality of life of these older subjects.

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

    PubMed

    Tang, Kwong-leung

    2008-01-01

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

  13. Current sexual activity and risky sexual behavior in older men with or at risk for HIV infection.

    PubMed

    Cooperman, Nina A; Arnsten, Julia H; Klein, Robert S

    2007-08-01

    In a cross-sectional analysis, we investigated frequency of sexual activity and factors associated with risky sexual behavior among 624 oldermen, aged 49-80, with or at risk for HIV infection. During the prior 6 months, 75% reported sexual activity with at least one partner, and one quarter of both the HIV-negative and HIV-positive men had more than one sexual partner. Only 18% of the HIV-negative men and 58% of the HIV-positive men always used condoms with their sexual partners. Factors independently and positively associated with risky sexual behavior included lack of HIV infection, any drug use in the past 6 months, greater importance of sex in one's life, weekly or more frequent sexual activity in the past 6 months, and ever taking sildenafil. These results suggest that older men with or at risk for HIV infection are sexually active, participate in risky sexual behavior, and need safer sex interventions.

  14. Independence at risk: older Californians with disabilities struggle to remain at home as public supports shrink.

    PubMed

    Kietzman, Kathryn G; Durazo, Eva M; Torres, Jacqueline M; Choi, Anne Soon; Wallace, Steven P

    2011-12-01

    This policy brief presents findings from a yearlong study that closely followed a small but typical set of older Californians with disabilities who depend on fragile arrangements of paid public programs and unpaid help to live safely and independently at home. Many of these older adults have physical and mental health needs that can rise or fall with little warning; most are struggling with increasing disability as they age. In spite of these challenges, most display resilience and fortitude, and all share a common determination to maintain their independence at almost any cost. Declines in health status and other personal circumstances among aging Californians have been exacerbated by recent reductions in public support, and will be made even worse by significant additional cuts that are pending. Policy recommendations include consolidating long-term care programs and enhancing support for caregivers.

  15. Psychosocial barriers to sexual intimacy for older people.

    PubMed

    Garrett, Dawne

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

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

    PubMed

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

    2012-09-01

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

  17. Older adults who are at risk of driving under the influence: A latent class analysis.

    PubMed

    Choi, Namkee G; DiNitto, Diana M; Marti, C Nathan

    2015-09-01

    Despite increasing rates of substance use among older adults, their risk of driving under the influence of alcohol and/or drugs (DUI) has received scant research attention. This study identified DUI risk profiles among individuals aged 50+ years based on their substance use patterns, previous DUI incidents, and previous arrests. This study's analytic sample of 11,188 individuals came from the public use data sets of the 2008 to 2012 National Survey on Drug Use and Health. Latent class analysis identified a 4-class model as the most parsimonious. Class 1 (63% of the analytic sample; lowest risk group) exhibited the lowest probabilities of substance use and trouble with law while Class 4 (9% of the sample; highest risk group) included binge/heavy drinkers who are also likely to use illicit drugs and had the highest probabilities of self-reported DUI and previous arrests. Class 2 (18.5%) and Class 3 (9.5%) exhibited low-to-medium DUI risks. Class 4 had the highest proportions of Blacks and divorced or never married persons and had lowest education and income, poorest self-rated health, and highest rates of mental health problems of all classes. Screening for substance abuse and comorbid mental health conditions should be included in protocols for assessing older adults' driving safety. More effort is also needed to improve access to substance abuse treatment and address mental health problems among older adults at high risk for DUI. (c) 2015 APA, all rights reserved).

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

    MedlinePlus

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

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

    ERIC Educational Resources Information Center

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

    2008-01-01

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

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

    ERIC Educational Resources Information Center

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

    2008-01-01

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

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed

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

    2015-09-01

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

  3. Thiamine for Wernicke-Korsakoff Syndrome in people at risk from alcohol abuse.

    PubMed

    Day, E; Bentham, P; Callaghan, R; Kuruvilla, T; George, S

    2004-01-01

    Autopsy studies suggest that Wernicke-Korsakoff Syndrome (WKS) is not a rare disorder, particularly in individuals who abuse alcohol. Thiamine has been established as the treatment of choice for over 50 years, but there is uncertainty about appropriate dosage and duration. Current practice guidelines are based on case reports and clinical experience. To determine the quality of evidence for the efficacy of thiamine in preventing and treating the manifestations of WKS as a consequence of alcohol excess, and if so in which form it should be given, at what dose and for how long. Trials were identified from the latest updated search of the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group on 3 February 2003 using the terms "(thiamin* or aneurin*) and (Korsakoff* or Wernicke* or alcohol*). The CDCIG Specialized register contains up-to-date records from all major health care databases (Medline, Embase, PsycInfo, Cinahl and others) as well as from many trials databases. All randomized trials in which treatment with thiamine or thiamine-containing products was administered and compared with alternative interventions for people with, or at risk of developing, WKS secondary to alcohol abuse. All abstracts were independently inspected by two reviewers (ED & PB) and relevant papers were retrieved and assessed for methodological quality using Cochrane Reviewers' Handbook criteria. Two studies were identified that met the inclusion criteria, but only one contained sufficient data for quantitative analysis. Ambrose (2001) randomized participants (n=107) to one of five doses of intramuscular thiamine and measured outcomes after 2 days of treatment. We compared the lowest dose (5mg/day) with each of the other four doses. There was a significant difference in favour of the 200mg/day compared with the 5 mg/day dose in the number of trials taken to reach criterion on a delayed alternation test (MD -17.90, 95% CI -35.4 to -0.40, p=0.04). No significant

  4. Exercise for improving balance in older people.

    PubMed

    Howe, Tracey E; Rochester, Lynn; Neil, Fiona; Skelton, Dawn A; Ballinger, Claire

    2011-11-09

    In older adults, diminished balance is associated with reduced physical functioning and an increased risk of falling. This is an update of a Cochrane review first published in 2007. To examine the effects of exercise interventions on balance in older people, aged 60 and over, living in the community or in institutional care. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, CENTRAL (The Cochrane Library 2011, Issue 1), MEDLINE and EMBASE (to February 2011). Randomised controlled studies testing the effects of exercise interventions on balance in older people. The primary outcomes of the review were clinical measures of balance. Pairs of review authors independently assessed risk of bias and extracted data from studies. Data were pooled where appropriate. This update included 94 studies (62 new) with 9,917 participants. Most participants were women living in their own home.Most trials were judged at unclear risk of selection bias, generally reflecting inadequate reporting of the randomisation methods, but at high risk of performance bias relating to lack of participant blinding, which is largely unavoidable for these trials. Most studies only reported outcome up to the end of the exercise programme.There were eight categories of exercise programmes. These are listed below together with primary measures of balance for which there was some evidence of a statistically significant effect at the end of the exercise programme. Some trials tested more than one type of exercise. Crucially, the evidence for each outcome was generally from only a few of the trials for each exercise category. 1. Gait, balance, co-ordination and functional tasks (19 studies of which 10 provided primary outcome data): Timed Up & Go test (mean difference (MD) -0.82 s; 95% CI -1.56 to -0.08 s, 114 participants, 4 studies); walking speed (standardised mean difference (SMD) 0.43; 95% CI 0.11 to 0.75, 156 participants, 4 studies), and the Berg Balance Scale (MD 3

  5. A memory clinic for older people with intellectual disabilities.

    PubMed

    Hassiotis, A; Strydom, A; Allen, K; Walker, Z

    2003-11-01

    Cognitive decline in older people with intellectual disabilities (ID) is often under-recognized. Following the publication of the National Service Framework for Older People and the white paper Valuing People, older people with intellectual disabilities of all aetiologies should have access to a systematic assessment of their cognitive function in order to detect decline in cognition and adaptive skills and implement appropriate treatments as early as possible. The development of a memory clinic for older people with ID is described, including instruments used and characteristics of attendees. Such projects are in line with current UK government policies and can contribute to the improvement of standards of care and support research in this vulnerable group of people.

  6. Falls in older people: the role of assessment in prevention and care.

    PubMed

    Unsworth, John

    2003-06-01

    Falls among older people constitute a serious public health problem, which has a substantial impact on both the person and on healthcare services. Falls assessment can be divided into a number of types. Community nurses are well placed to use falls risk checklists to identify older people who may be at risk of falling and then offer these individuals a more in-depth assessment. In addition, community nurses have a role to play in assessing older people who have recently fallen to prevent future falls and potential injury. Falls prevention programmes centre on the identification of risk factors and the planning and delivery of interventions designed to eliminate or ameliorate these risks. A falls assessment should include a review of intrinsic factors such as mobility, lower extremity functioning, vision, medications, footwear and past medical history. It is also important to consider extrinsic factors such as tripping, slipping and other environmental hazards.

  7. The experience of older people living independently in Singapore.

    PubMed

    Tan, K-K; He, H-G; Chan, S W-C; Vehviläinen-Julkunen, K

    2015-12-01

    Globally, older people are living independently either alone or with their spouse, population continues to age. In Singapore, some may live with an unrelated older person in a public rental apartment. In Asia, these older people are associated with increased risks of poor health and social isolation, have poorer social support and a poor quality of life. Few studies have explored why these older people choose such living arrangements, the challenges they encountered and what has helped or may help them overcome these challenges. To explore older people's experiences of living independently or with an unrelated older person. This descriptive qualitative study involved face-to-face interviews with 25 informants, 65 years or older in Singapore. Thematic analysis was adopted. Five themes emerged: (1) making own choice--participants decided to live apart from their families, (2) contending with concerns--the availability of external resources for participants was shrinking, (3) coping with the available assistance--depending on available external resources from the community, (4) holding on to their values--participants rely on their internal resources to manage, and (5) preparing for the inevitable--participants were planning for their final years of life and for their death. Older people have such living arrangements for many reasons. They attain well-being and quality of life by devising strategies, tapping on their limited external resources and relying on their values to manage their diminishing resources and the foreseeable death. Understanding older people's experiences may help nurses and health professionals to develop health promotion programmes that support older people's everyday needs and help them to stay healthy. Public health policy must support older people to live in a safe environment near their extended family to reduce their need to relocate. © 2015 International Council of Nurses.

  8. Depression in older people is underdiagnosed.

    PubMed

    Allan, Charlotte E; Valkanova, Vyara; Ebmeier, Klaus P

    2014-05-01

    Depression is more common in old age than dementia yet is underdiagnosed and undertreated. It is important to recognise that patients may not always present in a typical way, features that may indicate depression include anxiety, a preoccupation with somatic symptoms, and a change in function. The presence of understandable triggers and causes should not deter GPs from offering treatment, as long as symptoms are pervasive and continuously persist beyond two weeks. Age-related disabilities and changes to physical health are major risk factors for depression in older people. Vascular diseases, including stroke, MI and diabetes increase the risk of depression, both through direct effects on the brain and the psychological effects. Likewise, dementia is a risk factor for depression. Psychological factors such as loneliness and loss of a valued role, as well as social factors related to retirement, bereavement and reduced independence may also increase the risk. Patients with a previous history of depression and anxiety disorders are at increased risk of depression in later life. Assessment and diagnosis are largely based on a careful history. This should focus on eliciting current features of depression, which have been present for at least two weeks, and are associated with a significant change in function. It is important to exclude organic disorders including anaemia, B12 and folate deficiency, and hypothyroidism that may mimic symptoms of depressive disorder. Referral to specialist mental health services is indicated in the following cases: diagnostic difficulty, poor response to treatment, psychotic symptoms, significant psychiatric comorbidity or a risk of self-neglect or suicide.

  9. Efficacy of myringoplasty in older people.

    PubMed

    Migirov, Lela; Lipschitz, Noga; Slonimsky, Guy; Yakirevitch, Arkadi; Wolf, Michael

    2014-12-01

    The aim of current investigation was to analyze the efficacy of myringoplasty in an elderly population. The medical records of 12 males and 9 females, aged 65-90 years (mean 70.7 years), who underwent myringoplasty between 2007 and 2013 were retrospectively reviewed for age, gender, co-morbidities, perforation size and location, pre- and postoperative pure tone averages of air/bone thresholds at 500, 1,000, 2,000 and 3,000 Hz, graft material, postoperative complications and surgical outcome. The most frequent co-morbidities included hypertension (n = 8), hyperlipidemia (n = 7), diabetes mellitus (n = 5) and ischemic heart disease (n = 4). Fifteen patients had two or more co-morbidities. All surgeries were performed via a trans-canal approach. Seventeen patients had central perforations and four patients had marginal perforations. Temporalis fascia, perichondrium or chondro-perichondrial graft and fat were used as grafting material in 9, 11 and 1 patient, respectively. The post-operative complications were infection (n = 4) and tragal seroma (n = 1). Surgical outcome was successful in 16/21 patients with graft take rates of 89, 72 and 0% for temporalis fascia, perichondrium/cartilage, and fat, respectively. Pre-operative audiometric data were available for all 21 patients; however, the post-operative data were available for only 15 of them. Myringoplasty in older people was a safe procedure with a 76.2% surgical success rate in the current study. The choice of graft material, perforation size, gender and associated co-morbidities had no significant effect on achieving an intact tympanic membrane and a dry ear. The audiometric results did not show significant changes following myringoplasty.

  10. Older people and attachment to things, places, pets, and ideas.

    PubMed

    Cookman, C A

    1996-01-01

    A model of older adult to environment interactions is proposed that moves beyond the perspective of environment as safety hazard to environment as supportive resource the framework encourages health professionals to look for ways to incorporate positive environmental influences into individualized plans of care with older adults. Research is reviewed on the attachments formed by older adults to things, places, companion animals, ideas, and beliefs-which alongside people-to-people attachments comprise the "attachment structure." Research on attachments of older people to environmental objects identifies important sources of security, belonging, and self-identity. Further research is needed to define the nature of environmental connections in later life, their developmental characteristics, and their potential to influence the health of older people.

  11. [Improving Mental Health Care in People at Risk for Getting Homeless].

    PubMed

    Salize, Hans Joachim; Arnold, Maja; Uber, Elisa; Hoell, Andreas

    2017-01-01

    Objective: Overall aim was to reduce the untreated prevalence in persons with untreated mental disorders and at risk for loosing accommodation and descending into homelessness. Primary aim was treatment initiation and treatment adherence by motivational interviewing. Secondary aims were to reduce social or financial problems. Methods: Persons at risk were identified in social welfare services or labour agencies, diagnosed and motivated to initiate treatment in a community mental health service. Results: 58 persons were included, 24 were referred to regular mental health care, 8 were stabilized enough after the initial motivational to refrain from acute treatment, 26 dropped out. During a 6-month follow-up quality of life and social support was improved (partly statistically significant) and psycho-social needs for care decreased. Conclusion: Motivational interviewing is likely to increase insight into illness and acceptance of mental health care in untreated persons with mental disorders at risk for social decline.

  12. Cognitive person variables in the delay of gratification of older children at risk.

    PubMed

    Rodriguez, M L; Mischel, W; Shoda, Y

    1989-08-01

    The components of self-regulation were analyzed, extending the self-imposed delay of gratification paradigm to older children with social adjustment problems. Delay behavior was related to a network of conceptually relevant cognitive person variables, consisting of attention deployment strategies during delay, knowledge of delay rules, and intelligence. A positive relationship was demonstrated between concurrent indexes of intelligence, attention deployment, and actual delay time. Moreover, attention deployment, measured as an individual differences variable during the delay process, had a direct, positive effect on delay behavior. Specifically, as the duration of delay and the frustration of the situation increased, children who spent a higher proportion of the time distracting themselves from the tempting elements of the delay situation were able to delay longer. The effect of attention deployment on delay behavior was significant even when age, intelligence, and delay rule knowledge were controlled. Likewise, delay rule knowledge significantly predicted delay time, even when age, attention deployment, and intelligence were controlled.

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

    ERIC Educational Resources Information Center

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

    2015-01-01

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

  14. Hand function is impaired in healthy older adults at risk of Parkinson's disease.

    PubMed

    Todd, Gabrielle; Haberfield, Miranda; Faulkner, Patrick L; Rae, Caroline; Hayes, Michael; Wilcox, Robert A; Taylor, Janet L; Gandevia, Simon C; Godau, Jana; Berg, Daniela; Piguet, Olivier; Double, Kay L

    2014-11-01

    Abnormal substantia nigra morphology in healthy individuals, viewed with transcranial ultrasound, is a significant risk factor for Parkinson's disease. However, little is known about the functional consequences of this abnormality (termed 'hyperechogenicity') on movement. The aim of the current study was to investigate hand function in healthy older adults with (SN+) and without (SN-) substantia nigra hyperechogenicity during object manipulation. We hypothesised that SN+ subjects would exhibit increased grip force and a slower rate of force application compared to SN- subjects. Twenty-six healthy older adults (8 SN+ aged 58 ± 8 years, 18 SN- aged 57 ± 6 years) were asked to grip and lift a light-weight object with the dominant hand. Horizontal grip force, vertical lift force, acceleration, and first dorsal interosseus EMG were recorded during three trials. During the first trial, SN+ subjects exhibited a longer period between grip onset and lift onset (i.e. preload duration; 0.27 ± 0.25 s) than SN- subjects (0.13 ± 0.08 s; P = 0.046). They also exerted a greater downward force prior to lift off (-0.54 ± 0.42 N vs. -0.21 ± 0.12 N; P = 0.005) and used a greater grip force to lift the object (19.5 ± 7.0 N vs. 14.0 ± 4.3 N; P = 0.022) than SN- subjects. No between group differences were observed in subsequent trials. SN+ subjects exhibit impaired planning for manipulation of new objects. SN+ individuals over-estimate the grip force required, despite a longer contact period prior to lifting the object. The pattern of impairment observed in SN+ subjects shares similarities with de novo Parkinson's disease patients.

  15. Yearly transitions of disability profiles in older people living at home.

    PubMed

    Raîche, Michel; Hébert, Réjean; Dubois, Marie-France; Gueye, N'deye Rokhaya; Dubuc, Nicole

    2012-01-01

    Planning home services for older people requires extensive knowledge about the progression of disabilities. Disability-based case-mix classifications identify meaningful groups of older people; yet transitions between profiles are mostly unknown. Disability was assessed annually over four years with the Functional Autonomy Measurement System (SMAF) in 1410 older people at risk of functional decline aged 75 and over and living at home. The SMAF generates a case-mix classification of 14 Iso-SMAF profiles with progressive mean disability levels. Transitions made by older people were analyzed using a continuous-time, multi-state Markov model to estimate the probabilities of annual transitions into and out of each profile as well as the mean sojourn time in each profile. The probability of staying in a profile tended to decrease as profile severity increased. For profiles 5 and above, recovery to mild profiles 1, 2 and 3 was low, while annual probabilities of death and institutionalization were high (>0.10). The lower disability profiles (1 and 2) evidenced a mean profile sojourn time of over two years, contrary to sojourn times of 18 months or less with the other profiles. The probabilities are identifiable, indicating that a disability-based classification can characterize progression in older people. Since the required resources and costs are known for each profile, these probabilities are very helpful in planning home services for elderly populations. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  16. Exercise adoption among older, low-income women at risk for cardiovascular disease.

    PubMed

    Hays, Laura M; Pressler, Susan J; Damush, Teresa M; Rawl, Susan M; Clark, Daniel O

    2010-01-01

    Using an expanded Social Cognitive Theory (SCT) model, we hypothesized that self-efficacy, outcome expectations, and exercise self-definition would predict exercise adoption. This secondary analysis examined data from a prospective single-group study of low-income women who received a physician screen and referral to a community-based, free exercise program. The sample included 190 older, low-income women with a mean age of 64 years, the majority of whom were African American (66%) and had at least one cardiovascular risk factor (92%). Baseline values of self-efficacy, outcome expectations, and exercise self-definition were measured using instruments developed for the study. Exercise adoption was defined as the number of exercise sessions completed over 8 weeks. Our hypothesis was tested using hierarchical multiple regression. The mean number of exercise sessions completed over the 8-week period was 5.7 out of a recommended 24. Value of Exercise scores, a subscale of the Exercise Self-Definition scale, predicted exercise adoption. Self-efficacy and outcome expectations were not predictive. The significance of Value of Exercise scores reinforces the importance of expanding SCT with additional variables such as exercise self-definition. Future work should emphasize the social and environmental factors that form an important part of SCT.

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

    PubMed

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

    2012-01-01

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

  18. Circadian temperature rhythms of older people

    NASA Technical Reports Server (NTRS)

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

    1995-01-01

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

  19. Circadian temperature rhythms of older people

    NASA Technical Reports Server (NTRS)

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

    1995-01-01

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

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

    PubMed

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

    2015-09-01

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

  1. Young people at risk of psychosis: a user-led exploration of interpersonal relationships and communication of psychological difficulties.

    PubMed

    Byrne, Rory; Morrison, Anthony P

    2010-05-01

    The aim of the present study was to qualitatively explore experiences and perceptions of interpersonal relationships and interpersonal communication among young people at risk of psychosis. Semi-structured interviews were conducted using a qualitative grounded theory approach. Participants had entered into a service providing psychological interventions for young people assessed to be at a high risk of developing psychosis (Northwest UK). Our sample comprised one female and seven male participants (n = 8), ranging in age from 16 to 28 years, with a mean age of 22.4 years. Analyses identified three central themes: difficulty with interpersonal relationships and reduced opportunities for helpful communication, difficulty talking to others about psychological problems, and experiences of talking to others about psychological problems. Individuals at risk of psychosis may have experienced significant difficulties with interpersonal relationships. Such difficulties may contribute directly to the development of unusual psychological experiences, and to an inability or reluctance to communicate these to others. In addition, commonly held stigmatizing ideas associated with unusual psychological experiences may contribute to a fear among at-risk individuals that they are 'going mad', and this may lead to concealment of their difficulties, and to delayed help-seeking. For at-risk individuals, helpful communication of psychological distress offers significant benefits, including improved psychological and emotional well-being and reduced risk of psychosis. Thus, while concealment of distress may directly impact on the development of unusual psychological difficulties, communication of such difficulties may be central to recovery.

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

    PubMed

    Magallares, Alejandro

    2012-11-01

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

  3. Does the body temperature change in older people?

    PubMed

    Güneş, Ulkü Yapucu; Zaybak, Ayten

    2008-09-01

    The aim of this study was to determine the mean body temperatures in older people using mercury-in-glass thermometer. Older people are unable to regulate their body temperatures to the same degree as young adults because their responses to changes in body temperature are altered. Several published reports suggest that body temperature decreases with advancing age and has a greater variability in older populations. The aim of this study was to determine the mean body temperatures in older people. Non-experimental. Axillary body temperatures were taken in 133 older subjects in a nursing home for older people using mercury-in-glass thermometer. Temperatures were measured at 8 a.m., 2 p.m., and 6 p.m., over three consecutive days. Each subject had all three measurements taken on the same day. The mean age of the subjects was 77.2, SD 7.3. In the 133 older subjects, the mean axillary temperatures ranged from 35.1 to 36.4 degrees C (95.3-97.6 degrees F). The mean temperatures for those aged 65-74 was higher than in those aged 75-84 (p < 0.001) and those aged 85 and older (p < 0.001) at 6 p.m. but not at 8 a.m. or 2 p.m. We concluded that older people have mean axillary body temperatures lower than the reference point of 36.5 degrees C (97.7 degrees F). When assessing body temperature, it is important to take the age of the patient into consideration. Also, the reference point of 36.5 degrees C is inappropriate in older people, especially when diagnosing a febrile illness.

  4. The new caring: financial asset management and older people.

    PubMed

    Tilse, Cheryl; Wilson, Jill; Setterlund, Deborah; Rosenman, Linda

    2007-10-01

    Increasing longevity and the growing proportion of the aged in the population in most countries have served to focus on the question of how governments and older people can finance living, health, and care options in retirement. Prudent management of income and assets is an increasingly complex and important aspect of aging as assets and expectations of self-financing increase. Although many informal caregivers act as asset managers and/or substitute decision-makers for older people, little attention has been paid to this increasingly important aspect of care. This paper summaries key findings of a broad research program exploring family involvement in the management of older people's assets and the practices that constitute good practice as well as financial mismanagement and abuse. It identifies multi-level and multi-strategy responses needed to address the issues raised by the research and outlines an innovative community demonstration project aimed at improving financial management practices in relation to older people's assets.

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

    ERIC Educational Resources Information Center

    Hansen, Anna; Zipsane, Henrik

    2014-01-01

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

  6. Reluctant Learners: Social Work Students and Work with Older People.

    ERIC Educational Resources Information Center

    Quinn, Ann

    2000-01-01

    Studies show that social work students prefer work with children and families over older people. The Repertory Grid Technique was used with 13 students to provide a structure for reflection on attitudes. Dialog about work with older adults was stimulated. (SK)

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

    ERIC Educational Resources Information Center

    Hansen, Anna; Zipsane, Henrik

    2014-01-01

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

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

    ERIC Educational Resources Information Center

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

    2010-01-01

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

  9. Effectiveness of home based support for older people: systematic review and meta-analysis

    PubMed Central

    Elkan, Ruth; Kendrick, Denise; Dewey, Michael; Hewitt, Michael; Robinson, Jane; Blair, Mitch; Williams, Deb; Brummell, Kathy

    2001-01-01

    Objective To evaluate the effectiveness of home visiting programmes that offer health promotion and preventive care to older people. Design Systematic review and meta-analysis of 15 studies of home visiting. Participants Older people living at home, including frail older people at risk of adverse outcomes. Outcome measures Mortality, admission to hospital, admission to institutional care, functional status, health status. Results Home visiting was associated with a significant reduction in mortality. The pooled odds ratio for eight studies that assessed mortality in members of the general elderly population was 0.76 (95% confidence interval 0.64 to 0.89). Five studies of home visiting to frail older people who were at risk of adverse outcomes also showed a significant reduction in mortality (0.72; 0.54 to 0.97). Home visiting was associated with a significant reduction in admissions to long term care in members of the general elderly population (0.65; 0.46 to 0.91). For three studies of home visiting to frail, “at risk” older people, the pooled odds ratio was 0.55 (0.35 to 0.88). Meta-analysis of six studies of home visiting to members of the general elderly population showed no significant reduction in admissions to hospital (odds ratio 0.95; 0.80 to 1.09). Three studies showed no significant effect on health (standardised effect size 0.06; –0.07 to 0.18). Four studies showed no effect on activities of daily living (0.05; –0.07 to 0.17). Conclusion Home visits to older people can reduce mortality and admission to long term institutional care. What is already known on this topicThe benefits of regular, preventive home visits to older people are the subject of controversyA recent systematic review found no clear evidence that preventive home visits were effectiveWhat this study addsThis meta-analysis of 15 trials shows that home visiting can reduce mortality and admission to institutional care among older people PMID:11576978

  10. Nutritional status of community-dwelling older people with dementia: associations with individual and family caregivers' characteristics.

    PubMed

    Rullier, Laetitia; Lagarde, Alexia; Bouisson, Jean; Bergua, Valérie; Barberger-Gateau, Pascale

    2013-06-01

    The objective of this study was to explore the associations of individual characteristics of both older people with dementia and family caregivers with the nutritional status of older people with dementia. This cross-sectional study comprising 56 community-dwelling older persons with dementia and 56 family caregivers was conducted at home by a psychogerontologist working for a community gerontological center. Older people with dementia were assessed with Mini mental state examination, Instrumental Activities of Daily Living, Activities of Daily Living (ADL), and NeuroPsychiatric Inventory (NPI) and family caregivers with the Burden Interview (Zarit scale), the State-Trait Anxiety Inventory, the Center for Epidemiologic Studies Depression Scale, and the emotional impact measure of NPI. For both, nutritional status was evaluated using the Mini Nutritional Assessment (MNA). Among older people with dementia, 58.9% were at risk of malnutrition and 23.2% presented a poor nutritional status, and among the family caregivers, 32.1% and 5.4%, respectively. The MNA score of older people with dementia was strongly and inversely associated with the ADL score and was strongly and positively associated with the MNA score of family caregiver. These two factors significantly explained 32% of variation of MNA score of older people with dementia. These findings confirm the value of investigating nutritional deficiencies in dementia within the caregiving dyad and suggest that the functional status of older people with dementia and the nutritional status of family caregivers should be carefully assessed. Copyright © 2012 John Wiley & Sons, Ltd.

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

    ERIC Educational Resources Information Center

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

    2004-01-01

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

  12. Body weight, anorexia, and undernutrition in older people.

    PubMed

    Soenen, Stijn; Chapman, Ian M

    2013-09-01

    Ideal body weight for maximum life expectancy increases with advancing age. Older people, however, tend to weigh less than younger adults, and old age is also associated with a tendency to lose weight. Weight loss in older people is associated with adverse outcomes, particularly if unintentional, and initial body weight is low. When older people lose weight, more of the tissue lost is lean tissue (mainly skeletal muscle) than in younger people. When excessive, the loss of lean muscle tissue results in sarcopenia, which is associated with poor health outcomes. Unintentional weight loss in older people may be a result of protein-energy malnutrition, cachexia, the physiological anorexia of aging, or a combination of these. The physiological anorexia of aging is a decrease in appetite and energy intake that occurs even in healthy people and is possibly caused by changes in the digestive tract, gastrointestinal hormone concentrations and activity, neurotransmitters, and cytokines. A greater understanding of this decrease in appetite and energy intake during aging, and the responsible mechanisms, may aid the search for ways to treat undernutrition and weight loss in older people. Copyright © 2013 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

  13. Factors influencing nurses' readiness to care for hospitalised older people.

    PubMed

    Baumbusch, Jennifer; Leblanc, Marie-Eve; Shaw, Maureen; Kjorven, Mary

    2016-06-01

    To gain a better understanding of nurses' perspectives on factors that influence their readiness to provide appropriate care for hospitalised older people. Hospitals have consistently been criticised for failing to address the unique, complex needs of older people. Research suggests that multiple issues have led to this situation, including a lack of educational preparation for nurses, limited attention to environmental factors, and an absence of organisational preparedness that ensures hospitals are adapted to meet the needs of older people. An exploratory, qualitative approach was used. Forty-one Registered Nurses participated (24 point-of-care nurses; 17 organisational leaders). Six focus groups and one individual interview were conducted. Thematic data analysis was employed to generate the main study findings. An overarching theme of 'Poor Fit' emerged. While participants identified the shifting needs of patients towards more complex and relational care, the broader organisational and societal contexts were, largely, unchanging. This resulted in nurses recognising the factors needed to be ready to care for older patients and their families, but working in hospitals that were not suited to these needs. The findings identify factors at the point-of-care, the organisational level, and in broader societal attitudes that shape nurses' readiness to care for hospitalised older people. However, many of these factors are modifiable and care for older people could be improved through quality improvement initiatives and nursing leadership. This study offers insight into ways to re-imagine nursing care that can be responsive to older people's complex needs in hospitals. With a growing contingent of hospitalised older people, it is imperative that nurses, who comprise the largest workforce in this setting, be included in the planning and delivery of healthcare services to ensure readiness to meet the needs of this population. © 2015 John Wiley & Sons Ltd.

  14. Myths about older people's use of information and communication technology.

    PubMed

    Wandke, Hartmut; Sengpiel, Michael; Sönksen, Malte

    2012-01-01

    This paper discusses six myths common in the field of 'human-computer interaction (HCI) and older people'. These myths are widespread among computer scientists, engineers and programmers, as well as among the general public and even older individuals themselves. We can define these myths as follows. (1) Just wait and see. Future generations of older people will use computers without problems. This myth differs from those following, as it may lead to a (dangerous) conclusion of avoidance and inactivity by integrating myths 2-6. If the other myths are accepted as being true and one assumes that the problems will eventually solve themselves, it might not seem worthwhile to expend any effort on 'universal design' for older people's use of information and communication technology (ICT). However, we argue that if we do not actively and properly counteract these myths, we will perpetuate them and their grave consequences. (2) Older people are not interested in using computers. They are unaware of computer capabilities. (3) Older people consider computers as useless and unnecessary. (4) Older people lack the physical capabilities to use ICT. (5) Older people simply cannot understand interactive computing technology. (6) You can't teach an old dog new tricks. The problem of HCI for older people is that they do not learn to use new technologies and interaction techniques. In discussing these myths, we demonstrate that each one contains a grain of truth. However, the myths are improperly overgeneralized and, therefore, often wrong. Such myths are problematic. Designers and engineers often accept them as truths and neglect older users and/or apply information and communication technologies in an age-discriminating manner. Furthermore, the myths are problematic as they lead older people to avoid computer usage (i.e. a self-fulfilling prophecy). We present evidence to support the notion that these myths may often be largely - although not completely - wrong. We then demonstrate

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

    PubMed

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

    2015-08-01

    According to stress-vulnerability models, social stressors contribute to the onset of schizophrenia. Stigma and discrimination associated with mental illness may be a stressor for young people at risk of psychosis even prior to illness onset, but quantitative longitudinal data on this issue are lacking. We examined the cognitive appraisal of stigma-related stress as predictor of transition to schizophrenia among young people at risk of psychosis. In Zürich, Switzerland, 172 participants between 13 and 35years old and with either high or ultra-high risk of psychosis or risk of bipolar disorder were included. With 71 dropouts, transition was assessed during 12months among 101 participants of whom 13 converted to schizophrenia. At baseline, the cognitive appraisal of stigma as a stressor was measured by self-report, based on the primary appraisal of stigma as harmful and the secondary appraisal of resources to cope with stigma. Positive and negative symptoms were examined using the Positive and Negative Syndrome Scale. Compared with participants who did not convert to schizophrenia, converters had significantly more positive (p<.001) and negative (p<.001) symptoms and reported higher levels of stigma-related harm (p=.003) and stress (p=.009) at baseline. More perceived harm due to stigma at baseline predicted transition to schizophrenia (odds ratio 2.34, 95%-CI 1.19-4.60) after adjusting for age, gender, symptoms and functioning. Stigma stress may increase the risk of transition to schizophrenia. Research is needed on interventions that reduce public negative attitudes towards young people at risk and that support individuals at risk to cope with stigma-related stress. Copyright © 2015 Elsevier B.V. All rights reserved.

  16. Hippocampal volume in older adults at risk of cognitive decline: the role of sleep, vascular risk, and depression.

    PubMed

    Elcombe, Emma L; Lagopoulos, Jim; Duffy, Shantel L; Lewis, Simon J G; Norrie, Louisa; Hickie, Ian B; Naismith, Sharon L

    2015-01-01

    Decreased hippocampal volume in older adults is associated with neurodegenerative and psychiatric diseases. Several modifiable risk factors have been associated with the size of this structure, however the relative contribution of these factors to hippocampal atrophy is unclear. This study aimed to examine the relationship between modifiable risk factors and hippocampal volume in older adults at risk of cognitive decline. Two hundred and eighteen participants (mean age = 67.3 years, MMSE = 28.6) with mood and/or memory complaints underwent clinical and neuropsychological assessment, and magnetic resonance imaging. Measures of depression, global cognitive functioning, exercise, vascular health, cognitive reserve, sleep, and memory were collected. Hippocampal volumes were derived using image segmentation as implemented by FMRIB Software Library. Smaller hippocampal volumes were strongly associated with poorer verbal learning and memory as well as diagnoses of either multiple or amnestic mild cognitive impairment. Based on univariate correlations, multivariable regressions were performed (controlling for age and total intracranial volume) to determine which modifiable risk factors were associated with hippocampal volume. For the left hippocampus, poor sleep efficiency and greater than five years untreated depressive illness remained significant predictors. For the right hippocampus, diabetes and low diastolic blood pressure significant predictors. Although their contribution is small, lower sleep efficiency, low blood pressure, diabetes, and untreated depression are associated with reduced hippocampal volumes. Studies exploring the impact of early intervention for these risk factors on hippocampal integrity are warranted.

  17. Are Young People Biased against Older Teachers?

    ERIC Educational Resources Information Center

    Peterson, Candida C.

    1980-01-01

    Elementary school students and university students indicated they preferred younger male and female (under 35) to older teachers. Personality and competence were given as reasons for their preferences by sixth graders and university students. Younger children gave no explanation nor did they indicate teacher appearance or resemblance to well-known…

  18. Are Young People Biased against Older Teachers?

    ERIC Educational Resources Information Center

    Peterson, Candida C.

    1980-01-01

    Elementary school students and university students indicated they preferred younger male and female (under 35) to older teachers. Personality and competence were given as reasons for their preferences by sixth graders and university students. Younger children gave no explanation nor did they indicate teacher appearance or resemblance to well-known…

  19. ICT and Older People: Beyond Usability

    ERIC Educational Resources Information Center

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

    2009-01-01

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

  20. Managing constipation in older people in hospital.

    PubMed

    Wessel-Cessieux, Elizabeth

    Constipation is a distressing disorder that is common among older patients in hospital. It is often underdiagnosed and undertreated, and can lead to increased morbidity and prolonged hospital stays. In most cases this common problem can be treated successfully if the correct management plan is adopted. This article reviews the prevention and management strategies available to address the issue.

  1. The welfare implications of disability for older people in Ireland.

    PubMed

    Cullinan, John; Gannon, Brenda; O'Shea, Eamon

    2013-04-01

    Recent data analysed for Ireland suggest a strong link between disability status and household poverty, while there exists substantial evidence to suggest that disability is highly prevalent among persons of older age. Within this context, this paper estimates the welfare implications of disability for older people in Ireland. We define and estimate models of the private costs borne by households with older persons who have a disability in Ireland, both in general and by severity of illness or condition. Our modelling framework is based on the standard of living approach to estimating the cost of disability. The model quantifies the extra costs of living associated with disability and is estimated by comparing the standard of living of households with and without disabled members at a given income, controlling for other sources of variation. The analysis suggests that the estimated economic cost of disability for older people in Ireland is significant and varies by severity of disability, as well as by household type. The results also suggest that the cost of disability increases in proportionate terms as the number of people in the household decreases. Our results are important when considering the effectiveness of policies that aim to address the economic problems associated with disability for older people, suggesting that current policy in Ireland does not go far enough. They indicate that older people face a double jeopardy through age and disability, which is not reflected in official poverty rates and support the case for the introduction of disability-adjusted poverty payments.

  2. Family involvement in emergency department discharge education for older people.

    PubMed

    Palonen, Mira; Kaunonen, Marja; Åstedt-Kurki, Päivi

    2016-11-01

    To report findings concerning family involvement in emergency department discharge education for older people. The current trend of population ageing in Western countries has caused an increase in emergency department visits. Due to the continuing improvement in the mental and physical status of older people, they are frequently discharged home. Proper discharge education enables older people and their families to better understand how they can cope with the medical issue at home. Given the lack of research, we know relatively little about the significance of family involvement in older people's emergency department discharge education. A descriptive qualitative design was used. Qualitative thematic interviews of seven older patients, five family members and fifteen nurses were conducted. Data were analysed using content analysis. Family involvement in discharge education was seen as turbulent. The experiences were twofold: family involvement was acknowledged, but there was also a feeling that family members were ostracised. Families were seen as a resource for nurses, but as obliged initiators of their own involvement. Our findings suggest that family members are not considered participants in emergency department care. For a family-friendly approach, actions should be taken on both individual and organisational levels. The findings support healthcare providers and organisation leaders in promoting family involvement in discharge education for older people. Families can be encouraged to be involved without feeling responsible for the interaction. © 2016 John Wiley & Sons Ltd.

  3. Physical Activity among Older People and Related Factors

    ERIC Educational Resources Information Center

    Persson, Ann; While, Alison

    2012-01-01

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

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

    PubMed Central

    Gruber, June; Johnson, Sheri L.

    2010-01-01

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

  5. How Drama Can Engage Young People at Risk of Leaving School Early

    ERIC Educational Resources Information Center

    Stokes, Helen

    2005-01-01

    Health promotion and community building strategies are increasingly using the arts as a basis for engaging young people. Through involvement in arts activity, participants have been shown to develop supportive social networks and report increased feelings of well-being (Jermyn, 2001). In particular, drama strategies and programs have been used as…

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

    ERIC Educational Resources Information Center

    Hanewald, Ria

    2011-01-01

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

  7. Physical activity in older people: a systematic review

    PubMed Central

    2013-01-01

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

  8. Promoting personalization in social care services for older people.

    PubMed

    Xie, Chengqiu; Hughes, Jane; Sutcliffe, Caroline; Chester, Helen; Challis, David

    2012-01-01

    This article presents findings on 4 themes associated with the personalization of social care for older people: integration of health and social care services; initiatives that prevent the need for more costly interventions; services to maintain people at home; and systems that promote choice, control, and flexibility. The quantitative study utilized data from a national postal survey conducted in England. Findings suggest variable progress regarding the range and style of support available to older people. These are discussed in the context of service integration, community-based services, and consumer-directed care. Implications for service development and future research are highlighted.

  9. Predictors of the quality of life of older people with heart failure recruited from primary care.

    PubMed

    Gott, Merryn; Barnes, Sarah; Parker, Chris; Payne, Sheila; Seamark, David; Gariballa, Salah; Small, Neil

    2006-03-01

    Current understanding of quality of life in heart failure is largely derived from clinical trials. Older people, women and those with co-morbidities are underrepresented in these. Little is known about factors predictive of quality of life amongst older people with heart failure recruited from community settings. To identify factors predictive of quality of life amongst older people recruited from community settings. prospective questionnaire survey. General practice surgeries located in four areas of the UK: Bradford, Barnsley, East Devon and West Hampshire. A total of 542 people aged >60 years with heart failure. Participants completed a postal questionnaire, which included a disease-specific measure (Kansas City Cardiomyopathy Questionnaire), a generic quality-of-life measure (SF-36) and sociodemographic information. A multiple linear regression analysis identified the following factors as predictive of decreased quality of life: being female, being in New York Heart Association (NYHA) functional class III or IV, showing evidence of depression, being in socioeconomic groups III-V and experiencing two or more co-morbidities. Older age was associated with decreased quality of life, as measured by a generic health-related quality-of-life tool (the SF-36 mental and physical health functioning scales) but not by a disease-specific tool (the Kansas City Cardiomyopathy Questionnaire). Findings from the study suggest that quality of life for older people with heart failure can be described as challenging and difficult, particularly for women, those in a high NYHA class, patients showing evidence of depression, patients in socioeconomic groups III-V, those experiencing two or more co-morbidities and the 'oldest old'. Such information can help clinicians working with older people identify those at risk of reduced quality of life and target interventions appropriately.

  10. A brighter future for older people.

    PubMed

    2001-05-01

    There was a cartoon in a recent issue of Private Eye in which a doctor was telling an older woman: 'Under the new charter, elderly patients will not be treated differently by the NHS - they'll be treated just as badly as everyone else.' If you overlooked the fact that the woman's slightly dotty hat and nervous clutching of her handbag were the cartoonist's clumsy way of indicating her advancing years, there was a certain ironic wit in the caricature.

  11. Nutrition screening of older people in a community general practice, using the MNA-SF.

    PubMed

    Winter, J; Flanagan, D; McNaughton, S A; Nowson, C

    2013-04-01

    The study aimed to determine the prevalence of malnutrition risk in a population of older people (aged 75 years and over) attending a community general practice and identify characteristics of those classified as malnourished or at risk of malnutrition. Cross-sectional study of nutritional risk screen conducted over a six month period. Patients attending a general practice clinic in Victoria, Australia, who attended for the "75 plus" health assessment check. The Mini Nutritional Assessment Short Form (MNA®-SF) was included as part of the health assessment. Information was collected on living situation, co-morbidities, independence with meal preparation and eating, number of medications. Height and weight was measured and MNA®-SF score recorded. Two hundred and twenty five patients attending a general practice for a health assessment with a mean age of 81.3(4.3)(SD) years, 52% female and 34% living alone. Only one patient was categorised by the MNA®-SF as malnourished, with an additional 16% classified as at risk of malnutrition. The mean Body Mass Index (BMI) of the at-risk group was significantly lower than the well-nourished group (23.6 ± 0.8 (SEM) vs 27.4 ± 0.3; p=0.0001). However, 34% of the at-risk group had a BMI of 25 or more with only 13% in the underweight category. In this population of older adults attending their general practitioner for an annual health assessment, one in six were identified as being at nutritional risk which is an additional risk factor for a severe health issue. Importantly, one third of the at-risk group had a BMI in the overweight or obese category, highlighting that older people can be at nutritional risk although they may be overweight or obese.

  12. Mental well-being and independence for older people.

    PubMed

    Pearce, Lynne

    2017-02-08

    Essential facts The UK population is ageing rapidly, with the number of people aged 65 or above rising by almost half in the past three decades. By 2035, it is estimated that almost one in four people will be aged 65 or more. The Mental Health Foundation says five main factors affect the mental health and well-being of older people: discrimination, participating in meaningful activities, relationships, physical health and poverty.

  13. STEREOTYPES ABOUT PEOPLE LIVING WITH HIV: IMPLICATIONS FOR PERCEPTIONS OF HIV RISK AND TESTING FREQUENCY AMONG AT-RISK POPULATIONS

    PubMed Central

    Earnshaw, Valerie A.; Smith, Laramie R.; Chaudoir, Stephenie R.; Lee, I-Ching; Copenhaver, Michael M.

    2013-01-01

    Although research continues to demonstrate that HIV stigma is associated with decreased HIV testing, the psychological processes implicated in this association remain unclear. The authors address this gap by differentiating between the HIV stigma mechanisms of stereotypes, prejudice, and discrimination. They hypothesize that HIV stereotypes specifically, more so than prejudice or discrimination, are associated with HIV testing among at-risk populations. Ninety-three HIV-negative people receiving methadone maintenance therapy at a clinic in the northeastern United States participated by completing a survey. Results demonstrated that HIV stereotypes are associated with HIV testing via the mediator of perceived HIV risk. As hypothesized, prejudice, discrimination, and objective HIV risk were not associated with perceived HIV risk. Differentiating between HIV stigma mechanisms in future work can provide critical insight into how to intervene in HIV stigma to increase HIV testing and improve HIV prevention among at-risk populations. PMID:23206205

  14. Stereotypes about people living with HIV: implications for perceptions of HIV risk and testing frequency among at-risk populations.

    PubMed

    Earnshaw, Valerie A; Smith, Laramie R; Chaudoir, Stephenie R; Lee, I-Ching; Copenhaver, Michael M

    2012-12-01

    Although research continues to demonstrate that HIV stigma is associated with decreased HIV testing, the psychological processes implicated in this association remain unclear. The authors address this gap by differentiating between the HIV stigma mechanisms of stereotypes, prejudice, and discrimination. They hypothesize that HIV stereotypes specifically, more so than prejudice or discrimination, are associated with HIV testing among at-risk populations. Ninety-three HIV-negative people receiving methadone maintenance therapy at a clinic in the northeastern United States participated by completing a survey. Results demonstrated that HIV stereotypes are associated with HIV testing via the mediator of perceived HIV risk. As hypothesized, prejudice, discrimination, and objective HIV risk were not associated with perceived HIV risk. Differentiating between HIV stigma mechanisms in future work can provide critical insight into how to intervene in HIV stigma to increase HIV testing and improve HIV prevention among at-risk populations.

  15. Comparison of anxiety as reported by older people with intellectual disabilities and by older people with normal intelligence.

    PubMed

    Hermans, Heidi; Beekman, Aartjan T F; Evenhuis, Heleen M

    2014-12-01

    Older people with intellectual disabilities (ID) may experience more and different symptoms of anxiety than older people with normal intelligence. (1) Is the reported severity of anxiety in this group similar to that in the general older population; (2) Are specific anxiety symptoms reported as frequently by both groups? Cross-sectional. Formal Dutch intellectual disability services and Dutch population-based study. One hundred fifty-four participants of the Healthy Ageing and Intellectual Disability study with mild or moderate ID (IQ <70), aged 55-85 years, and 2,917 participants of the Longitudinal Aging Study Amsterdam with normal intelligence, aged 55-85 years. The general anxiety subscale of the Hospital Anxiety and Depression Scale. Mean (standard deviation) Hospital Anxiety and Depression Scale total score of subjects with ID was significantly higher than that of subjects with normal intelligence (3.53 [3.03]) versus 2.53 [3.30]; p <0.01), whereas the percentage of scores above cutoff in both groups was similar. Four of 7 items were more often reported as present by subjects with ID: "tense or wound up feelings," "frightened feelings," "worrying thoughts," and "sudden feelings of panic." Older people with ID report more symptoms of anxiety than older people with normal intelligence. Tense feelings and worrying especially need more attention, because more than one-half of all older people with ID reported such symptoms. Copyright © 2014 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

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

    ERIC Educational Resources Information Center

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

    2011-01-01

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

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

    ERIC Educational Resources Information Center

    Lu, Luo

    2010-01-01

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

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

    ERIC Educational Resources Information Center

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

    2011-01-01

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

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

    ERIC Educational Resources Information Center

    Lu, Luo

    2010-01-01

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

  20. Better Mental Health Care for Older People in India

    PubMed Central

    Shaji, K.S.; Kishore, N.R. Arun; Lal, K. Praveen; Pinto, Charles; Trivedi, J.K.

    2004-01-01

    Demographic aging will soon lead to a sudden increase in the number of older people with dementia and depression in India. We need to develop services to meet the mental health needs of the aged in the population. Geriatric Psychiatry section of IPS has initiated a process of consultations to address this emerging public health issue. Health professionals involved in the care of older people with mental health problems took part in focus group discussions Their opinion and suggestions regarding development of psychogeriatric services and research were gathered. Urgent action is needed to improve the existing low levels of public awareness about mental health problems of older people. Home based care needs to be supported through formal services in the community. If sensitised properly clinicians, can be more effective in managing depression and dementia at primary care level. Research initiatives can be facilitated by networking of researchers and active efforts at dissemination of important research findings. Community health workers could be trained to identify and provide help to older people with mental health problems and their carers. Community outreach programmes for elderly could be particularly relevant in the rural areas where as development of clinic based psycho-geriatric services may be feasible in urban settings. Good research can influence and shape policies which in turn can result in better mental health care for older people. PMID:21206797

  1. Better mental health care for older people in India.

    PubMed

    Shaji, K S; Kishore, N R Arun; Lal, K Praveen; Pinto, Charles; Trivedi, J K

    2004-10-01

    Demographic aging will soon lead to a sudden increase in the number of older people with dementia and depression in India. We need to develop services to meet the mental health needs of the aged in the population. Geriatric Psychiatry section of IPS has initiated a process of consultations to address this emerging public health issue. Health professionals involved in the care of older people with mental health problems took part in focus group discussions Their opinion and suggestions regarding development of psychogeriatric services and research were gathered. Urgent action is needed to improve the existing low levels of public awareness about mental health problems of older people. Home based care needs to be supported through formal services in the community. If sensitised properly clinicians, can be more effective in managing depression and dementia at primary care level. Research initiatives can be facilitated by networking of researchers and active efforts at dissemination of important research findings. Community health workers could be trained to identify and provide help to older people with mental health problems and their carers. Community outreach programmes for elderly could be particularly relevant in the rural areas where as development of clinic based psycho-geriatric services may be feasible in urban settings. Good research can influence and shape policies which in turn can result in better mental health care for older people.

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

    PubMed Central

    Ward, Lizzie; Barnes, Marian

    2016-01-01

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

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

    PubMed Central

    Nowson, Caryl; O’Connell, Stella

    2015-01-01

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

  4. Self-determination and older people--a concept analysis.

    PubMed

    Ekelund, Christina; Dahlin-Ivanoff, Synneve; Eklund, Kajsa

    2014-03-01

    Self-determination has emerged as an important concept within health care, used to emphasize clients' control and independence as they participate in rehabilitation. To strengthen clients' self-determination is a central aim in occupational therapy. However, there is a lack of a clear definition of self-determination concerning community-dwelling older people. The definition should be flexible in different contexts, such as cultural. To define and clarify the concept of self-determination in relation to community-dwelling frail older people. Walker & Avant's analysis procedure was carried out to identify textual attributes to the concept of self-determination, supplemented by a content analysis of 21 articles that were used to define and further justify the textual attributes. Self-determination was used in diverse contexts for community-dwelling older people, concerning: decision-making in everyday life, professionals' views, health, and legal/ethical rights. Different textual attributes were identified, to propose a conceptual definition of self-determination in relation to community-dwelling frail older people: A process in which a person has control and legal/ethical rights, and has the knowledge and ability to make a decision of his/her own free choice. This concept analysis has contributed to clarifying the concept for the convenience of research with community-dwelling frail older people.

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

    PubMed

    Miller, Evonne; Brockie, Lauren

    2015-08-01

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

  6. Risk Factors for Suicidal Ideation in People at Risk for Huntington's Disease.

    PubMed

    Anderson, Karen E; Eberly, Shirley; Groves, Mark; Kayson, Elise; Marder, Karen; Young, Anne B; Shoulson, Ira

    2016-12-15

    Suicidal ideation (SI) and attempts are increased in Huntington's disease (HD), making risk factor assessment a priority. To determine whether, hopelessness, irritability, aggression, anxiety, CAG expansion status, depression, and motor signs/symptoms were associated with Suicidal Ideation (SI) in those at risk for HD. Behavioral and neurological data were collected from subjects in an observational study. Subject characteristics were calculated by CAG status and SI. Logistic regression models were adjusted for demographics. Separate logistic regressions were used to compare SI and non-SI subjects. A combined logistic regression model, including 4 pre-specified predictors, (hopelessness, irritability, aggression, anxiety) was used to assess the relationship of SI to these predictors. 801 subjects were assessed, 40 were classified as having SI, 6.3% of CAG mutation expansion carriers had SI, compared with 4.3% of non- CAG mutation expansion carriers (p = 0.2275). SI subjects had significantly increased depression (p < 0.0001), hopelessness (p < 0.0001), irritability (p < 0.0001), aggression (p = 0.0089), and anxiety (p < 0.0001), and an elevated motor score (p = 0.0098). Impulsivity, assessed in a subgroup of subjects, was also associated with SI (p = 0.0267). Hopelessness and anxiety remained significant in combined model (p < 0.001; p < 0.0198, respectively) even when motor score was included. Behavioral symptoms were significantly higher in those reporting SI. Hopelessness and anxiety showed a particularly strong association with SI. Risk identification could assist in assessment of suicidality in this group.

  7. Nutritional Advice in Older Patients at Risk of Malnutrition during Treatment for Chemotherapy: A Two-Year Randomized Controlled Trial

    PubMed Central

    Bourdel-Marchasson, Isabelle; Blanc-Bisson, Christelle; Doussau, Adélaïde; Germain, Christine; Blanc, Jean-Frédéric; Dauba, Jérôme; Lahmar, Cyril; Terrebonne, Eric; Lecaille, Cédric; Ceccaldi, Joël; Cany, Laurent; Lavau-Denes, Sandrine; Houede, Nadine; Chomy, François; Durrieu, Jessica; Soubeyran, Pierre; Senesse, Pierre; Chene, Geneviève; Fonck, Mariane

    2014-01-01

    Objective We tested the effect of dietary advice dedicated to increase intake in older patients at risk for malnutrition during chemotherapy, versus usual care, on one-year mortality. Method We conducted a multicentre, open-label interventional, stratified (centre), parallel randomised controlled trial, with a 1∶1 ratio, with two-year follow-up. Patients were aged 70 years or older treated with chemotherapy for solid tumour and at risk of malnutrition (MNA, Mini Nutritional Assessment 17–23.5). Intervention consisted of diet counselling with the aim of achieving an energy intake of 30 kCal/kg body weight/d and 1.2 g protein/kg/d, by face-to-face discussion targeting the main nutritional symptoms, compared to usual care. Interviews were performed 6 times during the chemotherapy sessions for 3 to 6 months. The primary endpoint was 1-year mortality and secondary endpoints were 2-year mortality, toxicities and chemotherapy outcomes. Results Between April 2007 and March 2010 we randomised 341 patients and 336 were analysed: mean (standard deviation) age of 78.0 y (4·9), 51.2% male, mean MNA 20.2 (2.1). Distribution of cancer types was similar in the two groups; the most frequent were colon (22.4%), lymphoma (14.9%), lung (10.4%), and pancreas (17.0%). Both groups increased their dietary intake, but to a larger extent with intervention (p<0.01). At the second visit, the energy target was achieved in 57 (40.4%) patients and the protein target in 66 (46.8%) with the intervention compared respectively to 13 (13.5%) and 20 (20.8%) in the controls. Death occurred during the first year in 143 patients (42.56%), without difference according to the intervention (p = 0.79). No difference in nutritional status changes was found. Response to chemotherapy was also similar between the groups. Conclusion Early dietary counselling was efficient in increasing intake but had no beneficial effect on mortality or secondary outcomes. Cancer cachexia antianabolism may explain this

  8. Financial inequality and gender in older people.

    PubMed

    Vlachantoni, Athina

    2012-06-01

    Gender inequalities in the financial resources in later life result from the combined effect of women's atypical life courses, which include interrupted employment records and periods of care provision, and the fact that pension systems have generally been slow in mitigating 'diversions' from continuous and full-time working lives. Gender differentials in financial resources can often result in a greater likelihood of facing poverty for older women compared to older men, and such risk can be experienced for longer periods for women, as a result of their higher life expectancy on average. For example, across the EU-27, 16% of men compared to 23% of women aged 65 and over faced a poverty risk, and at age 65, men can expect to live another 17 years on average, while women another 21 years. Although modern pension systems are increasingly recognising the diversity of women's patterns of paid and unpaid work, for example by accounting for periods of childcare in the calculation of the state pension, research continues to show a 'penalty' for women who have spent significant periods of their life providing care to children or dependent adults in and outside the household. Reducing such penalty is particularly important as population ageing and an increasing demand for formal and informal care are likely to present challenges with critical policy implications for societies and individuals alike.

  9. Care for suicidal older people: current clinical–ethical considerations

    PubMed Central

    Vanlaere, Linus; Bouckaert, Filip; Gastmans, Chris

    2007-01-01

    This article opens by reviewing the state of the knowledge on the most current worldwide facts about suicide in older people. Next, a number of values that have a role in this problem are considered. Having a clear and current understanding of suicide and of the related self‐held and social values forms the framework for a number of clinical–ethical recommendations for care practice. An important aspect of caring for older people with suicidal tendencies is to determine whether their primary care fosters self‐esteem and affirms their dignity. In addition to providing a timely and appropriate diagnosis and treatment of suicidality, the caregiver is responsible for helping the patient to cope with stressful conditions, and for treating the patient with respect and consideration, thereby supporting the patient's dignity and giving the patient a reason to live. Paying attention to these central points will foster caring contact with suicidal older people. PMID:17601861

  10. "Cultivating health": therapeutic landscapes and older people in northern England.

    PubMed

    Milligan, Christine; Gatrell, Anthony; Bingley, Amanda

    2004-05-01

    While gardening is seen, essentially, as a leisure activity it has also been suggested that the cultivation of a garden plot offers a simple way of harnessing the healing power of nature (The therapeutic garden, Bantam Press, London, 2000). One implication of this is that gardens and gardening activity may offer a key site of comfort and a vital opportunity for an individual's emotional, physical and spiritual renewal. Understanding the extent to which this supposition may be grounded in evidence underpins this paper. In particular, we examine how communal gardening activity on allotments might contribute to the maintenance of health and well being amongst older people. Drawing on recently completed research in northern England, we examine firstly the importance of the wider landscape and the domestic garden in the lives of older people. We then turn our attention to gardening activity on allotments. Based on the findings of our study, we illustrate the sense of achievement, satisfaction and aesthetic pleasure that older people can gain from their gardening activity. However, while older people continue to enjoy the pursuit of gardening, the physical shortcomings attached to the aging process means they may increasingly require support to do so. Communal gardening on allotment sites, we maintain, creates inclusionary spaces in which older people benefit from gardening activity in a mutually supportive environment that combats social isolation and contributes to the development of their social networks. By enhancing the quality of life and emotional well being of older people, we maintain that communal gardening sites offer one practical way in which it may be possible to develop a 'therapeutic landscape'.

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

    PubMed

    Lu, Luo

    2010-01-01

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

  12. Pharmaceutical strategies towards optimising polypharmacy in older people.

    PubMed

    Hughes, Carmel M; Cadogan, Cathal A; Patton, Deborah; Ryan, Cristín A

    2016-10-30

    This paper focuses on the issue of polypharmacy in older people and potential pharmaceutical strategies to optimize the use of multiple medicines. Although polypharmacy has long been viewed negatively, increasing emphasis is being placed on the difference between appropriate and inappropriate polypharmacy. This is largely being driven by the increasing prevalence of multimorbidity and the use of evidence-based guidelines. In this paper, we outline a number of key considerations that are pertinent to optimizing polypharmacy, notably prescribing appropriate polypharmacy, pharmaceutical formulations, the involvement of older people in clinical trials and patient adherence. Crown Copyright © 2016. Published by Elsevier B.V. All rights reserved.

  13. Measuring the value of older people's production: a diary study.

    PubMed

    Sahlen, Klas-Göran; Löfgren, Curt; Brodin, Håkan; Dahlgren, Lars; Lindholm, Lars

    2012-01-09

    The productive capacity of retired people is usually not valued. However, some retirees produce much more than we might expect. This diary-based study identifies the activities of older people, and suggests some value mechanisms. One question raised is whether it is possible to scale up this diary study into a larger representative study. Diaries kept for one week were collected among 23 older people in the north of Sweden. The texts were analysed with a grounded theory approach; an interplay between ideas and empirical data. Some productive activities of older people must be valued as the opportunity cost of time or according to the market value, and others must be valued with the replacement cost. In order to make the choice between these methods, it is important to consider the societal entitlement. When there is no societal entitlement, the first or second method must be used; and when it exists, the third must be used. An explicit investigation of the content of the entitlement is needed to justify the choice of valuation method for each activity. In a questionnaire addressing older people's production, each question must be adjusted to the type of production. In order to fully understand this production, it is important to consider the degree of free choice to conduct an activity, as well as health-related quality of life.

  14. Measuring the value of older people's production: a diary study

    PubMed Central

    2012-01-01

    Background The productive capacity of retired people is usually not valued. However, some retirees produce much more than we might expect. This diary-based study identifies the activities of older people, and suggests some value mechanisms. One question raised is whether it is possible to scale up this diary study into a larger representative study. Methods Diaries kept for one week were collected among 23 older people in the north of Sweden. The texts were analysed with a grounded theory approach; an interplay between ideas and empirical data. Results Some productive activities of older people must be valued as the opportunity cost of time or according to the market value, and others must be valued with the replacement cost. In order to make the choice between these methods, it is important to consider the societal entitlement. When there is no societal entitlement, the first or second method must be used; and when it exists, the third must be used. Conclusions An explicit investigation of the content of the entitlement is needed to justify the choice of valuation method for each activity. In a questionnaire addressing older people's production, each question must be adjusted to the type of production. In order to fully understand this production, it is important to consider the degree of free choice to conduct an activity, as well as health-related quality of life. PMID:22230745

  15. The Long-Term Benefits of Increased Aspirin Use by At-Risk Americans Aged 50 and Older

    PubMed Central

    Agus, David B.; Gaudette, Étienne; Goldman, Dana P.; Messali, Andrew

    2016-01-01

    Background The usefulness of aspirin to defend against cardiovascular disease in both primary and secondary settings is well recognized by the medical profession. Multiple studies also have found that daily aspirin significantly reduces cancer incidence and mortality. Despite these proven health benefits, aspirin use remains low among populations targeted by cardiovascular prevention guidelines. This article seeks to determine the long-term economic and population-health impact of broader use of aspirin by older Americans at higher risk for cardiovascular disease. Methods and Findings We employ the Future Elderly Model, a dynamic microsimulation that follows Americans aged 50 and older, to project their lifetime health and spending under the status quo and in various scenarios of expanded aspirin use. The model is based primarily on data from the Health and Retirement Study, a large, representative, national survey that has been ongoing for more than two decades. Outcomes are chosen to provide a broad perspective of the individual and societal impacts of the interventions and include: heart disease, stroke, cancer, life expectancy, quality-adjusted life expectancy, disability-free life expectancy, and medical costs. Eligibility for increased aspirin use in simulations is based on the 2011–2012 questionnaire on preventive aspirin use of the National Health and Nutrition Examination Survey. These data reveal a large unmet need for daily aspirin, with over 40% of men and 10% of women aged 50 to 79 presenting high cardiovascular risk but not taking aspirin. We estimate that increased use by high-risk older Americans would improve national life expectancy at age 50 by 0.28 years (95% CI 0.08–0.50) and would add 900,000 people (95% CI 300,000–1,400,000) to the American population by 2036. After valuing the quality-adjusted life-years appropriately, Americans could expect $692 billion (95% CI 345–975) in net health benefits over that period. Conclusions Expanded

  16. Causes of homelessness among older people in Melbourne, Australia.

    PubMed

    Rota-Bartelink, Alice; Lipmann, Bryan

    2007-06-01

    A comparative study of the causes of new episodes of homelessness among people aged 50 years and over has been undertaken in Australia, the United States and England. Semi-structured questionnaires were used to collect information on the circumstances and problems that contributed to homelessness. This paper presents the findings from Australia, where information was obtained from 125 older homeless people (aged 50+ years) and their key workers in Melbourne. All three participating nations followed identical research methodologies. The factors most frequently reported by respondents as contributing to their homelessness were problems with people with whom they lived, followed by physical and mental ill-health and problems associated with the housing itself. The most frequently reported factors by case workers were problems with alcohol, followed by physical and mental health factors. This study demonstrates a significant under-utilisation of housing and support services among recently homeless older people and provides evidence that people who had previously been homeless appear to be more resigned to their homelessness than do those who had not experienced homelessness before. Significant issues relating to depression and gambling were also noted. The findings support the need for more targeted, specialised services to be developed or improved such that older homeless people can readily gain access to them and for improved collaboration or information exchange among housing providers and welfare agencies.

  17. The importance of 'approaching' older people: a grounded theory.

    PubMed

    Jonasson, Lise-Lotte; Berterö, Carina

    2012-03-01

    The aim of this study was to identify and describe the ethical values in caring encounters as experienced by older patients in their daily interaction with nurses in wards for older people. Ethical values and morals are important aspects that influence the quality of care. Empirical observational study including follow-up interviews. Twenty-two older patients participated voluntarily in this study. Constant comparative analysis, the core foundation of grounded theory was used. Five categories: being addressed, receiving respect, desiring to participate, increasing self-determination and gaining self-confidence formed the bases for the core category. APPROACHING: Approaching concerns how people become closer to each other in a physical space. It also includes how people become closer to each other in a dialogue, involving verbal or bodily communication. Approaching indicates the ethical values that guide nurses in their caring encounters with older patients. These values are noted by the patient and have an individual value as well as leading to improved quality of their care. The older patient will be confident and satisfied with the caring encounter if the desired components in the nurse's approaching are exhibited. © 2010 Blackwell Publishing Ltd.

  18. Why do older people report fewer headaches?

    PubMed

    Thomas, Elaine; Boardman, Helen F; Croft, Peter R

    2005-01-01

    We have previously confirmed a clear decline in headache prevalence with increasing age. This parallels the pattern in other painful conditions but the age-related decline in prevalence is greater for headache. To investigate whether the decline in headache prevalence with age was associated with the elimination of work-related factors, increases in other health problems or concomitant use of pain-relieving medicines. We discuss these and other possible explanations from the literature. Cross-sectional postal survey to a random sample of 5,000 adults with follow-up by (i) consultations with general practitioners and prescriptions issued during the 12 months subsequent to the survey and (ii) a follow-up postal survey at 12 months. Headache prevalence was similar in working and retired respondents within age strata. Headache sufferers were more likely to consult their general practitioner for any reason (excluding headache) compared with non-sufferers and this was true for each age group. Headache sufferers were also more likely to be frequent consulters compared with non-sufferers in all except the oldest age group (age 66 years and over) where there was no difference. There was a clear increase in prescriptions for analgesics and non-steroidal anti-inflammatory drugs issued with increasing age. There was no difference in the percentage of daily medication users among headache sufferers compared with non-sufferers. Neither retirement from work nor the presence of other health problems account for the decline in headache prevalence with age. Whilst the data on concomitant use of pain-relieving medicines suggest this is also not a major factor in the age-related decline, the high use of such medicines in older age groups means we cannot rule out a link. Evidence from the literature suggests that there may be a number of age-related factors involved including changes in reporting of headache, biochemical changes, and the development of strategies to prevent and manage

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

    ERIC Educational Resources Information Center

    Gilbert, Tony; Farrand, Paul; Lankshear, Gloria

    2013-01-01

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

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

    ERIC Educational Resources Information Center

    Gilbert, Tony; Farrand, Paul; Lankshear, Gloria

    2013-01-01

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

  1. Measures for Assessing Student Attitudes toward Older People

    ERIC Educational Resources Information Center

    Lin, Xiaoping; Bryant, Christina; Boldero, Jennifer

    2011-01-01

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

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

    ERIC Educational Resources Information Center

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

    2007-01-01

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

  3. Measures for Assessing Student Attitudes toward Older People

    ERIC Educational Resources Information Center

    Lin, Xiaoping; Bryant, Christina; Boldero, Jennifer

    2011-01-01

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

  4. Financial Literacy and Older People Moving On. NIACE Briefing Sheet.

    ERIC Educational Resources Information Center

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

    In the United Kingdom, the increasing sophistication of money management and financial services' increasing reliance on information and computer technology (ICT) have made financial literacy education particularly important for older people, who are less likely to be engaged in the ICT revolution and more likely to be living on a low income.…

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

    ERIC Educational Resources Information Center

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

    2001-01-01

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

  6. The Engagement of Older People in Civil Society Organizations

    ERIC Educational Resources Information Center

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

    2012-01-01

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

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

    ERIC Educational Resources Information Center

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

    2001-01-01

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

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

    PubMed

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

    2014-01-01

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

  9. Public Library Services to Older People in Pennsylvania: A Survey.

    ERIC Educational Resources Information Center

    Ling-nam, Leo Ip

    The purpose of this study was to establish a profile of services to older people in Pennsylvania public libraries. A survey was distributed to 50 district library centers and headquarters of the state library and 50 independent public libraries. The response rate was 65%. Major findings of the study were the following: (1) 66.15% of respondents…

  10. Full-Timing: A Housing Alternative for Older People.

    ERIC Educational Resources Information Center

    Hartwigsen, Gail; Null, Roberta

    Full-timing, living year-round in a recreational vehicle, may be a viable housing alternative for older people. Full-timers can enjoy life in recreational vehicles that are modern, convenient, and well-built. Full-timing can be as expensive or as economical as the individual circumstances are. The economic benefits of full-timing increase when the…

  11. 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…

  12. The Engagement of Older People in Civil Society Organizations

    ERIC Educational Resources Information Center

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

    2012-01-01

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

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

    ERIC Educational Resources Information Center

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

    2007-01-01

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

  14. 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…

  15. Balance-Boosting Footwear Tips for Older People

    MedlinePlus

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

  16. Sustainability literacy of older people in retirement villages.

    PubMed

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

    2014-01-01

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

  17. Sustainability Literacy of Older People in Retirement Villages

    PubMed Central

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

    2014-01-01

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

  18. Associations between performance on an abbreviated CogState battery, other measures of cognitive function, and biomarkers in people at risk for Alzheimer’s disease

    PubMed Central

    Racine, Annie M.; Clark, Lindsay R.; Berman, Sara E.; Koscik, Rebecca L.; Mueller, Kimberly D.; Norton, Derek; Nicholas, Christopher R.; Blennow, Kaj; Zetterberg, Henrik; Jedynak, Bruno; Bilgel, Murat; Carlsson, Cynthia M.; Christian, Bradley T.; Asthana, Sanjay; Johnson, Sterling C.

    2016-01-01

    It is not known whether computerized cognitive assessments, like the CogState battery, are sensitive to preclinical cognitive changes or pathology in people at risk for Alzheimer’s disease (AD). In 469 late middle-aged participants from the Wisconsin Registry for Alzheimer’s Prevention (mean age 63.8±7 years at testing; 67% female; 39% APOE4+), we examined relationships between a CogState abbreviated battery (CAB) of seven tests and demographic characteristics, traditional paper-based neuropsychological tests as well as a composite cognitive impairment index, cognitive impairment status (determined by consensus review); and biomarkers for amyloid and tau (CSF phosphorylated-tau/Aβ42 and global PET-PiB burden) and neural injury (CSF neurofilament light protein). CSF and PET-PiB were collected in n=71 and n=91 participants, respectively, approximately four years prior to CAB testing. For comparison, we examined three traditional tests of delayed memory in parallel. Similar to studies in older samples, the CAB was less influenced by demographic factors than traditional tests. CAB tests were generally correlated with most paper-based cognitive tests examined and mapped onto the same cognitive domains. Greater composite cognitive impairment index was associated with worse performance on all CAB tests. Cognitively impaired participants performed significantly worse compared to normal controls on all but one CAB test. Poorer One Card Learning test performance was associated with higher levels of CSF phosphorylated-tau/Aβ42. These results support the use of the CogState battery as measures of early cognitive impairment in studies of people at risk for AD. PMID:27589532

  19. Adverse drug reactions in older people: detection and prevention.

    PubMed

    Petrovic, Mirko; van der Cammen, Tischa; Onder, Graziano

    2012-06-01

    Adverse drug reactions (ADRs) in older adults are an important healthcare problem since they are frequently a cause of hospitalization, occur commonly during admission, and are an important cause of morbidity and mortality. Older adults are particularly susceptible to ADRs because they are usually on multiple drug regimens and because age is associated with changes in pharmacokinetics and pharmacodynamics. The presentation of an ADR in older adults is often atypical, which further complicates its recognition. One potential strategy for improving recognition of ADRs is to identify those patients who are at risk of an ADR. The recently developed GerontoNet ADR Risk Score is a practical tool for identification of older patients who are at increased risk for an ADR and who may represent a target for interventions aimed at reducing ADRs. Provision of adequate education in the domain of clinical geriatric pharmacology can improve recognition of ADRs. Besides formal surveillance systems, built-in computer programs with electronic prescribing databases and clinical pharmacist involvement in patient care within multidisciplinary geriatric teams might help to minimize the occurrence of ADRs. In addition, a number of actions can be taken in hospitals to stimulate appropriate prescribing and to assure adequate communication between primary and hospital care. In older adults with complex medical problems and needs, a global evaluation obtained through a comprehensive geriatric assessment may be helpful in simplifying drug prescription and prioritizing pharmacological and healthcare needs, resulting in an improvement in quality of prescribing.

  20. Prospective validation of a predictive model that identifies homeless people at risk of re-presentation to the emergency department.

    PubMed

    Moore, Gaye; Hepworth, Graham; Weiland, Tracey; Manias, Elizabeth; Gerdtz, Marie Frances; Kelaher, Margaret; Dunt, David

    2012-02-01

    To prospectively evaluate the accuracy of a predictive model to identify homeless people at risk of representation to an emergency department. A prospective cohort analysis utilised one month of data from a Principal Referral Hospital in Melbourne, Australia. All visits involving people classified as homeless were included, excluding those who died. Homelessness was defined as living on the streets, in crisis accommodation, in boarding houses or residing in unstable housing. Rates of re-presentation, defined as the total number of visits to the same emergency department within 28 days of discharge from hospital, were measured. Performance of the risk screening tool was assessed by calculating sensitivity, specificity, positive and negative predictive values and likelihood ratios. Over the study period (April 1, 2009 to April 30, 2009), 3298 presentations from 2888 individuals were recorded. The homeless population accounted for 10% (n=327) of all visits and 7% (n=211) of all patients. A total of 90 (43%) homeless people re-presented to the emergency department. The predictive model included nine variables and achieved 98% (CI, 0.92-0.99) sensitivity and 66% (CI, 0.57-0.74) specificity. The positive predictive value was 68% and the negative predictive value was 98%. The positive likelihood ratio 2.9 (CI, 2.2-3.7) and the negative likelihood ratio was 0.03 (CI, 0.01-0.13). The high emergency department re-presentation rate for people who were homeless identifies unresolved psychosocial health needs. The emergency department remains a vital access point for homeless people, particularly after hours. The risk screening tool is key to identify medical and social aspects of a homeless patient's presentation to assist early identification and referral. Copyright © 2012 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights reserved.

  1. Relationship between nonlinear properties of sacral skin blood flow oscillations and vasodilatory function in people at risk for pressure ulcers.

    PubMed

    Liao, Fuyuan; Garrison, David W; Jan, Yih-Kuen

    2010-07-01

    The purposes of this study were to quantify the nonlinear properties of sacral skin blood flow oscillations (BFO) and to explore their relationships with impaired vasodilatory function in people at risk for pressure ulcers. A total of 25 people with various levels of vasodilatory functions were studied, 10 people with normal vasodilatory function (Biphasic thermal index, BTI (5.5, 4.5, 10.1)), 10 people with slight impaired vasodilatory function (BTI (3.7, 3.2, 6.7)), and 5 people with severe impaired vasodilation (BTI (2.4, 1.7, 4.5)). A non-painful fast heating protocol was applied to the sacral region to induce biphasic vasodilation, axon reflex mediated and nitric oxide mediated. Biphasic thermal index is defined as ratios of first peak, nadir, and second peak to baseline blood flow. Laser Doppler flowmetry was used to record the BFO signals. Nonlinear properties of BFO were quantified based on self-similarity using Hurst exponent (HE) and detrended fluctuation analysis (DFA), regularity using sample entropy (SampEn), complexity using correlation dimension (CD), and chaotic behavior using largest Lyapunov exponent (LLE). The Wilcoxon signed rank tests were used to examine the differences between groups. Our results showed that local heating reduces the self-similarity and increases complexity of skin blood flow oscillations. Vasodilatory function has an inverse relationship with nonlinear properties in sacral skin baseline BFO. Nonlinear indexes, including HE, DFA, CD, and LLE, are appropriate tools to quantify nonlinear properties of BFO to study the microvascular dysfunction (p<0.05), and that SampEn may not be appropriate for this purpose (p>0.05). Our study supports the use of nonlinear indexes to predict the vasodilatory function, which can complement current analysis of blood flow control mechanisms using spectral (wavelet) analysis.

  2. [Healthcare Services for Older People: From Fragmentation to Integration].

    PubMed

    Chen, Liang-Kung

    2015-10-01

    The percentage of people aged 65 years and older is estimated to exceed 20% of the total population in Taiwan, which makes Taiwan a "super-aged" country. This rapid demographic transition, unprecedented in human history, presents unique challenges. The health characteristics of older people differ fundamentally from their younger adult peers, especially in terms of the critical impact of disability on health. Therefore, special attention to the interrelationship between multimorbidity and disability is required in order to provide healthcare services that are appropriate and effective. The integrated care approach of Europe, which concurrently addresses the needs of health and social care, has become the important foundation of social security in the European Union. The healthcare services available to older people in Taiwan, including outpatient, inpatient and intermediate care, are far from satisfactory and extensively fragmented. For older people with multimorbidities and / or disabilities, these fragmented healthcare services result in inconvenient access to healthcare and impaired quality of care and quality of life. At present, Taiwan has developed various healthcare models such as integrated outpatient services, age-friendly healthcare facilities, post-acute care, and a 10-year long-term care program. However, the development of these healthcare models clearly demonstrates the need for service integration. Integrated care promotes seamless case management, which aims to provide smooth access for older people with multiple, complex care needs to essential services and comprehensive healthcare benefits. During the process, the integration of services per se should be prioritized over the prompt merging of departments or facilities. The development and success of integrated care depend on the complete understanding of and promotion by the frontline working staff.

  3. [Quality of life for older people under oncological treatment].

    PubMed

    Ishitani, K; Murakami, S; Kishi, A

    1992-09-01

    Recently, an argument over the medical treatment of older patients has arisen in the field of clinical oncology. In the past oncological treatment has been geared to young and middle-aged people. Currently, oncological treatment takes the peculiarities of older people into consideration. Firstly, it highlights the multidimensionality of Quality of Life (QOL) as an important element, with subjectivity the second element. This notion has gained a worldwide consensus. The domain of "multidimensionality" consists of: 1. Physical status and functional abilities 2. Psychological status and well-being 3. Social interaction 4. Economic status and factors With these factors in mind, different questions are asked, depending on the condition of each patient, in order to let the patient form his/her own judgment on possible medical treatment. However, it is sometimes difficult for older people to make such judgments due to problems such as depression or their diminishing mental ability. Also, it is impossible to define life satisfaction indiscriminately without regard to individual outlook. QOL for older people is generally characterized by "individuality" which includes: 1) A person's integrity; 2) independence; and 3) autonomy. Though these elements are taken into account in adopting the above-mentioned methodology, the field of clinical oncology's two concepts of QOL still apply in principle. Flexibility to put emphasis on different elements of the domain will be necessary. Even though QOL for older people is a matter of subjective judgment, the "sound judgment of professionals" (objective and scientific judgment of caregivers) can be adopted in cases when there is difficulty in communication.(ABSTRACT TRUNCATED AT 250 WORDS)

  4. Robotic and Sensor Technologies for Mobility in Older People.

    PubMed

    Penteridis, Lazaros; D'Onofrio, Grazia; Sancarlo, Daniele; Giuliani, Francesco; Ricciardi, Francesco; Cavallo, Filippo; Greco, Antonio; Trochidis, Ilias; Gkiokas, Alexander

    2017-06-28

    Maintaining independent mobility is fundamental to independent living and to the quality of life of older people. Robotic and sensor technologies may offer a lot of potential and can make a significant difference in the lives of older people and to their primary caregivers. The aim of this study was to provide a presentation of the methods that are used up till now for analysis and evaluation of human mobility utilizing sensor technologies and to give the state of the art in robotic platforms for supporting older people with mobility limitations. The literature was reviewed and systematic reviews of cohort studies and other authoritative reports were identified. The selection criteria included (1) patients with age ≥60 years; (2) patients with unstable gait, with or without recurrent falls; (3) patients with slow movements, short strides, and little trunk movement; (4) sensor technologies that are currently used for mobility evaluation; and (5) robotic technologies that can serve as a supporting companion for older people with mobility limitations. One hundred eighty-one studies published up until February 2017 were identified, of which 36 were included. Two categories of research were identified from the review regarding the robot and sensor technologies: (1) sensor technologies for mobility analysis and (2) robots for supporting older people with mobility limitations. Potential for robotic and sensor technologies can be taken advantage of for evaluation and support at home for elder persons with mobility limitations in an automated way without the need of the physical presence of any medical personnel, reducing the stress of caregivers.

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

    PubMed

    Olphert, Wendy; Damodaran, Leela

    2013-01-01

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

  6. Metacognitive beliefs as psychological predictors of social functioning: An investigation with young people at risk of psychosis.

    PubMed

    Bright, Measha; Parker, Sophie; French, Paul; Fowler, David; Gumley, Andrew; Morrison, Anthony P; Birchwood, Max; Jones, Peter B; Stewart, Suzanne L K; Wells, Adrian

    2017-09-14

    Poor social functioning has been found to be present in those at risk for psychosis. This study aimed to examine metacognitive beliefs as potential predictors of structured activity (measure of social functioning) in those with an At Risk Mental State (ARMS). Regression and correlation analyses were conducted. The sample included 109 young people. Age was found to be positively correlated to structured activity. Metacognitive beliefs concerning uncontrollability and danger of worry were found to negatively predict structured activity. This was after controlling for age, gender, treatment allocation, cognitive schemas, positive symptom severity, social anxiety, and depression. Metacognitive danger items were most important. Age was the only control variable found to be an independent predictor of structured activity in the regression model, despite negative bi-variate relationships with structured activity found across three cognitive schema subscales and social anxiety. This is the first study to find that higher negative metacognitive beliefs about uncontrollability and danger predict lower social functioning in an ARMS sample, and that the perception of thoughts being dangerous was of particular importance. Psychological interventions should consider targeting this metacognitive dimension to increase social functioning. Future longitudinal research is required to strengthen findings in this area. Copyright © 2017 Elsevier B.V. All rights reserved.

  7. Using narratives to understand older people's decision-making processes.

    PubMed

    Tetley, Josephine; Grant, Gordon; Davies, Susan

    2009-09-01

    Despite the availability of health and social care services designed to support people in their own homes, older people often underuse or refuse these services. It is now acknowledged that this phenomenon contributes to older people being admitted to hospital and long-term care in circumstances that could be avoided. To understand how the uptake of supportive and preventative services can be improved, the first author, supervised by the second and third authors, developed a constructivist inquiry to explore what factors enhance or bar service use. This article describes how narratives were used not only to help identify decision- and choice-making influences, but also as a way of enhancing the hermeneutic processes associated with constructivism.

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

    PubMed Central

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

    2012-01-01

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

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

    PubMed Central

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

    2012-01-01

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

  10. Nurses' and Physicians' Perceptions of Older People and Attitudes towards Older People: Ageism in a Hospital in Turkey.

    PubMed

    Polat, Ulkü; Karadağ, Ayişe; Ulger, Zekeriya; Demir, Nevra

    2014-06-27

    Abstract Nurses and physicians provide health care for a growing number of older people as a result of the rapid increase in the life expectancies of older people. Health professionals' negative attitudes towards older people affect the quality of health care offered to these individuals. The sample for this study included 110 nurses and 57 physicians working in the medical and surgical clinics of a university hospital. A questionnaire form and the Ageism Attitude Scale (AAS) were used to collect the data. A 5-point Likert-type format was utilised for the AAS. The AAS total mean score was 80.02±2.64 for nurses and 83.17±9.09 for physicians. The difference between these mean scores was statistically significant (p<0.05). For the AAS subdimension "limiting the life of the older people", the physicians' score (35.14±6.22) was significantly higher than the nurses' score (33.22±3.59). In this study, nurses' and physicians' attitudes, approaches, and considerations were found to be generally positive.

  11. Nurses' and physicians' perceptions of older people and attitudes towards older people: Ageism in a hospital in Turkey.

    PubMed

    Polat, Ulkü; Karadaǧ, Ayişe; Ulger, Zekeriya; Demir, Nevra

    2014-01-01

    Abstract Nurses and physicians provide health care for a growing number of older people as a result of the rapid increase in the life expectancies of older people. Health professionals' negative attitudes towards older people affect the quality of health care offered to these individuals. The sample for this study included 110 nurses and 57 physicians working in the medical and surgical clinics of a university hospital. A questionnaire form and the Ageism Attitude Scale (AAS) were used to collect the data. A five-point Likert-type format was utilised for the AAS. The AAS total mean score was 80.02 ± 2.64 for nurses and 83.17 ± 9.09 for physicians. The difference between these mean scores was statistically significant (p < 0.05). For the AAS sub-dimension 'limiting the life of the older people,' the physicians' score (35.14 ± 6.22) was significantly higher than the nurses' score (33.22 ± 3.59). In this study, nurses' and physicians' attitudes, approaches, and considerations were found to be generally positive.

  12. 10 Hz flicker improves recognition memory in older people

    PubMed Central

    Williams, Jonathan; Ramaswamy, Deepa; Oulhaj, Abderrahim

    2006-01-01

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

  13. Views of family carers and older people of information technology.

    PubMed

    Andersson, Nils-Bertil; Hanson, Elizabeth; Magnusson, Lennart

    This article is the second in a series of four describing recent developments in Sweden aimed at promoting partnerships between older people, their families and formal service providers. The last article (Vol 11(11): 759-63) described the development of an information and communication technology (ICT) project ACTION -- Assisting Carers using Telematics Interventions to meet Older persons' Needs -- and focused on the use of CT to help family carers to be more prepared for their caregiving role. This article focuses on the concept of usability within the ACTION project and the importance of working closely with participants in order to create an information and communication service that is both acceptable and of direct benefit to family members in their everyday caring situations. Nielsen's (1993) Model of Usability is described within the overall context of the project and is used as a framework for the cycle of development and testing that underpin ACTION. A variety of research methods are highlighted, with a central theme being that of user involvement, with particular reference to the USERfit approach (Poulson et al, 1996). The education and training of older people and their family carers to use the ACTION technology is outlined and examples are given of the empowering effects of the use of the service and its user-driven focus. Recommendations for the further technical development of ACTION are firmly based on the comments and suggestions provided by older people and the family carers themselves.

  14. Acute stress and working memory in older people.

    PubMed

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

    2015-01-01

    Several studies have shown that acute stress affects working memory (WM) in young adults, but the effect in older people is understudied. As observed in other types of memory, older people may be less sensitive to acute effects of stress on WM. We performed two independent studies with healthy older men and women (from 55 to 77 years old) to investigate the effects of acute stress (Trier Social Stress Test; TSST) and cortisol on WM. In study 1 (n = 63), after the TSST women (but not men) improved their performance on Digit Span Forward (a measure of the memory span component of WM) but not on Digit Span Backward (a measure of both memory span and the executive component of WM). Furthermore, in women, cortisol levels at the moment of memory testing showed a positive association with the memory span component of WM before and after the TSST, and with the executive component of WM only before the stress task. In study 2 (n = 76), although participants showed a cortisol and salivary alpha-amylase (sAA) response to the TSST, stress did not affect performance on Letter-Number Sequencing (LNS; a task that places a high demand on the executive component of WM). Cortisol and sAA were not associated with WM. The results indicate that circulating cortisol levels at the moment of memory testing, and not the stress response, affect memory span in older women, and that stress and the increase in cortisol levels after stress do not affect the executive component of WM in older men and women. This study provides further evidence that older people may be less sensitive to stress and stress-induced cortisol response effects on memory processes.

  15. Technology and "natural death": a study of older people.

    PubMed

    Seymour, J

    2003-10-01

    This paper reports a qualitative study in which the aim was to examine older peoples' beliefs and risk perceptions regarding the use of innovative health technologies in end-of-life care and to relate these beliefs to their ideas about 'natural death'. Pictures, story boards and media extracts were used during interviews and focus groups, and the research team was assisted by an advisory group which included participants. Seventy-seven older people from three age cohorts (65-74; 75-84; 85 years and over) and from three contrasting areas of Sheffield, UK took part. Key messages are for the need to ensure that 'life prolonging' and 'basic care' technologies are provided in ways that respect a variety of understandings about love, comfort, obligation and burden during dying. The study highlights: the role that older people have in caring for the dying and their needs for support and training; information needs about issues of ethics, clinical practice and advance care planning; and the willingness of older research participants to discuss these matters and to enjoy the process of so doing. Developing a programme of public education and information was identified as an issue which should be addressed urgently if older people and their family carers are to be better equipped to make informed choices about these aspects of care. The study draws together issues previously considered under the largely separate remits of palliative care and gerontology. It is being used to provide advice on palliative and end-of-life care, especially to nursing and medical practitioners and to voluntary sector organisations as they begin to assess the need for action in this field.

  16. Delusion-like experiences in older people with anxiety disorders.

    PubMed

    Byrne, Gerard J; Steele, Sarah J; Pachana, Nancy A

    2015-07-01

    Little is known about the occurrence of psychotic or quasi-psychotic experiences in older people with anxiety disorders. We used a cross-sectional national probability sample of community-residing individuals to investigate the prevalence and correlates of delusion-like experiences in older people with DSM-IV anxiety disorders. The 2007 Australian National Survey of Mental Health and Well-being (NSMHWB) included 1,905 persons between the ages of 65 and 85 years. Anxiety disorder diagnoses were established using the Composite International Diagnostic Interview (CIDI v3). Participants were asked about three types of delusion-like experiences: thought control or interference, special meaning, and special powers. We used multivariate logistic regression to examine the relationship between a 12-month history of any anxiety disorder and the presence of these delusion-like experiences, adjusting for several potential confounders. Eighty-two of 1,905 (4.3%) older people met criteria for an anxiety disorder over the previous 12 months. Of these, six reported delusion-like experiences, whereas the prevalence of these experiences among older people without anxiety disorder was 26/1,822 (7.3% vs. 1.4%; χ(2) = 16.5; p = 0.000). In a logistic regression model, male gender (OR 0.38; p = 0.019), separated marital status (OR 4.86; p = 0.017), and the presence of anxiety disorder (OR 5.33; p = 0.001) were independently associated with delusion-like experiences, whereas MMSE (Mini-Mental State Examination) score, general medical conditions and affective disorder were not. In this cross-sectional study, self-reported delusion-like experiences occurred at increased prevalence among community-residing older persons with anxiety disorder. More work is needed to clarify the nature and significance of these findings.

  17. Self-labelling and stigma as predictors of attitudes towards help-seeking among people at risk of psychosis: 1-year follow-up.

    PubMed

    Xu, Ziyan; Müller, Mario; Heekeren, Karsten; Theodoridou, Anastasia; Dvorsky, Diane; Metzler, Sibylle; Brabban, Alison; Corrigan, Patrick W; Walitza, Susanne; Rössler, Wulf; Rüsch, Nicolas

    2016-02-01

    Mental health service use is helpful but rare among young people at risk of psychosis. The label and stigma associated with mental illness may affect attitudes towards help-seeking. We examined 67 individuals at risk of psychosis over the course of 1 year. An increase of self-labelling as "mentally ill" predicted more positive attitudes towards psychiatric medication, while increased perceived stigma and the cognitive appraisal of stigma as a stressor predicted poorer attitudes towards psychotherapy after 1 year. Early intervention could improve non-stigmatizing awareness of at-risk mental state and reduce the public stigma associated with at-risk status to facilitate help-seeking.

  18. The psychosocial impact of epilepsy in older people.

    PubMed

    Tebartz van Elst, Ludger; Baker, Gus; Kerr, Mike

    2009-06-01

    Given a prevalence of 0.5-1%, the epilepsies belong to the most common of neuropsychiatric diseases. Many clinicians think of the epilepsies as an entity beginning in early in life. However, the peak incidence of epilepsy in the developed world is now in the age group beyond 60 years. This population has thus an increasing importance; and in this paper we review and summarize the specific aspects of the clinical presentation, etiology, diagnosis, and treatment of older-age patients with epilepsy. In particular, we focus on the specific psychosocial impact that epilepsy has on the life of older people and their carers.

  19. Determinants of Physical Health of Older People in Iran

    PubMed Central

    Cheshmberah, Azar; Hoseini, Mostafa; Shojaee Zadeh, Davood

    2014-01-01

    Background. Many of the older people are encountered with physical and mental health problems, chronic diseases, and also living conditions. We aimed to evaluate the disability scores and its associated factors among a sample of older people in Iran. Material and Methods. 330 people aged 60–70 years were interviewed about daily living activities and physical functioning using two standard questionnaires. Results. According to univariate analysis, aging 66–70 years, being employed, and receiving financial aids were associated with better ADL mean score (P < 0.05). Also, being between 66 and 70 years of age, males, being illiterate, being employed, and receiving financial aids were statistically related to higher SF-36 mean scores (P < 0.05). Multivariate analyses have shown that higher age and receiving financial aids were related to less need for help and being unemployed with salary was related to higher need for help. However, being illiterate, being employed, and receiving financial aids were significant related factors for better physical functioning. Conclusions. Physical health in old people is decreased not only by aging of people but also by other factors such as financial problems and also employment status could decrease physical health of old people regardless of aging. PMID:27379291

  20. Pharmacokinetic and pharmacodynamic alterations in older people with dementia.

    PubMed

    Reeve, Emily; Trenaman, Shanna C; Rockwood, Kenneth; Hilmer, Sarah N

    2017-06-01

    The number of people with dementia internationally is increasing. Older adults with dementia are prescribed multiple medications, both to treat dementia symptoms and to manage their other medical conditions. Dementia is correlated with increasing age and frailty; this provides insight into how the efficacy and toxicity of medications may be altered in people with dementia. Areas covered: This review discusses the current evidence of the alterations in pharmacokinetics that can occur with aging, frailty and in people with dementia. The evidence is presented via the four primary pharmacokinetic processes (absorption, distribution, metabolism and elimination). Additionally, distribution into the brain, sex considerations and potential pharmacodynamic alterations in older people with dementia are discussed. Expert opinion: While the evidence is limited, people with dementia appear to be at a higher risk of toxicity of some medications due to altered pharmacokinetic processes and pharmacodynamics. There are a number of limitations to the research and there are still significant gaps in knowledge in this field. Proactive, ongoing review of the appropriateness of choice of medication, dose and whether or not a medication is required at all is necessary for achieving quality use of medications in people living with dementia.

  1. Association between oral health status and nutritional status in south Brazilian independent-living older people.

    PubMed

    De Marchi, Renato José; Hugo, Fernando Neves; Hilgert, Juliana Balbinot; Padilha, Dalva Maria Pereira

    2008-06-01

    Evidence suggests that older people with partial tooth loss and edentulism change their diet and lack specific nutrients, but few studies have assessed whether poor oral status is associated with risk of malnutrition and malnutrition in independent-living older people. We evaluated if poor oral status was associated with risk of malnutrition and malnutrition in this population. A random sample of 471 south Brazilians > or =60 y of age was evaluated. Measurements included a questionnaire to assess sociodemographic, behavioral, general, and oral health data; nutritional status assessment, according to the Mini-Nutritional Assessment (MNA); and oral status assessment, by means of oral examinations assessing the number of teeth and use of dental prostheses. Correlates of risk of malnutrition/malnutrition according to the MNA were assessed by means of multivariate logistic regression. Participants who reported dissatisfaction with their gingival health and edentulous persons wearing only one denture were more likely to be at risk of malnutrition, according to the screening MNA. Dissatisfaction with gingival health was a risk indicator, whereas having one to eight natural teeth was protective against the risk of malnutrition/malnutrition according to the full MNA. In the present study, older people with a compromised oral status had higher odds for risk of malnutrition. The maintenance of a few teeth had a crucial role in increasing the chance of maintaining an adequate nutritional status in the studied population. In cases where edentulism was present, complete dental prosthetic use was associated with better nutritional status.

  2. Wavelet-Based Sit-To-Stand Detection and Assessment of Fall Risk in Older People Using a Wearable Pendant Device.

    PubMed

    Ejupi, Andreas; Brodie, Matthew; Lord, Stephen R; Annegarn, Janneke; Redmond, Stephen J; Delbaere, Kim

    2017-07-01

    Wearable devices provide new ways to identify people who are at risk of falls and track long-term changes of mobility in daily life of older people. The aim of this study was to develop a wavelet-based algorithm to detect and assess quality of sit-to-stand movements with a wearable pendant device. The algorithm used wavelet transformations of the accelerometer and barometric air pressure sensor data. Detection accuracy was tested in 25 older people performing 30 min of typical daily activities. The ability to differentiate between people who are at risk of falls from people who are not at risk was investigated by assessing group differences of sensor-based sit-to-stand measurements in 34 fallers and 60 nonfallers (based on 12-month fall history) performing sit-to-stand movements as part of a laboratory study. Sit-to-stand movements were detected with 93.1% sensitivity and a false positive rate of 2.9% during activities of daily living. In the laboratory study, fallers had significantly lower maximum acceleration, velocity, and power during the sit-to-stand movement compared to nonfallers. The new wavelet-based algorithm accurately detected sit-to-stand movements in older people and differed significantly between older fallers and nonfallers. Accurate detection and quantification of sit-to-stand movements may provide objective assessment and monitoring of fall risk during daily life in older people.

  3. Preserving vision and promoting visual health in older people.

    PubMed

    Marsden, Janet

    2017-06-30

    Reduction in vision is not inevitable but a manageable consequence of getting older. Some physiological and disease processes associated with ageing may reduce vision and, in some cases, this reduction in vision cannot be treated. Much of it can be prevented, however. Prevention of visual loss is one of the keys to the maintenance of independence in older people. This article describes the main visual conditions associated with ageing and considers what can and should be done by the older person and their network of friends, relatives and carers to ensure that vision is maintained by the early detection and treatment of eye problems and that independence is maintained by putting strategies in place to help the person manage any untreatable vision loss.

  4. Factors affecting institutionalized older peoples' self-perceived dry mouth.

    PubMed

    Huang, Ying-Chia; Chu, Chiao-Lee; Ho, Ching-Sung; Lan, Shou-Jen; Chen, Wen-Yi; Liang, Yia-Wung; Hsieh, Yen-Ping

    2015-03-01

    The purpose of this study was to determine the factors affecting institutionalized older peoples' self-perceived dry mouth. This cross-sectional study was conducted on elderly residents at 22 long-term care facilities. A total of 165 questionnaires were returned from 13 senior citizen welfare institutions (SCWIs) and nine nursing homes. Multiple logistic regression analysis was used to analyze the data obtained. The results showed that the type of long-term care (LTC) facility, regular oral examinations, wearing dentures, and the ability to chew sticky foods affected self-perceived dry mouth. This study determined an association between the type of LTC facility where the participants lived and self-perceived dry mouth. The results indicated the importance of providing oral care in order to improve and prevent dry mouth among institutionalized older people living in SCWIs who do not undergo regular oral examinations, wear dentures, and have difficulty chewing sticky foods.

  5. Older people's participation in extra-cost disability benefits.

    PubMed

    Zantomio, Francesca

    2013-01-01

    The targeting of an UK extra-cost disability benefit for older people, Attendance Allowance, is analyzed using longitudinal data from the British Household Panel Survey. First, a binary model of benefit participation is used to investigate whether receipt is responsive to the onset of disability. Second, matching estimators are used to evaluate the consequences of missed participation on later financial wellbeing. Results indicate that participation is highly responsive to the onset of disability, although the chance of delays in receipt emerges. Personal characteristics unrelated to eligibility also appear to influence benefit receipt, translating into sizeable differences in the amount of cash support received. The comparison of recipients with observationally equivalent non-recipients confirms that timely participation reduces disabled older people's financial strain.

  6. Attitudes towards caring for older people: literature review and methodology.

    PubMed

    Kydd, Angela; Wild, Deidre

    2013-04-01

    Care of older people is often referred to as a 'Cinderella' service and is not seen as an attractive career option in health care, but with the global population continuing to age, caring for this group will become increasingly important. This article outlines the literature that formed the basis for two studies investigating the attitudes of healthcare staff towards working with older people, including respondents' perceptions of other healthcare professionals' attitudes toward this important area of work. The Multifactorial Attitudes Questionnaire was designed to examine five major themes identified from the literature: ageism; learning environment; working environment; professional esteem; and specialist status. This study is presented in two parts: this article discusses the literature and the design of the questionnaire. The second article, to be published in a subsequent issue of the journal, presents the results from two studies done in Scotland, the first in 1999, with a replication study in 2009.

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

    PubMed

    Armstrong, Kirsty

    2015-05-01

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

  8. Toward a conceptual definition of frail community dwelling older people.

    PubMed

    Gobbens, Robbert J; Luijkx, Katrien G; Wijnen-Sponselee, Maria T; Schols, Jos M

    2010-01-01

    In order to be able to identify frail community-dwelling older people, a reliable and valid definition of the concept of frailty is necessary. The aim of this study was to provide an overview of the literature on conceptual and operational definitions of frailty, and to determine which definitions are most appropriate for identifying frail community-dwelling older people. Therefore, a computerized search was performed in the PubMed database, Web of Science and PsychInfo. A successful definition of frailty reflects a multidimensional approach, makes clear its dynamic state, predicts adverse outcomes, does not include disease, comorbidity or disability, and meets the criterion of practicability. None of the current conceptual and operational definitions meet these criteria. In this article a new integral conceptual definition of frailty is proposed which meets the criteria of a successful definition. Copyright 2010 Mosby, Inc. All rights reserved.

  9. The life-course origins of mastery among older people.

    PubMed

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

    2007-06-01

    In this article, we aim to identify the sources of mastery--the understanding that individuals hold about their ability to control the circumstances of their lives. The sample for our inquiry was drawn from the Medicare beneficiary files of people 65 and older living in Washington, DC, and two adjoining Maryland counties. We find that past circumstances, particularly those reflecting status attainment and early exposure to intractable hardships, converge with stressors experienced in late life to influence elders' level of mastery. The impact of past conditions, however, does not necessarily directly affect the current mastery of older people. Instead, the effect of prior experiences on current mastery is mediated by what we refer to as life-course mastery: one's belief that one has directed and managed the trajectories that connect one's past to the present. Our analyses show that life-course mastery largely serves as the mediating channel through which individuals connect their past to their present.

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

    PubMed Central

    2011-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  12. Orthostatic hypotension and subjective sleep quality in older people.

    PubMed

    McHugh, Joanna E; Fan, Chie W; Kenny, Rose Ann; Lawlor, Brian A

    2012-01-01

    Poor sleep quality and orthostatic hypotension are common complaints in an older population, and both are related to factors such as polypharmacy and depression. However, it is not known whether there is a direct association between the two. Our objective is to investigate a potential association between orthostatic blood pressure response and subjective sleep quality in older people. A within-subjects, cross-sectional design embedded in a larger longitudinal study design. Participants were recruited from the community to visit the TRIL clinic at St James's Hospital, where they underwent a structured medical and psychosocial assessment. A total of 505 community dwelling adults aged 60+ (321 females, mean age 72.44) were participated in this study. Orthostatic blood pressure responses were recorded during an active stand using Finometer equipment, and health-related factors such as pain ratings, co-morbidities, polypharmacy, timed up and go, Mini-Mental State Examination score, body mass index, as well as depression, anxiety, age and gender, were also recorded. Self-reported sleep quality was also assessed using the Pittsburgh Sleep Quality Index. The results showed that timed up and go, polypharmacy, depression, anxiety, gender and delayed recovery of blood pressure at orthostasis were associated with subjective poor sleep quality. There is an association between subjective sleep quality and delayed recovery of blood pressure at orthostasis, independent of mental health or polypharmacy effects, in older adults. This link may have implications for the management of sleep disorders in older people.

  13. The Problems of Vitamin D Insufficiency in Older People

    PubMed Central

    Boucher, Barbara J

    2012-01-01

    This report reviews evidence on disorders related to inadequate vitamin D repletion in older people. Vitamin D is as essential for bone health in adults as in children, preventing osteomalacia and muscle weakness and protecting against falls and low-impact fractures. Vitamin D is provided by skin synthesis by UVB-irradiation from summer sunshine and to a small extent by absorption from food. However, these processes become less efficient with age. Loss of mobility or residential care restricts solar exposure. Reduced appetite and financial problems often add to these problems. Thus, hypovitaminosis D is common world-wide, but is more common and more severe in older people. Non-classical effects of vitamin D, depending on serum circulating 25-hydroxyvitamin D concentrations, are present in most non-bony tissues; disorders associated with hypovitaminosis D include increased risks of sepsis [bacterial, mycobacterial and viral], cardiovascular and metabolic disorders [e.g. hyperlipidemia, type 2 diabetes mellitus, acute vascular events, dementia, stroke and heart failure]. Many cancer risks are associated with vitamin D inadequacy, though causality is accepted only for colo-rectal cancer. Maintenance of repletion in healthy older people requires intakes of ≥800IU/day [20μg], as advised by the Institute of Medicine [IOM], but achieving such intakes usually requires supplementation. Excessive intakes are dangerous, especially in undiagnosed primary hyperparathyroidism or sarcoidosis, but the IOM finds doses <4000 IU/day are safe. Many experts suggest that ≥1000–2000 IU [25–50μg] of vitamin D daily is necessary for older people, especially when independence is lost, or hypovitaminosis D could add to the clinical problem[s]. Much higher doses than these are needed for treatment of established deficiency or insufficiency. PMID:23185713

  14. 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.…

  15. The effects of music therapy for older people with dementia.

    PubMed

    Wall, Michelle; Duffy, Anita

    The aim of this literature review is to explore how music therapy influences the behaviour of older people with dementia. Music therapy is often informally used in residential care units to enhance communication, emotional, cognitive and behavioural skills in elderly patients diagnosed with dementia both nationally and internationally. However, in Ireland the benefits of music therapy have not been fully recognized. Many studies have been carried out to establish the effectiveness of music therapy on the behaviour of older people with dementia with positive findings. Music therapy should be welcomed into care of the elderly settings in Ireland and elsewhere; however, more research is required to validate the effects of this therapy as a holistic tool to build altruistic connections between carers and clients. A comprehensive review of nursing literature using the online databases CINAHL, PsycINFO and MEDLINE were carried out. The search was limited to articles in the English language and peer-reviewed journals dating 2003-2009. Thirteen studies were reviewed and the majority of these studies reported that music therapy influenced the behaviour of older people with dementia in a positive way by reducing levels of agitation. The research further identified a positive increase in participants' mood and socialization skills, with carers having a significant role to play in the use of music therapy in care of the elderly nursing. However, methodological limitations were apparent throughout each of the studies reviewed. With reference to clinical practice, the authors recommend the undertaking of further research to explore the effects of music therapy on the behaviour and wellbeing of older people with dementia.

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

    PubMed

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

    2014-06-01

    Worse cognitive performance in older people has been associated with hypothalamic-pituitary-adrenal axis dysregulation (in particular, higher cortisol levels). Analysis of hair cortisol concentrations (HCC) is a novel method to measure long-term cortisol exposure, and its relationship with cognition in healthy older people has not yet been studied. We investigated whether HCC (measured in hair scalp) and diurnal salivary cortisol levels (awakening, 30min after awakening, and evening, across two days) were related to cognitive performance (assessed with the Trail-making Test A and B, Digit Span Forward and Backward, word list-RAVLT and Stories subtest of the Rivermead) in 57 healthy older people (mean age=64.75 years, SD=4.17). Results showed that lower HCC were consistently related to worse working memory, learning, short-term verbal memory (RAVLT first trial and immediate recall) and long-term verbal memory. In contrast, higher mean levels and higher diurnal area under the curve of diurnal salivary cortisol were related to worse attention and short-term verbal memory (immediate story recall), respectively. Interestingly, a higher ratio of mean levels of diurnal salivary cortisol over HCC were related to worse performance on working memory and short-term verbal memory, suggesting that those individuals with lower long-term cortisol exposure might be more vulnerable to the negative effect of HPA-axis dysregulation on these cognitive processes. Our findings suggest that both low long-term cortisol exposure and a possible dysregulation of the diurnal rhythm of the HPA-axis may account, at least in part, for the inter-individual variability in cognitive performance in healthy older people. Copyright © 2014 Elsevier Ltd. All rights reserved.

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

    PubMed

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

    2013-03-01

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

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

    PubMed

    Ullrich, Sandra; Crichton, Jonathan

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

  19. Factors related to tinnitus and hyperacusis handicap in older people.

    PubMed

    Aazh, Hashir; Lammaing, Karen; Moore, Brian C J

    2017-09-01

    The aim was to assess factors related to tinnitus and hyperacusis handicap in older people. Retrospective cross-sectional. Data were gathered for 184 patients with an average age of 69 years. Tinnitus handicap as measured via the Tinnitus Handicap Inventory (THI) was significantly predicted by tinnitus annoyance as measured via the visual analogue scale (VAS) (regression coefficient, b = 2.9, p < 0.001) and the effect of tinnitus on the patient's life as measured via the VAS (b = 3.9, p < 0.001). Hyperacusis handicap as measured via the Hyperacusis Questionnaire (HQ) was significantly predicted by the score on the depression subscale of the Hospital Anxiety and Depression Scale (HADS) (b = 0.8, p < 0.001) and to a small extent by the THI score (b = 0.07, p = 0.048). Insomnia scores as measured via the Insomnia Severity Index (ISI) were significantly predicted by scores on the depression subscale of the HADS (b = 0.46, p = 0.007). Since tinnitus annoyance significantly predicts tinnitus handicap, it is important to explore factors associated with annoyance that may be useful in designing appropriate rehabilitative interventions aimed at reducing tinnitus handicap in older people. Future studies should explore whether hyperacusis and insomnia in older people with tinnitus need to be managed in conjunction with treatment for depression.

  20. Older people's use of powered wheelchairs for activity and participation.

    PubMed

    Brandt, Ase; Iwarsson, Susanne; Ståhle, Agneta

    2004-03-01

    The aims of this study were to investigate outcomes of older people's use of powered wheelchairs and risk factors for negative outcomes. The study was a cross-sectional interview-study including 111 powered wheelchair users over 65 years of age. All participants used their powered wheelchair in the summer; nearly all users regarded it as important and found that it gave them independence. The wheelchair made activity and participation possible for the users. The most frequent activity in the summer was going for a ride, and in the winter it was shopping. However, some could not use the wheelchair for visits, and supplementary travel modes are called for. Users who could not walk at all or who could not transfer without assistance were more likely not to be able to carry out prioritized activities. Furthermore, other risk factors for negative outcomes and need for further research were identified. The use of powered wheelchairs is a relevant societal intervention in relation to older people with limited walking ability in order to make activity and participation possible. It is likely that a larger proportion of older people could benefit from this intervention, in particular if current practices are improved taking activity and participation outcomes into consideration.

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

    PubMed Central

    Mortazavi, Hamed; Peyrovi, Hamid; Joolaee, Soodabeh

    2015-01-01

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

  2. The effect of an educational intervention on alcohol consumption, at-risk drinking, and health care utilization in older adults: the Project SHARE study.

    PubMed

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

    2014-05-01

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

  3. Neural correlates of cognitive decline in older adults at-risk for developing MCI: evidence from the CDA and P300.

    PubMed

    Newsome, Rachel N; Pun, Carson; Smith, Victoria M; Ferber, Susanne; Barense, Morgan D

    2013-01-01

    Improving the ability to detect Alzheimer's disease (AD) at the earliest stages is essential to effectively treat afflicted individuals. Electrophysiological signatures are a promising avenue for earlier diagnosis. In the present study, we investigated an ERP component associated with visual working memory capacity, the contralateral delay activity (CDA). Our participants were undiagnosed and supposedly healthy members of the community, but were defined to be at-risk for Mild Cognitive Impairment (MCI) based on performance from a brief, standardized neuropsychological test. We found that older adults at-risk for MCI had a reduced visual working memory capacity and reduced differentiation of the CDA. In a second experiment, we found that the P300, a well-characterized ERP component shown to be useful in determining conversion from MCI to AD, showed reduced amplitude in our at-risk group. Together, these findings suggest that electrophysiological signatures may be especially sensitive markers of the very earliest stages of AD.

  4. The use of wide-scale mental agility testing to identify people at risk of dementia: crucial or harmful?

    PubMed

    Fox, C; Alessi, C; Ahluwalia, S; Hachinski, V

    2014-01-01

    The prevalence of dementia in the UK is rising rapidly and is predicted to double over the next 30 years. The NHS in England has been told to push for a rapid rise in dementia diagnosis rates, so that by 2015, two out of three cases are identified. The Prime Minister has raised the 'dementia challenge' as a priority for the NHS. While there is agreement on the need for action, debate arises over the nature of that intervention. Some, including Professor Alessi, argue that tools exist to support the diagnosis of mild cognitive impairment and they should be used because the disease is amenable to interventions. He believes that we need a shift in knowledge and attitude from thresholds to a continuum of cognitive impairment, from late to early stages and from effects to causes. The Montreal Cognitive Assessment (MoCa) should become part of the routine NHS Health Check after people reach age 40. Dr Fox argues on the other hand that widespread testing could lead to unnecessary anxiety and panic among those at risk and that funding should be focused on learning more about the early stages of dementia. While the concept of early testing is appealing, there is a large knowledge gap; instruments in use have not been tested in pre-dementia patients and have limited validity. While there is debate over the approach, we can agree that the economic and social impacts of this condition need to be addressed sooner rather than later.

  5. Frailty, body mass index, and abdominal obesity in older people.

    PubMed

    Hubbard, Ruth E; Lang, Iain A; Llewellyn, David J; Rockwood, Kenneth

    2010-04-01

    Frailty has been conceptualized as a wasting disorder with weight loss as a key component. However, obesity is associated with disability and with physiological markers also recently linked with frailty, for example, increased inflammation and low antioxidant capacity. We aimed to explore the relationship between frailty and body mass index (BMI) in older people. Data were from 3,055 community-dwelling adults aged 65 years and older who participated in the English Longitudinal Study of Ageing. Frailty was defined both by an index of accumulated deficits and by the Fried phenotype. BMI was divided into five categories, and waist circumference 88 cm or more (for women) and 102 cm or more (for men) was defined as high. Analyses were adjusted for sex, age, wealth, level of education, and smoking status. The association between BMI and frailty showed a U-shaped curve. This relationship was consistent across different frailty measures. The lowest frailty index (FI) scores and lowest prevalence of Fried frailty were in those with BMI 25-29.9. At each BMI category, and using either measure of frailty, those with a high waist circumference were significantly more frail. Both the phenotypic definition of frailty and the FI show increased levels of frailty among those with low and very high BMIs. In view of the rise in obesity in older populations, the benefits and feasibility of diet and exercise for obese older adults should be a focus of urgent inquiries. The association of frailty with a high waist circumference, even among underweight older people, suggests that truncal obesity may be an additional target for intervention.

  6. Causes, assessment and treatment of malnutrition in older people.

    PubMed

    Willis, Helen

    2017-02-28

    Malnutrition is a growing problem in the UK with as many as 14% of people aged over 65 at risk. It is of particular concern in care homes where more than one third of residents are undernourished. Weight loss is not the only symptom of malnourishment and nurses should examine any changes to a person's health and well-being to identify causes. Regular monitoring of patients' risk of malnutrition through use of screening assessments, such as the Malnutrition Universal Screening Tool, ensures undernourishment is identified early. As the population ages, it is more important than ever that the implications of malnutrition are recognised and addressed.

  7. Risk factors for hip fracture among institutionalised older people.

    PubMed

    Chen, Jian Sheng; Sambrook, Philip N; Simpson, Judy M; Cameron, Ian D; Cumming, Robert G; Seibel, Markus J; Lord, Stephen R; March, Lyn M

    2009-07-01

    risk factors for hip fracture in community-dwelling individuals have been extensively studied, but there have been fewer studies of institutionalised older people. a total of 1,894 older people (1,433 females, 461 males; mean age 86 years, SD 7.1 years) were recruited from 52 nursing homes and 30 intermediate-care nursing care facilities in Australia during March 1999 and February 2003. We assessed clinical risk factors for hip fracture and skeletal fragility by calcaneus broadband ultrasound attenuation (BUA) at baseline and then followed up for fracture for 4 years. Hip fractures were validated by x-ray reports. Survival analysis with age as a time-dependent covariate was used to analyse the data. during a mean follow-up period of 2.65 years (SD 1.38), 201 hip fractures in 191 residents were recorded, giving an overall hip fracture incidence rate of 4.0% per person year (males 3.6% and females 4.1%). Residents living in intermediate-care hostels had a higher crude hip fracture rate (4.6% vs. 3.0%) than those living in high-care nursing homes. In multivariate analysis, an increased risk of hip fracture was significantly associated with older age, cognitive impairment, a history of fracture since age 50, lower body weight, longer lower leg length and poorer balance in intermediate-care hostel residents, but not with lower BUA. institutionalised older people, who are at a higher risk of hip fracture than community-dwelling individuals, have differences in some risk factors for hip fracture that should be considered in targeting intervention programs.

  8. Serum thyroid-stimulating hormone and cognition in older people.

    PubMed

    Ojala, Anna K; Schalin-Jäntti, Camilla; Pitkälä, Kaisu H; Tilvis, Reijo S; Strandberg, Timo E

    2016-01-01

    high TSH concentrations and cognitive decline are both very common among older people and could be linked. to assess cognition in our cohort of 335 home-dwelling older people (75 years and older) and to cross-sectionally relate the results to thyroid-stimulating hormone (TSH) concentrations. Our special focus was on the upper normal TSH range and subclinical hypothyroidism. cognitive performance was evaluated using the Consortium to Establish a Registry for Alzheimer's disease neuropsychological battery (CERAD-nb). The Clinical Dementia Rating (CDR) scale was used to evaluate severity of cognitive disorder. The APOEε4 genotype was also defined. Subjects were divided into quartiles based on the TSH concentrations, and results were compared between these groups. expected relations were observed between CERAD domains and both educational level and APOEε4 genotype. Female sex significantly associated with better performance in Boston naming (OR = 0.48; 95% CI = 0.27-0.85). In the whole cohort, higher TSH concentrations tended to associate with better scores in most parts of the CERAD-nb tests, but differences were not statistically significant. However, subjects with the highest TSH concentration (90th TSH percentile, range 4.14-14.4 mU/l) had better CDR scores compared with subjects with the lowest TSH concentration (10th percentile, range 0.001-0.63 mIU/l; OR 0.10; 95% CI 0.014-0.76). our results do not support the notion that higher TSH concentrations, not even in the range of subclinical hypothyroidism, would adversely affect cognition among older people. © The Author 2015. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

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

    PubMed Central

    Ahmed, Tanvir; Haboubi, Nadim

    2010-01-01

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

  10. Eating and drinking interventions for people at risk of lacking decision-making capacity: who decides and how?

    PubMed

    Clarke, Gemma; Galbraith, Sarah; Woodward, Jeremy; Holland, Anthony; Barclay, Stephen

    2015-06-11

    Some people with progressive neurological diseases find they need additional support with eating and drinking at mealtimes, and may require artificial nutrition and hydration. Decisions concerning artificial nutrition and hydration at the end of life are ethically complex, particularly if the individual lacks decision-making capacity. Decisions may concern issues of life and death: weighing the potential for increasing morbidity and prolonging suffering, with potentially shortening life. When individuals lack decision-making capacity, the standard processes of obtaining informed consent for medical interventions are disrupted. Increasingly multi-professional groups are being utilised to make difficult ethical decisions within healthcare. This paper reports upon a service evaluation which examined decision-making within a UK hospital Feeding Issues Multi-Professional Team. A three month observation of a hospital-based multi-professional team concerning feeding issues, and a one year examination of their records. The key research questions are: a) How are decisions made concerning artificial nutrition for individuals at risk of lacking decision-making capacity? b) What are the key decision-making factors that are balanced? c) Who is involved in the decision-making process? Decision-making was not a singular decision, but rather involved many different steps. Discussions involving relatives and other clinicians, often took place outside of meetings. Topics of discussion varied but the outcome relied upon balancing the information along four interdependent axes: (1) Risks, burdens and benefits; (2) Treatment goals; (3) Normative ethical values; (4) Interested parties. Decision-making was a dynamic ongoing process with many people involved. The multiple points of decision-making, and the number of people involved with the decision-making process, mean the question of 'who decides' cannot be fully answered. There is a potential for anonymity of multiple decision

  11. Nutritional status predicts preterm death in older people: a prospective cohort study.

    PubMed

    Söderström, Lisa; Rosenblad, Andreas; Adolfsson, Eva Thors; Saletti, Anja; Bergkvist, Leif

    2014-04-01

    There is an association between malnutrition and mortality. However, it is uncertain whether this association is independent of confounders. The aim of the present study was to examine whether nutritional status, defined according to the three categories in the full Mini Nutritional Assessment (MNA) instrument, is an independent predictor of preterm death in people 65 years and older. This prospective cohort study included individuals aged ≥65 years who were admitted to hospital between March 2008 and May 2009 and followed-up after 50 months (n = 1767). Nutritional status was assessed with the MNA, and possible risk factors associated with malnutrition were recorded during participants hospital stay. Main outcome measure was overall survival. Based on the MNA definitions, 628 (35.5%) were well-nourished, 973 (55.1%) were at risk of malnutrition, and 166 (9.4%) of the participants were malnourished at baseline. During the follow-up period 655 (37.1%) participants died. At follow-up, the survival rates were 75.2% for well-nourished participants, 60.0% for those at risk of malnutrition, and 33.7% for malnourished participants (p < 0.001). After adjusting for confounders the hazard ratios (95% CI) for all-cause mortality were 1.56 (1.18-2.07) in the group at risk of malnutrition and 3.71 (2.28-6.04) in the malnourished group. Nutritional status defined according to the three categories in the full MNA independently predicts preterm death in people aged 65 years and older. These findings are clinically important and emphasise the usefulness of the MNA for screening of nutritional status. Copyright © 2013 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  12. A narrative exploration of older people's transitions into residential care.

    PubMed

    Lee, Victoria S P; Simpson, Jane; Froggatt, Katherine

    2013-01-01

    Moving into residential care has been argued to be a significant life transition for older people, often resulting in stress and anxiety. This research aimed to explore qualitatively older people's experiences of this transition, including how relocation is reflected upon and incorporated into their personal narratives. Eight older adults (65-97 years) living in a residential facility for between three and 12 months participated in interviews focussed on their experiences of relocating to a residential care home. Narrative analysis revealed that rather than depicting time bound stages of transition, participants' experiences reflected key plots of 'control', 'power', 'identity' and 'uncertainty' interwoven throughout their narratives. Participants experienced some difficulties in incorporating this transition into their life stories. Furthermore, participants discussed not feeling confident in their decision to move, living in constant fear of losing their memory, and limited expectations for their future. Professionals should move away from considering transition as a stage-based process ending in acceptance, instead focussing on how residents perceive relocation in relation to previous life experiences, unspoken fears evoked by moving and how the environment and relationships with staff may be altered to assist residents in maintaining their identity and sense of control.

  13. Belief in AIDS-related conspiracy theories and mistrust in the government: relationship with HIV testing among at-risk older adults.

    PubMed

    Ford, Chandra L; Wallace, Steven P; Newman, Peter A; Lee, Sung-Jae; Cunningham, William E

    2013-12-01

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

  14. Defining pastoral care for older people in residential care.

    PubMed

    Wilkes, Lesley; Cioffi, Jane; Fleming, Andrew; LeMiere, Jenny

    2011-02-01

    The concept and definition of pastoral care in aged care remains ambiguous. This paper reports on the defining characteristics and meaning of pastoral care from the perspective of older recipients, their family members and pastoral care workers. Using a qualitative descriptive approach semi-structured in-depth interviews were conducted with 18 pastoral care workers and 11 older people. Transcribed data were analysed using NVivo software and coded for emerging themes. The defining characteristics of pastoral care that emerged from analysis of transcribed interviews were: a trusting relationship, spiritual support, emotional support and practical support. Findings also portray the role of the pastoral care worker as spiritual guide, confidante, and emotional and practical supporter acting within a trusting relationship. Future studies should confirm these results by exploring the perceptions of experts in the field of pastoral care.

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

    PubMed

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

    2014-05-01

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

  16. [Global self-rated health and mortality in older people].

    PubMed

    Moreno, Ximena; Huerta, Martín; Albala, Cecilia

    2014-01-01

    To explore the association between global self-rated health and mortality in older people. A systematic review was performed. The inclusion criteria were longitudinal studies that assessed self-rated health with a single general question and samples of community-dwelling persons aged 60 years or more. Electronic databases were searched and references were reviewed. We selected 18 studies published between 1993 and 2011. Six out of seven studies that analyzed men and women found a higher risk of dying among persons who rated their health as poor; the most frequent covariables were age, gender, chronic diseases, and functional status. Half of the studies that analyzed only men or women found a significant association. The effect of self-reported health on mortality was observed among people younger than 75 years. Results were not dependent on the length of follow-up. The results confirm previous findings suggesting that a negative self-rating of general health predicts mortality. The mechanisms through which this indicator may predict mortality among older people could differ in men and women and need to be elucidated. The role of depression should be investigated, considering that the effect of self-rated health on mortality was not present when depression was included. Copyright © 2013 SESPAS. Published by Elsevier Espana. All rights reserved.

  17. Older people dying with dementia: a nationwide study.

    PubMed

    Meeussen, Koen; Van den Block, Lieve; Echteld, Michael; Boffin, Nicole; Bilsen, Johan; Van Casteren, Viviane; Deliens, Luc

    2012-10-01

    Large-scale nationwide data describing the end-of-life characteristics of older people with dementia are lacking. This paper describes the dying process and end-of-life care provided to elderly people with mild or severe dementia in Belgium. It compares with elderly people dying without dementia. A nationwide retrospective mortality study was conducted, via representative network of general practitioners (GPs) in 2008 in Belgium, with weekly registration of all deaths (aged ≥ 65) using a standardized form. GPs reported on diagnosis and severity of dementia, aspects of end-of-life care and communication, and on the last week of life in terms of symptoms that caused distress as judged by the GP, and the patients' physical and cognitive abilities. Thirty-one percent of our sample (1,108 deaths) had dementia (43% mildly, 57% severely). Of those, 26% died suddenly, 59% in care home, and 74% received palliative treatment, versus 37%, 19%, and 55% in people without dementia. GP-patient conversations were less frequent among those with (45%) than those without (73%) dementia, and 11% of both groups had a proxy decision-maker. During the last week of life, physical and psychological distress was common in both groups. Of older people with dementia, 83% were incapable of decision-making and 83% were bedridden; both significantly higher percentages than found in the group without dementia (24% and 52%). Several areas of end-of-life care provision could be improved. Early communication and exploration of wishes and appointment of proxy decision-makers are important components of an early palliative care approach which appears to be initiated too infrequently.

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

    ERIC Educational Resources Information Center

    Villar, Feliciano; Faba, Josep

    2012-01-01

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

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

    PubMed

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

    2014-06-01

    Reducing low-density lipoprotein cholesterol (LDL-C) levels using statins is associated with significant reductions in cardiovascular (CV) events in a wide range of patient populations. Although statins are generally considered to be safe, recent studies suggest they are associated with an increased risk of developing Type 2 diabetes (T2D). This led the US Food and Drug Administration (FDA) to change their labelling requirements for statins to include a warning about the possibility of increased blood sugar and HbA1c levels and the European Medicines Agency (EMA) to issue guidance on a small increased risk of T2D with the statin class. This review examines the evidence leading to these claims and provides practical guidance for primary care physicians on the use of statins in people with or at risk of developing T2D. Overall, evidence suggests that the benefits of statins for the reduction of CV risk far outweigh the risk of developing T2D, especially in individuals with higher CV risk. To reduce the risk of developing T2D, physicians should assess all patients for T2D risk prior to starting statin therapy, educate patients about their risks, and encourage risk-reduction through lifestyle changes. Whether some statins are more diabetogenic than others requires further study. Statin-treated patients at high risk of developing T2D should regularly be monitored for changes in blood glucose or HbA1c levels, and the risk of conversion from pre-diabetes to T2D should be reduced by intensifying lifestyle changes. Should a patient develop T2D during statin treatment, physicians should continue with statin therapy and manage T2D in accordance with relevant national guidelines. Copyright © 2014. Published by Elsevier Ireland Ltd.

  20. Characteristics of outdoor falls among older people: a qualitative study.

    PubMed

    Nyman, Samuel R; Ballinger, Claire; Phillips, Judith E; Newton, Rita

    2013-11-18

    Falls are a major threat to older people's health and wellbeing. Approximately half of falls occur in outdoor environments but little is known about the circumstances in which they occur. We conducted a qualitative study to explore older people's experiences of outdoor falls to develop understanding of how they may be prevented. We conducted nine focus groups across the UK (England, Wales, and Scotland). Our sample was from urban and rural settings and different environmental landscapes. Participants were aged 65+ and had at least one outdoor fall in the past year. We analysed the data using framework and content analyses. Forty-four adults aged 65 - 92 took part and reported their experience of 88 outdoor falls. Outdoor falls occurred in a variety of contexts, though reports suggested the following scenarios may have been more frequent: when crossing a road, in a familiar area, when bystanders were around, and with an unreported or unknown attribution. Most frequently, falls resulted in either minor or moderate injury, feeling embarrassed at the time of the fall, and anxiety about falling again. Ten falls resulted in fracture, but no strong pattern emerged in regard to the contexts of these falls. Anxiety about falling again appeared more prevalent among those that fell in urban settings and who made more visits into their neighbourhood in a typical week. This exploratory study has highlighted several aspects of the outdoor environment that may represent risk factors for outdoor falls and associated fear of falling. Health professionals are recommended to consider outdoor environments as well as the home setting when working to prevent falls and increase mobility among older people.

  1. Omega 3 fatty acids and cognitive health in older people.

    PubMed

    Dangour, Alan D; Andreeva, Valentina A; Sydenham, Emma; Uauy, Ricardo

    2012-06-01

    Oily fish and other sources of long-chain n-3 polyunsaturated fatty acids (n-3 LCPs) have been proposed as protective against dementia and age related cognitive impairment. The basic mechanisms underlying these proposed benefits have been postulated and experimental studies supporting the plausibility of the putative effects have been published. Observational epidemiological and case control studies also largely support a protective role of fish consumption on cognitive function with advancing age, albeit with important unexplained heterogeneity in findings. In this review we report the findings of the latest Cochrane review on the benefits of n-3 LCP supplementation on cognitive function among cognitively healthy older people and expand the review by including trials conducted with individuals with prevalent poor cognitive function or dementia. We identified seven relevant trials, four among cognitively healthy older people, and three among individuals with pre-existing cognitive decline or dementia, and overall conclude that there is no evidence to support the routine use of n-3 LCPs supplements for the prevention, or amelioration, of cognitive decline in later life. We identified several challenges in the design of intervention studies for the prevention of dementia and cognitive decline in older people that require careful consideration especially in recruitment and retention in long-term trials. Whether the lack of agreement in findings from mechanistic and observational data and from intervention studies reflects a real absence of benefit on cognitive function from n-3 LCP supplementation, or whether it reflects intrinsic limitations in the design of published studies remains open to question.

  2. Registered Nurses working together with family members of older people.

    PubMed

    Weman, Karin; Fagerberg, Ingegerd

    2006-03-01

    The aim of the study was to reach a more profound understanding, through looking at nurses' working situation, of those factors that influence how nurses are able to work together with family members of older people living in nursing homes or similar facilities. Working with the care of older people as a Registered Nurse provides a varied job with many challenges. Nurses have to co-operate with family members of those in community health care. Co-operation is important and necessary for all involved. Nurses working in elder care in a geographically defined area received a questionnaire with three open-ended questions, on the difficulties and/or problems involved with working together with family members, and the positive or negative aspects of this co-operation. Analysis was carried out using the latent content analysis method. Three themes, problems within the system, interaction with families and caring in nursing work, are presented with categories and their subcategories. The nurses wanted their superior to be a nurse so that their working situation would be better understood. Appreciation from their superior and family members was also a very important part of their work as nurses in community health care. The frequent changes and the lack of time in the work of elder care often put nurses under considerable psychological pressure. For the most part family members are a resource for the elder, but sometimes they will avoid contact, which will make co-operating difficult. Registered Nurses and family members are dependent on each other in their care of the elder. Relevance to clinical practice. More attention should be paid to the working situation of Registered Nurses in community health care, and their ability to work together with family members of older people.

  3. Body composition and frailty profiles in Brazilian older people: Frailty in Brazilian Older People Study-FIBRA-BR.

    PubMed

    Ferriolli, Eduardo; Pessanha, Fernanda Pinheiro Amador Dos Santos; Moreira, Virgílio Garcia; Dias, Rosângela Corrêa; Neri, Anita Liberalesso; Lourenço, Roberto Alves

    2017-07-01

    To determine the association between body composition and frailty in older Brazilian subjects. This is a Cross-sectional study called FIBRA-BR and developed in community Brazilian aged ≥65 (n=5638). Frailty was assessed according to Fried et al. definition and body composition was determined by BMI, waist circumference and waist-hip ratio. The lowest prevalence of frailty was observed in subjects with BMI between 25.0 and 29.9kg/m(2). Subjects with a BMI <18.5 and those with elevated WC presented a higher risk of frailty compared to eutrophic subjects (odds ratio (OR)=3.10; 95% CI: 2.06-4.67) and (OR=1.15; 95% CI: 1.03-1.27), respectively. Being overweight was protective for pre-frailty (OR=0.48; 95% CI: 0.4-0.58) and frailty (OR=0.77; 95% CI: 0.67-0.9). Obese older people presented a higher risk of pre-frailty only (OR=1.29; 95% CI: 1.09-1.51). Older people with high WC showed a greater proportion of frailty regardless of the BMI range. Undernutrition is associated with pre-frailty and frailty in Brazilian elderly subjects, whereas obesity is associated only with pre-frailty. Overweight seems to have a protective effect against the syndrome. The excess of abdominal fat is associated with both profiles independent of the BMI. Copyright © 2017 Elsevier B.V. All rights reserved.

  4. PATTERNS OF DIETARY SUPPLEMENT USAGE IN DEMOGRAPHICALLY DIVERSE OLDER PEOPLE

    PubMed Central

    Kishiyama, Shirley S.; Leahy, Marjorie J.; Zitzelberger, Tracy A.; Guariglia, Robin; Zajdel, Daniel P.; Calvert, James F.; Kaye, Jeffrey A.; Oken, Barry S.

    2005-01-01

    Objective To analyze dietary supplement usage data from 494 older adults, aged 65 to 101 years. Setting Community dwellers living independently of institutionalized care. Design All dietary supplements, including botanicals, were recorded to aid in assessing the health status of older adults. Participants 1) 224 individuals enrolled in a study that follows the health of persons 85 years and older (oldest-old) in Klamath County, a non-metropolitan area in southern Oregon: 2) 134 participants of oldest-old age living in the metropolitan Portland area, enrolled in a randomized clinical trial of GBE biloba extract (GBE) for dementia prevention: and 3) 136 participants, ages 65–85 years (young-old), also of the Portland area, enrolled in a study of the effects of yoga and exercise on cognition. Measurements Data verified from labels, not from self-report. Results Of the participants, 70.6% used dietary supplements. Women took supplements more often than men, and usage decreased with age. A greater percentage, 67.4%, of the non-metropolitan oldest-old took supplements, compared to 56.7% of the metropolitan oldest-old. The greatest usage, 89.7%, was in the metropolitan young-olds. All of these percentages exceed those for comparable age groups in national representative surveys. Conclusions Dietary supplement usage by older adults in these studies in Oregon exceeded that in other reports and may reflect high interest in complementary and alternative medicine. This report confirms the results of other studies showing that elderly adults, particularly women, use dietary supplements more than other segments of the US population. Researchers and clinicians should be aware of this pattern and potential conflicts with research design or treatment regimen intended for older people. PMID:15945136

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

    ERIC Educational Resources Information Center

    Turner, Sue; Cooper Ueki, Madeline

    2015-01-01

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

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

    ERIC Educational Resources Information Center

    Turner, Sue; Cooper Ueki, Madeline

    2015-01-01

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

  7. Physical Fitness in Older People Recently Diagnosed with Cognitive Impairment Compared to Older People Recently Discharged from Hospital

    PubMed Central

    Hesseberg, Karin; Bergland, Astrid; Rydwik, Elisabeth; Brovold, Therese

    2016-01-01

    Background/Aims There is evidence of an association between cognitive function and physical fitness. The aim of this study was to compare physical fitness in patients with cognitive impairment with a group of older people recently discharged from hospital. Methods A cross-sectional study with 98 patients recently diagnosed with cognitive impairment and 115 patients recently discharged from hospital. Associations between the study group variable and different components in the Senior fitness test were examined, controlling for demographic factors and comorbidity. Results The group recently diagnosed with cognitive impairment indicated poorer results on three of six physical fitness components (p < 0.05). Conclusion Older adults with cognitive impairment are in need of individually tailored physical activity programs to increase the level of physical fitness. PMID:27703472

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

    PubMed

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

    2015-01-01

    Reminders are often part of interventions to help older people adhere to complicated medication regimes. Computer-generated (synthetic) speech is ideal for tailoring reminders to different medication regimes. Since synthetic speech may be less intelligible than human speech, in particular under difficult listening conditions, we assessed how well older people can recall synthetic speech reminders for medications. 44 participants aged 50-80 with no cognitive impairment recalled reminders for one or four medications after a short distraction. We varied background noise, speech quality, and message design. Reminders were presented using a human voice and two synthetic voices. Data were analyzed using generalized linear mixed models. Reminder recall was satisfactory if reminders were restricted to one familiar medication, regardless of the voice used. Repeating medication names supported recall of lists of medications. We conclude that spoken reminders should build on familiar information and be integrated with other adherence support measures. © The Author 2014. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.comFor numbered affiliations see end of article.

  9. 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…

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

    ERIC Educational Resources Information Center

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

    2011-01-01

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

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

    ERIC Educational Resources Information Center

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

    2011-01-01

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

  12. 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…

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

    PubMed

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

    2016-01-01

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

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

    ERIC Educational Resources Information Center

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

    2011-01-01

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

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

    ERIC Educational Resources Information Center

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

    2011-01-01

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

  16. Unique Factors that Place Older Hispanic Women at Risk for HIV: Intimate Partner Violence, Machismo, and Marianismo

    PubMed Central

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

    2013-01-01

    Hispanic women who are 50 years of age and older have been shown to be at increased risk of acquiring HIV infection due to age and culturally related issues. The purpose of our study was to investigate factors that increase HIV risk among older Hispanic women (OHW) as a basis for development or adaptation of an age and culturally tailored intervention designed to prevent HIV-related risk behaviors. We used a qualitative descriptive approach. Five focus groups were conducted in Miami, FL, with 50 participants. Focus group discussions centered around 8 major themes: intimate partner violence (IPV), perimenopausal-postmenopausal related biological changes, cultural factors that interfere with HIV prevention, emotional and psychological changes, HIV knowledge, HIV risk perception, HIV risk behaviors, and HIV testing. Findings from our study stressed the importance of nurses' roles in educating OHW regarding IPV and HIV prevention. PMID:23790277

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

    PubMed

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

    2013-01-01

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

  18. Be Well: results of a nutrition, exercise, and weight management intervention among at-risk older adults.

    PubMed

    Kogan, Alexis Coulourides; Gonzalez, Jorge; Hart, Bonita; Halloran, Skip; Thomason, Brenda; Levine, Morgan; Enguidanos, Susan

    2013-10-01

    The objective of this article is to test the effectiveness of a multifaceted exercise and nutritional education intervention for chronically ill, community-dwelling older adults. A pre/post cohort design was implemented with measures of physical activity, fitness, depression, and anthropometry collected via 4-month in-person interview and telephone follow-up. The study was conducted at two community-based senior centers in the Los Angeles area and participants (n=62) were older adults aged 60 or older, with multiple chronic conditions, with one or more emergency department visits or hospital admissions in the previous 6 months, and at nutritionally moderate to high risk. The intervention was a fitness program providing nutritional counseling, low-impact exercise, and weight management. Results revealed significant improvements for hours of weekly exercise (Z = -4.3, p < .001), daily walking distance (Z = -5.7, p < .001), performance on fitness tests, depression (Z = 3.9, p < .001), and body measurements were observed. Findings speak to the healthy benefits of exercise and good nutrition as possible alternatives or adjuncts to pharmacotherapy for weight loss and depression.

  19. Polypharmacy cut-points in older people with cancer: how many medications are too many?

    PubMed

    Turner, Justin P; Jamsen, Kris M; Shakib, Sepehr; Singhal, Nimit; Prowse, Robert; Bell, J Simon

    2016-04-01

    Polypharmacy is often defined as use of 'five-or-more-medications'. However, the optimal polypharmacy cut-point for predicting clinically important adverse events in older people with cancer is unclear. The aim was to determine the sensitivities and specificities of a range of polypharmacy cut-points in relation to a variety of adverse events in older people with cancer. Data on medication use, falls and frailty criteria were collected from 385 patients aged ≥70 years presenting to a medical oncology outpatient clinic. Receiver operating characteristic (ROC) curves were produced to examine sensitivities and specificities for varying definitions of polypharmacy in relation to exhaustion, falls, physical function, Karnofsky Performance Scale (KPS) and frailty. Sub-analyses were performed when stratifying by age, sex, comorbidity status and analgesic use. Patients had a mean age of 76.7 years. Using Youden's index, the optimal polypharmacy cut-point was 6.5 medications for predicting frailty (specificity 67.0 %, sensitivity 70.0 %), physical function (80.2 %, 49.3 %) and KPS (69.8 %, 52.1 %), 5.5 for falls (59.2 %, 73.0 %) and 3.5 for exhaustion (43.4 %, 74.5 %). For polypharmacy defined as five-or-more-medications, the specificities and sensitivities were frailty (44.9 %, 77.5 %), physical function (58.0 %, 69.7 %), KPS (47.7 %, 69.4 %), falls (44.5 %, 75.7 %) and exhaustion (52.6 %, 64.1 %). The optimal polypharmacy cut-points were similar when the sample was stratified by age, sex, comorbidity status and analgesic use. Our results suggest that no single polypharmacy cut-point is optimal for predicting multiple adverse events in older people with cancer. In this population, the common definition of five-or-more-medications is reasonable for identifying 'at-risk' patients for medication review.

  20. Disease management for depression and at-risk drinking via telephone in an older population of veterans.

    PubMed

    Oslin, David W; Sayers, Steven; Ross, Jennifer; Kane, Vince; Ten Have, Thomas; Conigliaro, Joseph; Cornelius, Jack

    2003-01-01

    The purpose of this study was to explore the efficacy in a primary care setting of a telephone-based disease management program for the acute management of depression and/or at-risk drinking. Veterans (N= 97) with depression and/or at-risk drinking were identified by systematic screening and assessment. Eligible subjects received either telephone disease management (TDM) program or usual care based on random assignment of their clinician. The TDM program consisted of regular contacts with each subject by a behavioral health specialist (BHS) to assist in assessment, education, support, and treatment planning. Symptomatic outcomes were assessed at 4 months. Overall response rates favored those assigned to TDM compared with those assigned to usual care (39.1% responded vs. 17.6%, p= 0.022). Response rates within the separate diagnostic groups also favored TDM, but this was only significant for depressive disorders. Although the sample size was modest and the sample was limited to veterans, findings strongly suggest that a telephone-based disease management program can improve outcomes for patients with a behavioral health problem. Findings also suggest that a health specialist can focus and manage patients with different diagnoses, thus expanding the role beyond just depression care. TDM may be a viable, low-cost, model for primary care clinicians to deliver manual guideline-adherent behavioral health care, especially in a VA clinical setting.

  1. The wills of older people: risk factors for undue influence.

    PubMed

    Peisah, C; Finkel, S; Shulman, K; Melding, P; Luxenberg, J; Heinik, J; Jacoby, R; Reisberg, B; Stoppe, G; Barker, A; Firmino, H; Bennett, H

    2009-02-01

    As people live longer, there is increasing potential for mental disorders to interfere with testamentary distribution and render older people more vulnerable to "undue influence" when they are making a will. Accordingly, clinicians dealing with the mental disorders of older people will be called upon increasingly to advise the courts about a person's vulnerability to undue influence. A Subcommittee of the IPA Task Force on Testamentary Capacity and Undue Influence undertook to establish consensus on the definition of undue influence and the provision of guidelines for expert assessment of risk factors for undue influence. International jurisdictions differ in their approach to the notion of undue influence. Despite differences in legal systems, from a clinical perspective, the subcommittee identified some common "red flags" which might alert the expert to risk of undue influence. These include: (i) social or environmental risk factors such as dependency, isolation, family conflict and recent bereavement; (ii) psychological and physical risk factors such as physical disability, deathbed wills, sexual bargaining, personality disorders, substance abuse and mental disorders including dementia, delirium, mood and paranoid disorders; and (iii) legal risk factors such as unnatural provisions in a will, or provisions not in keeping with previous wishes of the person making the will, and the instigation or procurement of a will by a beneficiary. This review provides some guidance for experts who are requested by the courts to provide an opinion on the risk of undue influence. Whilst international jurisdictions require different thresholds of proof for a finding of undue influence, there is good international consensus on the clinical indicators for the concept.

  2. Living on the Edge: Social Exclusion and the Receipt of Informal Care in Older People.

    PubMed

    Dahlberg, Lena; McKee, Kevin J

    2016-01-01

    Older people have been identified as being at risk of social exclusion. However, despite the fact that care is commonly required in later life and the majority of that care is provided by informal carers, a connection between social exclusion and informal care-receipt has rarely been considered. The aim of this study was to examine how informal care-receipt is related to social exclusion. A face-to-face questionnaire survey on social exclusion and informal care-receipt was carried out among older people (n = 1255) living in Barnsley, United Kingdom. Multivariable analyses examined the association between social exclusion and categories of informal care-receipt: care-receiver; assurance-receiver; nonreceiver with no need; and nonreceiver with need. Compared to being a nonreceiver with no need, participants were more likely to be care-receivers or assurance-receivers if they had higher levels of social exclusion. The highest level of social exclusion, however, was found in nonreceivers with need. Despite a lack of informal care and support, formal practical support and personal care were also low in this latter group. Findings are discussed in relation to the conceptualisation of care-receipt and how contact with medical services could be an opportunity for identification and appropriate referral of nonreceivers with need.

  3. Living on the Edge: Social Exclusion and the Receipt of Informal Care in Older People

    PubMed Central

    2016-01-01

    Older people have been identified as being at risk of social exclusion. However, despite the fact that care is commonly required in later life and the majority of that care is provided by informal carers, a connection between social exclusion and informal care-receipt has rarely been considered. The aim of this study was to examine how informal care-receipt is related to social exclusion. A face-to-face questionnaire survey on social exclusion and informal care-receipt was carried out among older people (n = 1255) living in Barnsley, United Kingdom. Multivariable analyses examined the association between social exclusion and categories of informal care-receipt: care-receiver; assurance-receiver; nonreceiver with no need; and nonreceiver with need. Compared to being a nonreceiver with no need, participants were more likely to be care-receivers or assurance-receivers if they had higher levels of social exclusion. The highest level of social exclusion, however, was found in nonreceivers with need. Despite a lack of informal care and support, formal practical support and personal care were also low in this latter group. Findings are discussed in relation to the conceptualisation of care-receipt and how contact with medical services could be an opportunity for identification and appropriate referral of nonreceivers with need. PMID:27882247

  4. Individualised dietary counselling for nutritionally at-risk older patients following discharge from acute hospital to home: a systematic review and meta-analysis.

    PubMed

    Munk, T; Tolstrup, U; Beck, A M; Holst, M; Rasmussen, H H; Hovhannisyan, K; Thomsen, T

    2016-04-01

    Many older patients are undernourished after hospitalisation. Undernutrition impacts negatively on physical function and the ability of older patients to perform activities of daily living at home after discharge from acute hospital. The present study aimed to evaluate the evidence for an effect of individualised dietary counselling following discharge from acute hospital to home on physical function, and, second, on readmissions, mortality, nutritional status, nutritional intake and quality of life (QoL), in nutritionally at-risk older patients. A systematic review of randomised controlled trials was conducted. The overall quality of the evidence was assessed according to Grading of Recommendations Assessment, Development and Evaluation system (GRADE) criteria. Four randomised controlled trials (n = 729) were included. Overall, the evidence was of moderate quality. Dietitians provided counselling in all studies. Meta-analyses showed a significant increase in energy intake [mean difference (MD) = 1.10 MJ day(-1), 95% confidence interval (CI) = 0.66-1.54, P < 0.001], protein intake (MD = 10.13 g day(-1), 95% CI = 5.14-15.13, P < 0.001) and body weight (BW) (MD = 1.01 kg, 95% CI = 0.08-1.95, P = 0.03). Meta-analyses revealed no significant effect on physical function assessed using hand grip strength, and similarly on mortality. Narrative summation of effects on physical function using other instruments revealed inconsistent effects. Meta-analyses were not conducted on QoL and readmissions as a result of a lack of data. Individualised dietary counselling by dietitians following discharge from acute hospital to home improved BW, as well as energy and protein intake, in older nutritionally at-risk patients, although without clearly improving physical function. The effect of this strategy on physical function and other relevant clinical outcomes warrants further investigation. © 2015 The British Dietetic Association Ltd.

  5. Social peptides: measuring urinary oxytocin and vasopressin in a home field study of older adults at risk for dehydration.

    PubMed

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

    2014-11-01

    We present the novel urine collection method used during in-home interviews of a large population representative of older adults in the United States (aged 62-91, the National Social Life, Health and Aging Project). We also present a novel assay method for accurately measuring urinary peptides oxytocin (OT) and vasopressin (AVP), hormones that regulate social behaviors, stress, and kidney function. Respondents in a randomized substudy (N = 1,882) used airtight containers to provide urine specimens that were aliquoted, stored under frozen refrigerant packs and mailed overnight for frozen storage (-80 °C). Assays for OT, AVP, and creatinine, including freeze-thaw cycles, were refined and validated. Weighted values estimated levels in the older U.S. population. Older adults had lower OT, but higher AVP, without the marked gender differences seen in young adults. Mild dehydration, indicated by creatinine, specific gravity, acidity, and AVP, produced concentrated urine that interfered with the OT assay, yielding falsely high values (18% of OT). Creatinine levels (≥ 1.4 mg/ml) identified such specimens that were diluted to solve the problem. In contrast, the standard AVP assay was unaffected (97% interpretable) and urine acidity predicted specimens with low OT concentrations. OT and AVP assays tolerated 2 freeze-thaw cycles, making this protocol useful in a variety of field conditions. These novel protocols yielded interpretable urinary OT and AVP values, with sufficient variation for analyzing their social and physiological associations. The problem of mild dehydration is also likely common in animal field studies, which may also benefit from these collection and assay protocols. © The Author 2014. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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

    PubMed Central

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

    2014-01-01

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

  7. Tailored and Adaptive Computerized Cognitive Training in Older Adults at Risk for Dementia: A Randomized Controlled Trial.

    PubMed

    Bahar-Fuchs, Alex; Webb, Shannon; Bartsch, Lauren; Clare, Linda; Rebok, George; Cherbuin, Nicolas; Anstey, Kaarin J

    2017-01-01

    Computerized Cognitive Training (CCT) has been shown to improve cognitive function in older adults with mild cognitive impairment (MCI) or mood-related neuropsychiatric symptoms (MrNPS), but many questions remain unresolved. To evaluate the extent to which CCT benefits older adults with both MCI and MrNPS, and its effects on meta-cognitive and non-cognitive outcomes, as well as establish whether adapting difficulty levels and tailoring to individuals' profile is superior to generic training. Older adults with MCI (n = 9), MrNPS (n = 11), or both (MCI+, n = 25) were randomized into a home-based individually-tailored and adaptive CCT (n = 21) or an active control condition (AC; n = 23) in a double-blind design. Interventions lasted 8-12 weeks and outcomes were assessed after the intervention, and at a 3-month follow-up. Participants in both conditions reported greater satisfaction with their everyday memory following intervention and at follow-up. However, participants in the CCT condition showed greater improvement on composite measures of memory, learning, and global cognition at follow-up. Participants with MrNPS in the CCT condition were also found to have improved mood at 3-month follow-up and reported using fewer memory strategies at the post-intervention and follow-up assessments. There was no evidence that participants with MCI+ were disadvantaged relative to the other diagnostic conditions. Finally, informant-rated caregiver burden declined at follow-up assessment in the CCT condition relative to the AC condition. Home-based CCT with adaptive difficulty and personal tailoring appears superior to more generic CCT in relation to both cognitive and non-cognitive outcomes. Mechanisms of treatment effect and future directions are discussed.

  8. One-year prediction of pain killer use among at-risk older teens and emerging adults.

    PubMed

    Sussman, Steve; Rohrbach, Louise A; Spruijt-Metz, Donna; Barnett, Elizabeth; Lisha, Nadra; Sun, Ping

    2012-01-01

    The leading substance of misuse among teens after tobacco, alcohol, and marijuana is the use of pain killers. Very few longitudinal studies on prediction of pain killer use have been conducted among teens. This study examined the 1-year prediction of self-reported last 30-day pain killer use controlling for baseline 30-day painkiller use among 1186 alternative high school youth in California. Among demographic, behavioral, psychosocial, and environmental predictors, a multivariable model indicated that: (a) relatively higher levels of baseline pain killer use; (b) white ethnicity; (c) relatively lower levels of depressive symptoms (contrary to previous studies); and (d) those who live with both parents were more likely to report use of pain killer medications in the next year. It is speculated that those with relatively greater access to pain medication, within an at-risk social environment, are those who will use it later on.

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

    ERIC Educational Resources Information Center

    Tatnall, Arthur

    2014-01-01

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

  10. A Better Future for Us All: A Policy Paper on Older People and Learning

    ERIC Educational Resources Information Center

    National Institute of Adult Continuing Education, 2015

    2015-01-01

    This report is about learning and older people. In the UK, one person in three is over 50, and the numbers are rising. People are living longer, and while some of these years are healthy active retirement, some are spent in poor health. In both cases, learning can make a major contribution both to the well-being of older people, and their…

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

    ERIC Educational Resources Information Center

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

    2006-01-01

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

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

    ERIC Educational Resources Information Center

    Tatnall, Arthur

    2014-01-01

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

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

    ERIC Educational Resources Information Center

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

    2006-01-01

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

  14. The person-centred care of older people with cognitive impairment in acute care (POPAC) scale - psychometric evaluation.

    PubMed

    Grealish, Laurie; Chaboyer, Wendy; Harbeck, Emma; Edvardsson, David

    2017-03-01

    To test the reliability and validity of the Person-centred care of Older People with cognitive impairment in Acute Care scale to determine nurses' perceptions of person-centred care. One-third of older adults admitted to hospital are at risk of serious hospital-acquired complications such as falls, infections and pressure injuries because of cognitive impairment. These risks can be reduced through person-centred practices. The Person-centred care of Older People with cognitive impairment in Acute Care scale is a self-report staff instrument to explore the extent to which person-centred practices are undertaken; however psychometric testing is limited. A cross-sectional sample of acute care nurses (n = 240) in Queensland, Australia completing self-report questionnaires. Psychometric analyses of item performance, reliability and validity were conducted. Item analysis revealed independent items. One item was removed due to negatively associating with the scale, improving total Cronbach's alpha from 0.76 to 0.84. The three original factors were maintained with regrouping of items. Confirmatory factor analysis confirmed the revised model. The revised Person-centred care of Older People with cognitive impairment in Acute Care scale had satisfactory psychometric properties when used as a total scale. Scale brevity and simplicity together with rigorous development and testing indicates that the revised Person-centred care of Older People with cognitive impairment in Acute Care may be useful for quality improvement programmes into the care of older people in hospitals. © 2016 John Wiley & Sons Ltd.

  15. Informing the debate on oral health care for older people: a qualitative study of older people's views on oral health and oral health care.

    PubMed

    Borreani, E; Jones, K; Scambler, S; Gallagher, J E

    2010-03-01

    Older people represent a growing and diverse section of the population. As age increases, people are more likely to experience health and mobility problems and be at higher risk of developing oral disease. Nevertheless, few older people utilise primary oral healthcare services. It is therefore important to understand the value older people place on oral health and dental services to inform providers and planners of oral health care. This research was conducted as part of a study to identify potential ways of minimising barriers to oral health care in older people. To explore perceptions of oral health and oral healthcare services amongst older people living in a socially deprived inner city area and how these are related to service utilisation. A qualitative approach was utilised to explore the range of issues related to older people's perceptions of oral health and their views on health care. This involved a combination of focus groups and semi-structured individual interviews with older people and their carers. Data analysis was conducted using the Framework approach. * Thirty-nine older people and/or their carers participated in focus groups. * Oral health perception: Oral health was associated with the presence of natural teeth, the absence of pain, practical/social functioning, preferably supported by positive assessment by a dentist. * Oral health life-course: Older people have a long and complex dental history. Past negative experiences with oral health care, especially in childhood, strongly influenced present attitudes towards dentistry and dental personnel. * Citizenship and right to health care: There was a strong perception that, as 'British citizens', older people should have a right to free health care and that the National Health Service (NHS) should support them in this phase of their life. The oral health life-course of older people is an important influence on their perceptions of oral health and dental attendance. They consider oral health of

  16. Community mental health teams for older people: variations in case mix and service receipt (II).

    PubMed

    Wilberforce, Mark; Tucker, Sue; Brand, Christian; Abendstern, Michele; Jasper, Rowan; Stewart, Karen; Challis, David

    2015-06-01

    To determine the extent to which services provided to older people via community mental health teams (CMHTs) vary in duration, composition and intensity. In particular, to identify the degree to which differences between teams are due to casemix. Data were collected about the services provided to a random sample of patients from 15 CMHT caseloads, including contact with CMHT staff, other specialist mental health and social care services. The relationship between patients' needs and service receipt was explored. Information was obtained for 1396 patients. Average time on CMHT caseloads was 11.6 months, but there were marked between-team differences. The proportion of re-referrals also varied from under a tenth to over half. People with functional mental health problems and complex needs were most likely to be long-term CMHT clients. The proportion of patients seen by a consultant in the previous 6 months ranged from approximately a fifth to almost all. Differences with respect to contact with other qualified practitioners were less marked. Older people with functional disorders, challenging behaviour and at least one medium risk had the most regular contact with CMHT staff. Risk of self-harm, delusions and paranoia increased the likelihood of consultant involvement. Support workers were more likely to see people at risk of self-neglect. The receipt of other services, including day hospitals and inpatient care varied greatly. Considerable diversity was found in the length, nature and frequency of services provided to patients with different needs. Differences between teams were not wholly explained by case mix. Copyright © 2014 John Wiley & Sons, Ltd.

  17. Comprehension by older people of medication information with or without supplementary pharmaceutical pictograms.

    PubMed

    Ng, Annie W Y; Chan, Alan H S; Ho, Vincy W S

    2017-01-01

    This study examined the benefits of pharmaceutical pictograms for improving comprehension of medication information for older people. Fifty Hong Kong Chinese older people completed a medical information comprehension task for five drugs. Participants in the control group were presented with text labels while those in the experimental group were given the text labels plus supplementary pharmaceutical pictograms, and then all reported their understanding of the medication information conveyed. Lower educated older people had poorer understanding of medication information. The addition of pharmaceutical pictograms significantly improved the comprehension of medication information for older people. The majority of older people tested with pictograms favored adding pictograms to text and thought the pictograms were useful for conveying medical information rather than using written text alone. The findings suggested that pharmaceutical and health care professionals should include pharmaceutical pictograms on labels to better convey instructions on medication to older people. Copyright © 2016 Elsevier Ltd. All rights reserved.

  18. Healing determinants in older people with leg ulcers.

    PubMed

    Johnson, M

    1995-10-01

    A descriptive correlational design was used to identify the physiologic, therapeutic, and psychosocial determinants of leg ulcer healing in community-residing older people with venous and venous-arterial disease (N = 156). A regression model with healing rate as the dependent variable explained 49% of the variance. Increased pain when mobilizing, increased hours with limbs horizontal to the torso, and moderate and severe liposclerosis (hardening and induration of the skin) were associated with poorer healing rates. Higher wound status scores were associated with more rapid healing rates. Self-efficacy beliefs and social support were not significant factors. The findings suggest the need for early detection and management of limb pain that interferes with normal mobility. Limb position and edema assessment prior to the application of compression bandages is recommended, with bandages that provide clients with high compression when ambulant and low compression when resting being potentially beneficial.

  19. Time in Care for Older People Living in Nursing Homes

    PubMed Central

    Thorsell, K. B. E.; Nordström, B. M.; Fagerström, L.; Sivberg, B. V.

    2010-01-01

    In order to measure actual care needs in relation to resources required to fulfill these needs, an instrument (Time in Care) with which to evaluate care needs and determine the time needed for various care activities has been developed with the aim of assessing nursing intensity in municipal care for older people. Interreliability (ICC = 0.854) of time measurements (n = 10'546) of 32 nursing activities in relation to evaluated care levels in two nursing homes (staff n = 81) has been determined. Nursing intensity for both periods at the two nursing homes comprised on average a direct care time of 75 (45%) and 101 (42%) minutes, respectively. Work time was measured according to actual schedule (462 hours per nursing home during two weeks). Given that the need for care was high, one must further investigate if the quality of care the recipients received was sufficiently addressed. PMID:21994810

  20. Dealing with troubled conscience in municipal care of older people.

    PubMed

    Ericson-Lidman, Eva; Strandberg, Gunilla

    2013-05-01

    Troubled conscience may jeopardize the health of healthcare personnel and, hence, the quality of care provided. Learning more about how personnel deal with their troubled conscience therefore seems important. The aim of this study was to describe personnel's experiences of how they deal with troubled conscience generated in their daily work in municipal care of older people. Interviews were conducted with 20 care providers and analysed with a thematic content analysis. The findings show that in order to deal with troubled conscience, personnel dialogued with themselves and with others. They took measures in a direction they perceived to be correct, and they expressed a need for distancing and re-energizing. It is of importance to share situations that generate troubled conscience in order to find ways to deal with them. Reconsidering one's ways of dealing with troubled conscience may give care providers an opportunity to reach consensus within themselves.

  1. Effectiveness of a balance-focused exercise program for enhancing functional fitness of older adults at risk of falling: A randomised controlled trial.

    PubMed

    Zhao, Yanan; Chung, Pak-Kwong; Tong, Tom K

    2017-03-27

    This study examined the effectivenss of a balance-focused training program (i.e., Exercise for Balance Improvement Program, ExBP) in improving functional fitness of older nonfallers at risk of falling. Sixty-one participants were randomly assigned to receive 16 weeks of ExBP or Tai Chi (TC) training, or no treatment (CON) with an 8-week follow-up. The Senior Fitness Test battery was applied to assess functional fitness. After the intervention, results revealed significant improvements in all fitness components in the ExBP group. Compared with the CON group, the ExBP group demonstrated more improvements in lower extremity muscle strength, agility and balance, and aerobic endurance. The ExBP group also displayed more improvements in aerobic endurance than the TC group in posttest and follow-up test. Therefore, the balance-focused exercise can be applied as an effective way in improving overall functional fitness among older nonfallers who are at risk of falling.

  2. The effects of a long-term physical activity intervention on serum uric acid in older adults at risk for physical disability.

    PubMed

    Beavers, Kristen M; Hsu, Fang-Chi; Serra, Monica C; Yank, Veronica; Pahor, Marco; Nicklas, Barbara J

    2014-01-01

    Observational studies show a relationship between elevated serum uric acid (UA) and better physical performance and muscle function. The purpose of this paper was to determine whether regular participation in an exercise intervention, known to improve physical functioning, would result in increased serum UA. For this study, 424 older adults at risk for physical disability were randomized to participate in either a 12-mo moderate-intensity physical activity (PA) or a successful aging (SA) health education intervention. UA was measured at baseline, 6, and 12 mo (n = 368, 341, and 332, respectively). Baseline UA levels were 6.03 ± 1.52 mg/dl and 5.94 ± 1.55 mg/dl in the PA and SA groups, respectively. The adjusted mean UA at month 12 was 4.8% (0.24 mg/dl) higher in the PA compared with the SA group (p = .028). Compared with a health education intervention, a 1-yr PA intervention results in a modest increase in systemic concentration of UA in older adults at risk for mobility disability.

  3. Characteristics of outdoor falls among older people: a qualitative study

    PubMed Central

    2013-01-01

    Background Falls are a major threat to older people’s health and wellbeing. Approximately half of falls occur in outdoor environments but little is known about the circumstances in which they occur. We conducted a qualitative study to explore older people’s experiences of outdoor falls to develop understanding of how they may be prevented. Methods We conducted nine focus groups across the UK (England, Wales, and Scotland). Our sample was from urban and rural settings and different environmental landscapes. Participants were aged 65+ and had at least one outdoor fall in the past year. We analysed the data using framework and content analyses. Results Forty-four adults aged 65 – 92 took part and reported their experience of 88 outdoor falls. Outdoor falls occurred in a variety of contexts, though reports suggested the following scenarios may have been more frequent: when crossing a road, in a familiar area, when bystanders were around, and with an unreported or unknown attribution. Most frequently, falls resulted in either minor or moderate injury, feeling embarrassed at the time of the fall, and anxiety about falling again. Ten falls resulted in fracture, but no strong pattern emerged in regard to the contexts of these falls. Anxiety about falling again appeared more prevalent among those that fell in urban settings and who made more visits into their neighbourhood in a typical week. Conclusions This exploratory study has highlighted several aspects of the outdoor environment that may represent risk factors for outdoor falls and associated fear of falling. Health professionals are recommended to consider outdoor environments as well as the home setting when working to prevent falls and increase mobility among older people. PMID:24245830

  4. Systematic review of barriers and facilitators to accessing and engaging with mental health care among at-risk young people.

    PubMed

    Brown, Adrienne; Rice, Simon M; Rickwood, Debra J; Parker, Alexandra G

    2016-03-01

    This study aims to review the literature on barriers and facilitators to accessing and engaging with mental health care among young people from potentially disadvantaged groups, including young people identified as Aboriginal or Torres Strait Islander (ATSI); culturally and linguistically diverse (CALD); lesbian, gay, bisexual, transgender, queer, or intersex (LGBTQI); homeless; substance using; and youth residing in rural or remote areas. Fourteen databases were searched to identify qualitative and quantitative researches that examined barriers and/or facilitators to mental health care among the six groups of potentially disadvantaged young people. Out of 62 studies identified, 3 were conducted with ATSI young people, 1 with CALD young people, 4 with LGBTQI young people, 14 with homeless young people, 24 with substance-using young people, and 16 with young people residing in rural or remote areas. Findings generally confirmed barriers already established for all young people, but indicated that some may be heightened for young people in the six identified groups. Findings also pointed to both similarities and differences between these groups, suggesting that ATSI, CALD, LGBTQI, homeless, substance-using, and rural young people have some similar needs with respect to not only mental health care, but also other needs likely to reflect their individual circumstances. This systematic review highlights that young people from potentially disadvantaged groups have distinct needs that must be recognized to improve their experiences with mental health care. Future research of good methodological quality with young people is needed to increase accessibility of, and engagement with, mental health care. © 2015 Wiley Publishing Asia Pty Ltd.

  5. Is there an independent somatic symptom dimension in older people?

    PubMed

    Wijeratne, Chanaka; Hickie, Ian; Davenport, Tracey

    2006-08-01

    In explaining the dimensions underlying nonpsychotic symptom reporting, traditional psychiatric paradigm has advocated a hierarchical model in which somatic symptoms are subsumed within two correlated psychological dimensions. A more recent alternate view is that somatic symptoms may be clearly separated from typical anxiety and depression symptoms if somatic symptoms are adequately recorded. The main aim of this study is to determine whether discrete somatic dimension(s) could be derived in older people. Exploratory factor analysis was used to determine the factor structure underlying the responses of 10662 ambulatory primary care patients, aged 60 years and over, who completed the 34-item SPHERE (Somatic and Psychological HEalth REport) questionnaire of somatic and psychological symptoms. In addition, weighted factor scores were compared according to whether there was a physical or psychological reason for presentation to a doctor. A clinically interpretable four-factor solution, consisting of mood, cognitive, musculoskeletal, and fatigue symptoms, was derived. When factor analysis was repeated by gender, the only difference was that mood, cognitive, and pain-fatigue factors were derived in males. In the overall sample, all factor scores were higher in patients with a purely psychological reason for presentation. Somatic symptoms could be measured independently of psychological symptoms in the current sample of older primary care patients.

  6. Narrative-based educational nursing intervention for managing hospitalized older adults at risk for delirium: field testing and qualitative evaluation.

    PubMed

    Bélanger, Louise; Ducharme, Francine

    2015-01-01

    Though delirium is a common complication among hospitalized older adults and the nursing care required in these situations is complex, the subject has received little attention in the literature on continuing nursing education. A study was undertaken to field test and qualitatively evaluate a narrative-based educational intervention for nurses in hospital units with a high incidence of delirium. Triangulated data collection allowed carrying out a qualitative evaluation of the intervention process and outcomes. Process evaluation showed that the intervention was facilitated by the participants' attitudes and diversity of experience, as well as by the use of real care situations, which allowed integrating theory and practice. Outcome evaluation brought to light numerous elements of empirical, ethical and esthetic knowledge expressed by the participants. Study results evidence the applicability of such interventions as part of continuing nursing education and their contribution to knowledge development. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Skin cleansing practices for older people: a systematic review.

    PubMed

    Cowdell, Fiona; Steventon, Katerina

    2015-03-01

    To locate, summarise and critically analyse current knowledge about skin hygiene practices for older people. Maintaining personal hygiene for patients is one of the core elements of care in all fields of nursing. However, it is a subject that has been neglected in both research and education. Skin integrity is essential to the health and well-being of older people. Skin cleansing practices can contribute to the maintenance and promotion of skin integrity. It is therefore essential to have a robust evidence base for such practices. Literature review by searches of the electronic databases Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Academic Search Premier, psycINFO, Web of Science, SCOPUS and the Cochrane Library, using firstly key words and exclusion criteria, then citations and reference searches. An integrative review method was used. Studies included were alternative bathing protocol or bathing product interventions. Seven studies met the methodological requirements for inclusion. There is a significant lack of high-quality research studies to provide a framework for guiding evidence-based skin cleansing practice. Current guidance is based on clinical expertise rather than on robust trial evidence. A research agenda has been developed which may become the basis for developing evidence-based, best practice guidelines. Future research must move beyond descriptive studies to include more robust methods of investigation. The lack of intervention studies limits the practice-guiding implications that can be gained from the current body of research. Skin cleansing is one of the cornerstones of nursing practice, however, in the absence of a robust evidence base most such care is currently based on 'custom and practice'. There is a need to conduct further research into cleansing practices that will maintain or enhance skin health and skin integrity. © 2013 John Wiley & Sons Ltd.

  8. High proportions of older people with normal nutritional status have poor protein intake and low diet quality.

    PubMed

    Jyväkorpi, S K; Pitkälä, K H; Puranen, T M; Björkman, M P; Kautiainen, H; Strandberg, T E; Soini, H H; Suominen, M H

    2016-01-01

    The Mini Nutritional Assessment (MNA) is a well-validated instrument examining the nutritional status of older people. The aim of this study was to examine how older people's energy and nutrient intakes are associated with the MNA and to determine how sensitive and specific MNA is in identifying those having low energy and protein intakes. This cross-sectional study combined data from five nutritional studies (N=900): both home-dwelling and institutionalized older people without and with disabilities. Their nutritional status was assessed with MNA, and nutrient intakes were retrieved from 1 to 3day food diaries. Nutrient intakes were divided according to MNA status (normal nutritional status, at-risk of malnutrition, malnourished). Sensitivity, specificity, and likelihood ratios of MNA of various cut-off points were tested with recommended protein and energy intakes. ROC curves was constructed. Energy, protein and most nutrient intakes showed logical linear trends according to MNA classes. However, more than three-fourths of the participants with MNA>23.5 had lower than recommended protein intakes. Sensitivity of MNA ranged from 0.32 to 0.82 for recommended energy (F:1570kcal/d/M:2070kcal/d) and protein intakes (1.0g/kg BW or 1.2g/kgBW) cut-off points, and specificity from 0.75 to 0.25, respectively. AUC values were low (0.52-0.53). MNA status was consistently associated with nutrient intakes and diet quality. However, a high proportion of older people even with normal nutritional status had poor energy and protein intakes. Thus, MNA does not identify all those with poor nutrient intakes who may be at risk of developing malnutrition. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  9. Is stair climb power a clinically relevant measure of leg power impairments in at-risk older adults?

    PubMed

    Bean, Jonathan F; Kiely, Dan K; LaRose, Sharon; Alian, Joda; Frontera, Walter R

    2007-05-01

    To test the clinical relevance of the stair climb power test (SCPT) as a measure of leg power impairments in mobility-limited older adults. Cross-sectional analysis of baseline data from participants within a randomized controlled trial. Rehabilitation research gym. Community-dwelling older adults (N=138; mean age, 75.4 y) with mobility limitations as defined by the Short Physical Performance Battery (SPPB). Not applicable. Leg power measures included the SCPT and double leg press power measured at 40% (DLP40) and 70% (DLP70) of the 1 repetition maximum. Mobility performance tests included the SPPB and its 3 components: gait speed, chair stand time, and standing balance. Stair climb power per kilogram (SCP/kg) had correlations of moderate strength (r=.47, r=.52) with DLP40/kg and DLP70/kg, respectively. All 3 leg power measures correlated with each of the mobility performance measures with the exception of DLP40/kg (r=.11, P=.27) and DLP70/kg (r=.11, P=.18) with standing balance. Magnitudes of association, as described by the Pearson correlation coefficient, did not differ substantively among the separate power measures as they related to SPPB performance overall. Separate adjusted multivariate models evaluating the relationship between leg power and SPPB performance were all statistically significant and described equivalent amounts of the total variance (R(2)) in SPPB performance (SCP/kg, R(2)=.30; DLP40, R(2)=.32; DLP70, R(2)=.31). Analyses of the components of the SPPB show that the SCPT had stronger associations than the other leg power impairment measures with models predicting chair stand (SCP/kg, R(2)=.25; DLP40, R(2)=.12; DLP70, R(2)=.13), whereas both types of leg press power testing had stronger associations with models predicting gait speed (SCP/kg, R(2)=.16; DLP40, R(2)=.34; DLP70, R(2)=.34). Stair climb power was the only power measure that was a significant component of models predicting standing balance (SCP/kg R(2)=.20). The SCPT is a clinically

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

    PubMed Central

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

    2012-01-01

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

  11. "More than I expected": perceived benefits of yoga practice among older adults at risk for cardiovascular disease.

    PubMed

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

    2013-02-01

    This study was conducted with participants from trials examining the effects of an Iyengar yoga program on cardiovascular disease risk. The objective of the current study was to evaluate the perceived benefits of yoga in a population of older, predominantly overweight adults participating in a gentle 8-week yoga program. This study used a constructivist-interpretive approach to naturalistic inquiry. A total of 42 participants completed the intervention and met the inclusion criteria for the current qualitative study. The 8-week Iyengar yoga program included two 90-min yoga classes and five 30-min home sessions per week. Participants completed weekly logs and an exit questionnaire at the end of the study. Qualitative data from weekly logs and exit questionnaires were compiled and conventional content analysis performed with the use of ATLAS.ti to facilitate the process. Four broad themes emerged from content analysis: practicing yoga improved overall physical function and capacity (for 83% of participants); practicing yoga reduced stress/anxiety and enhanced calmness (83% of participants); practicing yoga enriched the quality of sleep (21% of participants); and practicing yoga supported efforts toward dietary improvements (14% of participants). These results suggest that yoga may have ancillary benefits in terms of improved physical function, enhanced mental/emotional state, enriched sleep quality, and improved lifestyle choices, and may be useful as a health promotion strategy in the prevention and management of chronic disease. Copyright © 2012 Elsevier Ltd. All rights reserved.

  12. Socioeconomic variation in the financial consequences of ill health for older people with chronic diseases: a systematic review.

    PubMed

    Valtorta, Nicole K; Hanratty, Barbara

    2013-04-01

    Chronic disease has financial consequences for older adults, but it is unclear how this varies between conditions with different disease trajectories. The aim of this study was to review evidence on the financial burden associated with cancer, heart failure or stroke in older people, to identify those most at risk of financial adversity. We systematically searched nine databases for studies with data on the illness-related financial burden (objective), or on the perception of financial hardship (subjective), of older patients and/or their informal caregivers in high-income countries. We identified thirty-eight papers published in English between 1984 and 2012. Studies fell into three categories: those reporting direct, out of pocket, costs (medical and/or non-medical); studies of the indirect costs associated with illness (such as wage or income loss); and papers reporting general financial or economic burdens secondary to illness. Three out of four studies focused on people with cancer. More affluent people had greater out of pocket costs, but were less financially burdened by illness, compared with older adults from lower socioeconomic backgrounds. Disadvantaged patients and families were more likely to report experiences of financial hardship, and spend a higher proportion of their income on all expenses related to their diagnoses. This review illustrates how little is known about the financial adversity experienced by patients with some common chronic conditions. It raises the possibility that higher expenditure by more affluent older people may be creating inequalities in how chronic illness is experienced. The development of effective strategies for financial protection at older ages will require more information on who is affected and at which point in their illness trajectory.

  13. What Do Older People Learn from Young People? Intergenerational Learning in "Day Centre" Community Settings in Malta

    ERIC Educational Resources Information Center

    Spiteri, Damian

    2016-01-01

    This study analyses what motivates older people to attend "day centres" in Malta and what they believe that they derive from young people who carry out their placements at these day "centres" These young people, who are aged 16-17, attend a vocational college in Malta and are studying health and social care. The study is based…

  14. What Do Older People Learn from Young People? Intergenerational Learning in "Day Centre" Community Settings in Malta

    ERIC Educational Resources Information Center

    Spiteri, Damian

    2016-01-01

    This study analyses what motivates older people to attend "day centres" in Malta and what they believe that they derive from young people who carry out their placements at these day "centres" These young people, who are aged 16-17, attend a vocational college in Malta and are studying health and social care. The study is based…

  15. Distribution and correlates of plantar hyperkeratotic lesions in older people

    PubMed Central

    Spink, Martin J; Menz, Hylton B; Lord, Stephen R

    2009-01-01

    Background Plantar hyperkeratotic lesions are common in older people and are associated with pain, mobility impairment and functional limitations. However, little has been documented in relation to the frequency or distribution of these lesions. The aim of this study was to document the occurrence of plantar hyperkeratotic lesions and the patterns in which they occur in a random sample of older people. Methods A medical history questionnaire was administered to a random sample of 301 people living independently in the community (117 men, 184 women) aged between 70 and 95 years (mean 77.2, SD 4.9), who also underwent a clinical assessment of foot problems, including the documentation of plantar lesion locations, toe deformities and the presence and severity of hallux valgus. Results Of the 301 participants, 180 (60%) had at least one plantar hyperkeratotic lesion. Those with plantar lesions were more likely to be female (χ2 = 18.75, p < 0.01; OR = 2.86), have moderate to severe hallux valgus (χ2 = 6.15, p < 0.02; OR = 2.95), a larger dorsiflexion range of motion at the ankle (39.4 ± 9.3 vs 36.3 ± 8.4°; t = 2.68, df = 286, p < 0.01), and spent more time on their feet at home (5.1 ± 1.0 vs 4.8 ± 1.3 hours, t = -2.46, df = 299, p = 0.01). No associations were found between the presence of plantar lesions and body mass index, obesity, foot posture, dominant foot or forefoot pain. A total of 53 different lesions patterns were observed, with the most common lesion pattern being "roll-off" hyperkeratosis on the medial aspect of the 1st metatarsophalangeal joint (MPJ), accounting for 12% of all lesion patterns. "Roll-off" lesions under the 1st MPJ and interphalangeal joint were significantly associated with moderate to severe hallux valgus (p < 0.05), whereas lesions under the central MPJs were significantly associated with deformity of the corresponding lesser toe (p < 0.05). Factor analysis indicated that 62% of lesion patterns could be grouped under three broad

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

    ERIC Educational Resources Information Center

    McNutt, Brendan

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

  17. A Prospective Analysis of Elevated Fasting Glucose Levels and Cognitive Function in Older People

    PubMed Central

    Euser, Sjoerd M.; Sattar, Naveed; Witteman, Jacqueline C.M.; Bollen, Eduard L.E.M.; Sijbrands, Eric J.G.; Hofman, Albert; Perry, Ivan J.; Breteler, Monique M.B.; Westendorp, Rudi G.J.

    2010-01-01

    OBJECTIVE To investigate the relationship between fasting glucose levels, insulin resistance, and cognitive impairment in old age. Diabetes is associated with cognitive impairment in older people. However, the link between elevated fasting glucose levels and insulin resistance in nondiabetic individuals, and the risk of cognitive impairment is unclear. RESEARCH DESIGN AND METHODS We analyzed data from, in total, 8,447 participants in two independent prospective studies: the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER), 5,019 participants, aged 69–84 years, and the Rotterdam Study, 3,428 participants, aged 61–97 years. Fasting glucose levels were assessed at baseline in both studies; fasting insulin levels were assessed in the Rotterdam Study only. Cognitive function was assessed in both studies at baseline and during follow-up. RESULTS Subjects with diabetes had impaired cognitive function at baseline. In contrast, in people without a history of diabetes, there was no clear association between baseline fasting glucose levels and executive function and memory, nor was there a consistent relationship between elevated baseline fasting glucose levels and the rate of cognitive decline in either cohort. Insulin resistance (homeostasis model assessment index) was also unrelated to cognitive function and decline. CONCLUSIONS Elevated fasting glucose levels and insulin resistance are not associated with worse cognitive function in older people without a history of diabetes. These data suggest either that there is a threshold for effects of dysglycemia on cognitive function or that factors other than hyperglycemia contribute to cognitive impairment in individuals with frank diabetes. PMID:20393152

  18. Predictors of adherence to a multifaceted podiatry intervention for the prevention of falls in older people

    PubMed Central

    2011-01-01

    Background Despite emerging evidence that foot problems and inappropriate footwear increase the risk of falls, there is little evidence as to whether foot-related intervention strategies can be successfully implemented. The aim of this study was to evaluate adherence rates, barriers to adherence, and the predictors of adherence to a multifaceted podiatry intervention for the prevention of falls in older people. Methods The intervention group (n = 153, mean age 74.2 years) of a randomised trial that investigated the effectiveness of a multifaceted podiatry intervention to prevent falls was assessed for adherence to the three components of the intervention: (i) foot orthoses, (ii) footwear advice and footwear cost subsidy, and (iii) a home-based foot and ankle exercise program. Adherence to each component and the barriers to adherence were documented, and separate discriminant function analyses were undertaken to identify factors that were significantly and independently associated with adherence to the three intervention components. Results Adherence to the three components of the intervention was as follows: foot orthoses (69%), footwear (54%) and home-based exercise (72%). Discriminant function analyses identified that being younger was the best predictor of orthoses use, higher physical health status and lower fear of falling were independent predictors of footwear adherence, and higher physical health status was the best predictor of exercise adherence. The predictive accuracy of these models was only modest, with 62 to 71% of participants correctly classified. Conclusions Adherence to a multifaceted podiatry intervention in this trial ranged from 54 to 72%. People with better physical health, less fear of falling and a younger age exhibited greater adherence, suggesting that strategies need to be developed to enhance adherence in frailer older people who are most at risk of falling. Trial registration Australian New Zealand Clinical Trials Registry ACTRN

  19. Screening for Older Emergency Department Inpatients at Risk of Prolonged Hospital Stay: The Brief Geriatric Assessment Tool

    PubMed Central

    Launay, Cyrille P.; de Decker, Laure; Kabeshova, Anastasiia; Annweiler, Cédric; Beauchet, Olivier

    2014-01-01

    Background The aims of this study were 1) to confirm that combinations of brief geriatric assessment (BGA) items were significant risk factors for prolonged LHS among geriatric patients hospitalized in acute care medical units after their admission to the emergency department (ED); and 2) to determine whether these combinations of BGA items could be used as a prognostic tool of prolonged LHS. Methods Based on a prospective observational cohort design, 1254 inpatients (mean age ± standard deviation, 84.9±5.9 years; 59.3% female) recruited upon their admission to ED and discharged in acute care medical units of Angers University Hospital, France, were selected in this study. At baseline assessment, a BGA was performed and included the following 6 items: age ≥85years, male gender, polypharmacy (i.e., ≥5 drugs per day), use of home-help services, history of falls in previous 6 months and temporal disorientation (i.e., inability to give the month and/or year). The LHS in acute care medical units was prospectively calculated in number of days using the hospital registry. Results Area under receiver operating characteristic (ROC) curves of prolonged LHS of different combinations of BGA items ranged from 0.50 to 0.57. Cox regression models revealed that combinations defining a high risk of prolonged LHS, identified from ROC curves, were significant risk factors for prolonged LHS (hazard ratio >1.16 with P>0.010). Kaplan-Meier distributions of discharge showed that inpatients classified in high-risk group of prolonged LHS were discharged later than those in low-risk group (P<0.003). Prognostic value for prolonged LHS of all combinations was poor with sensitivity under 77%, a high variation of specificity (from 26.6 to 97.4) and a low likelihood ratio of positive test under 5.6. Conclusion Combinations of 6-item BGA tool were significant risk factors for prolonged LHS but their prognostic value was poor in the studied sample of older inpatients. PMID:25333271

  20. Bioimpedance-Derived Phase Angle and Mortality Among Older People.

    PubMed

    Genton, Laurence; Norman, Kristina; Spoerri, Adrian; Pichard, Claude; Karsegard, Véronique L; Herrmann, François R; Graf, Christophe E

    2017-04-01

    Phase angle measured by bioelectrical impedance analysis (BIA) may be a marker of health state. This historical cohort study of prospectively collected BIA measurements aims to investigate the link between phase angle and mortality in older people and evaluate whether a phase angle cutoff can be defined. We included all adults aged ≥65 years who underwent a BIA measurement by the Nutriguard(®) device at the Geneva University Hospitals. We retrieved retrospectively the phase angle and comorbidities at the last BIA measurement and mortality until December 2012. We calculated phase angle standardized for sex, age, and body mass index (BMI), using reference values determined with the same brand of BIA device. Sex-specific and standardized phase angle were categorized into quartiles. The association of mortality with sex-specific or standardized phase angle was evaluated through univariate and multivariate Cox regression models, Kaplan-Meier curves, and receiver operating characteristic (ROC) curves. We included 1307 (38% women) participants, among whom 628 (44% women) died. In a multivariate Cox regression model adjusted for comorbidities and setting of measurement (ambulatory vs. hospitalized), the protective effect against mortality increased progressively as the standardized phase angle quartile increased (HR 0.71 [95% CI 0.58, 0.86], 0.53 [95% CI 0.42, 0.67], and 0.32 [95% CI 0.23, 0.43]). The discriminative value of continuous standardized phase angle, assessed as the area under the ROC curve, was 0.72 (95%CI 0.70, 0.75). We could not define an acceptable phase angle cutoff for individual prediction of mortality (LK), based on sensibility and specificity values. This study shows the association of phase angle and mortality in older patients, independent of age, sex, comorbidities, BMI categories, and setting of measurement.

  1. Anabolic steroids for rehabilitation after hip fracture in older people.

    PubMed

    Farooqi, Vaqas; van den Berg, Maayken E L; Cameron, Ian D; Crotty, Maria

    2014-10-06

    Hip fracture occurs predominantly in older people, many of whom are frail and undernourished. After hip fracture surgery and rehabilitation, most patients experience a decline in mobility and function. Anabolic steroids, the synthetic derivatives of the male hormone testosterone, have been used in combination with exercise to improve muscle mass and strength in athletes. They may have similar effects in older people who are recovering from hip fracture. To examine the effects (primarily in terms of functional outcome and adverse events) of anabolic steroids after surgical treatment of hip fracture in older people. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (10 September 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2013 Issue 8), MEDLINE (1946 to August Week 4 2013), EMBASE (1974 to 2013 Week 36), trial registers, conference proceedings, and reference lists of relevant articles. The search was run in September 2013. Randomised controlled trials of anabolic steroids given after hip fracture surgery, in inpatient or outpatient settings, to improve physical functioning in older patients with hip fracture. Two review authors independently selected trials (based on predefined inclusion criteria), extracted data and assessed each study's risk of bias. A third review author moderated disagreements. Only very limited pooling of data was possible. The primary outcomes were function (for example, independence in mobility and activities of daily living) and adverse events, including mortality. We screened 1290 records and found only three trials involving 154 female participants, all of whom were aged above 65 years and had had hip fracture surgery. All studies had methodological shortcomings that placed them at high or unclear risk of bias. Because of this high risk of bias, imprecise results and likelihood of publication bias, we judged the quality of the evidence for all primary outcomes to

  2. Anabolic steroids for rehabilitation after hip fracture in older people.

    PubMed

    Farooqi, Vaqas; Berg, Maayken E L van den; Cameron, Ian D; Crotty, Maria

    2016-01-01

    Hip fracture occurs predominantly in older people, many of whom are frail and undernourished. After hip fracture surgery and rehabilitation, most patients experience a decline in mobility and function. Anabolic steroids, the synthetic derivatives of the male hormone testosterone, have been used in combination with exercise to improve muscle mass and strength in athletes. They may have similar effects in older people who are recovering from hip fracture. To examine the effects (primarily in terms of functional outcome and adverse events) of anabolic steroids after surgical treatment of hip fracture in older people. Search methods: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialized Register (10 September 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2013 Issue 8), MEDLINE (1946 to August Week 4 2013), EMBASE (1974 to 2013 Week 36), trial registers, conference proceedings, and reference lists of relevant articles. The search was run in September 2013.Selection criteria: Randomized controlled trials of anabolic steroids given after hip fracture surgery, in inpatient or outpatient settings, to improve physical functioning in older patients with hip fracture.Data collection and analysis: Two review authors independently selected trials (based on predefined inclusion criteria), extracted data and assessed each study's risk of bias. A third review author moderated disagreements. Only very limited pooling of data was possible. The primary outcomes were function (for example, independence in mobility and activities of daily living) and adverse events, including mortality. We screened 1290 records and found only three trials involving 154 female participants, all of whom were aged above 65 years and had had hip fracture surgery. All studies had methodological shortcomings that placed them at high or unclear risk of bias. Because of this high risk of bias, imprecise results and likelihood of publication bias

  3. Problems experienced by older people when opening medicine packaging.

    PubMed

    Philbert, Daphne; Notenboom, Kim; Bouvy, Marcel L; van Geffen, Erica C G

    2014-06-01

    Medicine packages can cause problems in daily practice, especially among older people. This study aimed to investigate the prevalence of problems experienced by older people when opening medicine packaging and to investigate how patients manage these problems. A convenience sample of 30 community pharmacies participated in this study. They selected a systematic sample of 30 patients over 65 years old with a recent omeprazole prescription, and a questionnaire was administered by telephone for at least 10 patients per pharmacy. A total of 317 patients completed the questionnaire. They received their omeprazole in a bottle (n = 179, 56.5%), push-through blister pack (n = 102, 32.2%) or peel-off blister pack (n = 36, 11.4%). Some 28.4% of all patients experienced one or more problems with opening their omeprazole packaging; most problems occurred with peel-off blisters (n = 24, 66.7% of all respondents using peel-off blisters), followed by push-through blisters (n = 34, 33.3%) and finally bottles (n = 32, 17.9%). The risk of experiencing problems with peel-off blisters and push-through blisters was higher [relative risk 3.7 (95% confidence interval 2.5-5.5) and 1.9 (1.2-2.8), respectively] than the risk of experiencing problems with opening bottles. Two-thirds of respondents reported management strategies for their problems. Most were found for problems opening bottles (n = 24, 75%), followed by push-through blisters (n = 24, 70.6%) and peel-off blisters (n = 14, 58.3%). One in four patients over 65 experienced difficulties opening their omeprazole packaging and not all of them reported a management strategy for their problems. Manufacturers are advised to pay more attention to the user-friendliness of product packaging. In addition, it is important that pharmacy staff clearly instruct patients on how to open their medicine packaging, or assist them in choosing the most appropriate packaging. © 2013 Royal Pharmaceutical Society.

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

    ERIC Educational Resources Information Center

    Ballin, Liora; Balandin, Susan

    2007-01-01

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

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

    ERIC Educational Resources Information Center

    Ballin, Liora; Balandin, Susan

    2007-01-01

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

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

    ERIC Educational Resources Information Center

    National Institute of Adult Continuing Education, 2009

    2009-01-01

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

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

    ERIC Educational Resources Information Center

    National Institute of Adult Continuing Education, 2009

    2009-01-01

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

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

    ERIC Educational Resources Information Center

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

    2009-01-01

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

  9. Exploring the Housing Needs of Older People in Standard and Sheltered Social Housing

    PubMed Central

    Fox, Siobhan; Kenny, Lorna; Day, Mary Rose; O’Connell, Cathal; Finnerty, Joe; Timmons, Suzanne

    2017-01-01

    Objective: Our home can have a major impact on our physical and mental health; this is particularly true for older people who may spend more time at home. Older people in social (i.e., public) housing are particularly vulnerable. Housing options for older people in social housing include standard design dwellings or specially designed “sheltered housing.” The most suitable housing model should be identified, with older people consulted in this process. Method: Survey of older people (aged ≥60) living in standard or sheltered social housing. Data were analyzed using descriptive and inferential statistics in SPSS Version 22. Results: Overall, 380 surveys were returned (response rate = 47.2%). All older people had similar housing needs. Those in sheltered housing were more satisfied with the physical home design and reported more positive outcomes. Older people in standard housing were less likely to have necessary adaptations to facilitate aging-in-place. Discussion: Older people in standard housing reported more disability/illnesses, are worried about the future, and felt less safe at home. However, few wanted to move, and very few viewed sheltered housing as an alternative, suggesting limited knowledge about their housing options. Future social housing designs should be flexible, that is, adaptable to the needs of the tenants over time. PMID:28491914

  10. A Comparative Study on the Governance of Education for Older People in Japan and Korea

    ERIC Educational Resources Information Center

    Choi, Ilseon; Hori, Shigeo

    2016-01-01

    This paper compares the governance of education for older people in Japan and Korea. The findings revealed that the overall mechanisms of governance for the education of older people shared a number of similar features such as the structure of relevant laws, ministries, and policies. However, differences were also found regarding independence of…

  11. Hospital admissions following presentations to emergency departments for a fracture in older people.

    PubMed

    Boufous, Soufiane; Finch, Caroline; Close, Jacqueline; Day, Lesley; Lord, Stephen

    2007-06-01

    The aim of this paper is to estimate the proportion of older people who are hospitalised following a presentation to an emergency department for hip, pelvic and wrist fractures. The findings indicate that hospitalisation data do not accurately reflect the incidence of low-trauma fractures, particularly wrist and pelvic fractures, in older people.

  12. Hospital admissions following presentations to emergency departments for a fracture in older people

    PubMed Central

    Boufous, Soufiane; Finch, Caroline; Close, Jacqueline; Day, Lesley

    2007-01-01

    The aim of this paper is to estimate the proportion of older people who are hospitalised following a presentation to an emergency department for hip, pelvic and wrist fractures. The findings indicate that hospitalisation data do not accurately reflect the incidence of low‐trauma fractures, particularly wrist and pelvic fractures, in older people. PMID:17567981

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

    ERIC Educational Resources Information Center

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

    2012-01-01

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

  14. The Lifelong Learning Needs of Older People in Ireland: A Discussion Paper

    ERIC Educational Resources Information Center

    McKenna, Adele

    2007-01-01

    In January 2007 the Department of Education and Science approached AONTAS about conducting preliminary research into the lifelong learning needs of older people in Ireland. The findings of the research will be submitted to inform the Department's plans to address the educational needs of older people. In drafting this discussion paper, AONTAS has…

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

    ERIC Educational Resources Information Center

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

    2013-01-01

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

  16. A Comparative Study on the Governance of Education for Older People in Japan and Korea

    ERIC Educational Resources Information Center

    Choi, Ilseon; Hori, Shigeo

    2016-01-01

    This paper compares the governance of education for older people in Japan and Korea. The findings revealed that the overall mechanisms of governance for the education of older people shared a number of similar features such as the structure of relevant laws, ministries, and policies. However, differences were also found regarding independence of…

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

    ERIC Educational Resources Information Center

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

    2010-01-01

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

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

    ERIC Educational Resources Information Center

    Milbourne, Paul; Doheny, Shane

    2012-01-01

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

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

    ERIC Educational Resources Information Center

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

    2010-01-01

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

  20. 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,…

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

    ERIC Educational Resources Information Center

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

    2010-01-01

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

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

    ERIC Educational Resources Information Center

    Sayago, Sergio; Forbes, Paula; Blat, Josep

    2013-01-01

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

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

    ERIC Educational Resources Information Center

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

    2011-01-01

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

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

    ERIC Educational Resources Information Center

    Nyman, Samuel R.

    2011-01-01

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

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

    ERIC Educational Resources Information Center

    Sayago, Sergio; Forbes, Paula; Blat, Josep

    2013-01-01

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

  6. 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,…

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

    ERIC Educational Resources Information Center

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

    2010-01-01

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

  8. Effects of digital engagement on the quality of life of older people.

    PubMed

    Damant, Jacqueline; Knapp, Martin; Freddolino, Paul; Lombard, Daniel

    2016-02-25

    It is often asserted that older people's quality of life (QOL) is improved when they adopt information and communication technology (ICT) such as the Internet, mobile phones and computers. Similar assumptions are made about older people's use of ICT-based care such as telecare and telehealth. To examine the evidence around these claims, we conducted a scoping review of the academic and grey literature, coving the period between January 2007 and August 2014. A framework analysis approach, based on six domains of QOL derived from the ASCOT and WHOQOL models, was adopted to deductively code and analyse relevant literature. The review revealed mixed results. Older people's use of ICT in both mainstream and care contexts has been shown to have both positive and negative impacts on several aspects of QOL. Studies which have rigorously assessed the impact of older people's use of ICT on their QOL mostly demonstrate little effect. A number of qualitative studies have reported on the positive effects for older people who use ICT such as email or Skype to keep in touch with family and friends. Overall, the review unearthed several inconsistencies around the effects of older people's ICT use on their QOL, suggesting that implicit agreement is needed on the best research methods and instrumentation to adequately describe older people's experiences in today's digital age. Moreover, the available evidence does not consider the large number of older people who do not use ICT and how non-use affects QOL.

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

    ERIC Educational Resources Information Center

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

    2009-01-01

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

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

    ERIC Educational Resources Information Center

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

    2011-01-01

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

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

    ERIC Educational Resources Information Center

    Nyman, Samuel R.

    2011-01-01

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

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

    ERIC Educational Resources Information Center

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

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

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

    PubMed

    Grey, Carl; Hall, P Bradley

    2016-01-01

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

  14. Wise owls and professors: the role of older researchers in the review of the National Service Framework for Older People

    PubMed Central

    Cornes, Michelle; Peardon, John; Manthorpe, Jill

    2008-01-01

    Abstract Aim  This article explores the involvement of older people in research and inspection, reflecting on the learning from the recent ‘joint review’ of the National Service Framework for Older People in England. Methodological context  Working in 10 different localities, the ‘joint review’ comprised a formal inspection of health and local council services (carried out by the Healthcare Commission, Commission for Social Care Inspection and the Audit Commission) and an externally commissioned university‐led research project designed to ascertain the views and experiences of older people living in the 10 inspection sites. In total, 1839 older people were interviewed individually and through focus groups and an additional 4200 older people completed questionnaires. A distinctive feature of the research was the inclusion of a team of older researchers who had undertaken training in research methods in later life. Reflections of the older researchers and other members of the research team on undertaking this large‐scale user involvement project were ascertained via a day‐long seminar which was tape recorded and transcribed. Learning  While many espouse the principle of ‘service user involvement’ in research, there is a need to move beyond the rhetoric of participation and any blanket assumptions about what it means to be an ‘older researcher’, a ‘service user researcher’ or indeed, a ‘professional researcher’. This means ensuring that within any given team (user‐controlled or collaborative) there are clear lines of accountability and equal opportunities for individual appraisal, support, and personal or professional development. Such considerations are key to working with ‘older researchers’ and encouraging diversity in the research workforce more generally. PMID:19076669

  15. Diagnosis and management of insomnia in older people.

    PubMed

    McCall, W Vaughn

    2005-07-01

    Insomnia is a common but underrecognized problem in elderly patients. Five basic steps can help clinicians identify and treat insomnia. The first step is to ask a single question about sleep at every new patient visit, which goes a long way toward detection of patients with insomnia. The second step is to perform an initial evaluation of the problem, including symptoms, contributing factors, and effects on daytime function. Step three is to determine whether the patient is in crisis. True sleep emergencies are rare, and in most cases, treatment can be delayed until another appointment can be made for a full evaluation of the problem. A sleep evaluation constitutes the fourth step and focuses mainly on a thorough sleep history; blood tests and polysomnography rarely have a role. The final step is intervention. Nonpharmacological strategies are a mainstay of treatment for chronic insomnia, but hypnotics have a role in treating transient insomnia and chronic insomnia that does not improve with nonpharmacological treatment or treatment of associated primary conditions. Pharmacological therapy usually consists of benzodiazepines with short half-lives or nonbenzodiazepines such as zolpidem and zaleplon, although lack of demonstrated efficacy against sleep maintenance difficulties, one of the primary symptoms of insomnia among older people, limits use of these agents. Emerging nonbenzodiazepine agents such as indiplon and eszopiclone may specifically address sleep maintenance problems in elderly patients and are pending Food and Drug Administration (FDA) approval. (Editor's note: Since preparation of this manuscript, the FDA has approved eszopiclone for treatment of insomnia.).

  16. Social network characteristics and salivary cortisol in healthy older people.

    PubMed

    Lai, Julian C L; Chong, Alice M L; Siu, Oswald T; Evans, Phil; Chan, Cecilia L W; Ho, Rainbow T H

    2012-01-01

    Psychobiological research on aging in humans has been confounded by individual differences that have not been adequately characterized in the literature. This paper is an attempt to shed light on this issue by examining the impact of social network characteristics predictive of successful aging on salivary cortisol among 78 older Chinese people in Hong Kong. Eight salivary cortisol samples were collected each day for two consecutive days from immediately after awakening to 12 hours later. Two components of the cortisol diurnal cycle, response to awakening and diurnal decline, were examined in relation to social network characteristics including size, emotional support, and cultivation. ANOVAs with repeated measured were run to examine influences of the three social network characteristics on the cortisol awakening response and diurnal decline, with the effects of gender, age, socioeconomic status, and waking time controlled. Results indicated that those who spent more time and effort in developing and strengthening their social ties (i.e., those high in "cultivation") exhibited a significantly greater rise in cortisol in the morning and a significantly steeper decline over the day, thus attesting to more effective activation and deactivation of the HPA axis. Network cultivation reflected a positive motivation to nurture social relationships more than the other two network characteristics. Its effect on cortisol might stem from the positivity underlying the motivation.

  17. Interventions to optimise prescribing for older people in care homes.

    PubMed

    Alldred, David P; Raynor, David K; Hughes, Carmel; Barber, Nick; Chen, Timothy F; Spoor, Pat

    2013-02-28

    There is a substantial body of evidence that prescribing for care home residents is suboptimal and requires improvement. Consequently, there is a need to identify effective interventions to optimise prescribing and resident outcomes in this context. The objective of the review was to determine the effect of interventions to optimise prescribing for older people living in care homes. We searched the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register; Cochrane Central Register of Controlled Trials (CENTRAL), The Cochrane Library (Issue 11, 2012); Cochrane Database of Systematic Reviews, The Cochrane Library (Issue 11, 2012); MEDLINE OvidSP (1980 on); EMBASE, OvidSP (1980 on); Ageline, EBSCO (1966 on); CINAHL, EBSCO (1980 on); International Pharmaceutical Abstracts, OvidSP (1980 on); PsycINFO, OvidSP (1980 on); conference proceedings in Web of Science, Conference Proceedings Citation Index - SSH & Science, ISI Web of Knowledge (1990 on); grey literature sources and trial registries; and contacted authors of relevant studies. We also reviewed the references lists of included studies and related reviews (search period November 2012). We included randomised controlled trials evaluating interventions aimed at optimising prescribing for older people (aged 65 years or older) living in institutionalised care facilities. Studies were included if they measured one or more of the following primary outcomes, adverse drug events; hospital admissions;mortality; or secondary outcomes, quality of life (using validated instrument); medication-related problems; medication appropriateness (using validated instrument); medicine costs. Two authors independently screened titles and abstracts, assessed studies for eligibility, assessed risk of bias and extracted data. A narrative summary of results was presented. The eight included studies involved 7653 residents in 262 (range 1 to 85) care homes in six countries. Six studies were cluster

  18. Mapping the capacities of fixed health facilities to cover people at risk of gambiense human African trypanosomiasis

    PubMed Central

    2014-01-01

    Background The emphasis placed on the activities of mobile teams in the detection of gambiense human African trypanosomiasis (HAT) can at times obscure the major role played by fixed health facilities in HAT control and surveillance. The lack of consistent and detailed data on the coverage of passive case-finding and treatment further constrains our ability to appreciate the full contribution of the health system to the control of HAT. Methods A survey was made of all fixed health facilities that are active in the control and surveillance of gambiense HAT. Information on their diagnostic and treatment capabilities was collected, reviewed and harmonized. Health facilities were geo-referenced. Time-cost distance analysis was conducted to estimate physical accessibility and the potential coverage of the population at-risk of gambiense HAT. Results Information provided by the National Sleeping Sickness Control Programmes revealed the existence of 632 fixed health facilities that are active in the control and surveillance of gambiense HAT in endemic countries having reported cases or having conducted active screening activities during the period 2000-2012. Different types of diagnosis (clinical, serological, parasitological and disease staging) are available from 622 facilities. Treatment with pentamidine for first-stage disease is provided by 495 health facilities, while for second-stage disease various types of treatment are available in 206 health facilities only. Over 80% of the population at-risk for gambiense HAT lives within 5-hour travel of a fixed health facility offering diagnosis and treatment for the disease. Conclusions Fixed health facilities have played a crucial role in the diagnosis, treatment and coverage of at-risk-population for gambiense HAT. As the number of reported cases continues to dwindle, their role will become increasingly important for the prospects of disease elimination. Future updates of the database here presented will regularly provide

  19. Mapping the capacities of fixed health facilities to cover people at risk of gambiense human African trypanosomiasis.

    PubMed

    Simarro, Pere P; Cecchi, Giuliano; Franco, José R; Paone, Massimo; Diarra, Abdoulaye; Ruiz-Postigo, José A; Mattioli, Raffaele C; Jannin, Jean G

    2014-02-11

    The emphasis placed on the activities of mobile teams in the detection of gambiense human African trypanosomiasis (HAT) can at times obscure the major role played by fixed health facilities in HAT control and surveillance. The lack of consistent and detailed data on the coverage of passive case-finding and treatment further constrains our ability to appreciate the full contribution of the health system to the control of HAT. A survey was made of all fixed health facilities that are active in the control and surveillance of gambiense HAT. Information on their diagnostic and treatment capabilities was collected, reviewed and harmonized. Health facilities were geo-referenced. Time-cost distance analysis was conducted to estimate physical accessibility and the potential coverage of the population at-risk of gambiense HAT. Information provided by the National Sleeping Sickness Control Programmes revealed the existence of 632 fixed health facilities that are active in the control and surveillance of gambiense HAT in endemic countries having reported cases or having conducted active screening activities during the period 2000-2012. Different types of diagnosis (clinical, serological, parasitological and disease staging) are available from 622 facilities. Treatment with pentamidine for first-stage disease is provided by 495 health facilities, while for second-stage disease various types of treatment are available in 206 health facilities only. Over 80% of the population at-risk for gambiense HAT lives within 5-hour travel of a fixed health facility offering diagnosis and treatment for the disease. Fixed health facilities have played a crucial role in the diagnosis, treatment and coverage of at-risk-population for gambiense HAT. As the number of reported cases continues to dwindle, their role will become increasingly important for the prospects of disease elimination. Future updates of the database here presented will regularly provide evidence to inform and monitor a

  20. Home visits for frail older people: a qualitative study on the needs and preferences of frail older people and their informal caregivers

    PubMed Central

    van Kempen, Janneke AL; Robben, Sarah HM; Zuidema, Sytse U; Rikkert, Marcel GM Olde; Melis, René JF; Schers, Henk J

    2012-01-01

    Background A number of studies have examined the effects of home visits and showed inconsistent results on physical functioning, institutionalisation, and mortality. Despite continuing interest from professionals in home visits for older people, reports on older people’s needs and preferences for such visits are scarce. Aim This qualitative study aims to explore the views and needs of community-dwelling frail older people concerning home visits. Design and setting A qualitative study including interviews with frail older persons and their informal caregivers living in the area of Nijmegen, the Netherlands. Method Semi-structured interviews were conducted with frail older people and informal caregivers. A grounded theory approach was used for data-analysis. Results Eleven frail older people and 11 informal caregivers were included. Most participants emphasised the importance of home visits for frail older people. They felt that it would give older people the personal attention they used to receive from GPs but miss nowadays. Most stated that this would give them more trust in GPs. Participants stated that trust is one of the most important factors in a good patient–professional relationship. Further, participants preferred home visits to focus on the psychosocial context of the patient. They stated that more knowledge of the psychosocial context and a good patient–professional relationship would enable the professional to provide better and more patient-centred care. Conclusion Patients’ expectations of home visits are quite different from the actual purpose of home visiting programmes; that is, care and wellbeing versus cure and prevention. This difference may partly explain why the effectiveness of home visits remains controversial. Future studies on home visits should involve patients in the development of home visiting programmes. PMID:22867679

  1. Effectiveness of a Community-Based Exercise Program on Balance Performance and Fear of Falling in Older Nonfallers at Risk for Falling: A Randomized, Controlled Study.

    PubMed

    Zhao, Yanan; Chung, Pak-Kwong; Tong, Tomas K

    2016-10-01

    This study evaluated the effectiveness of the community-based Exercise for Balance Improvement Program (ExBP) in improving dynamic balance (DB) and static balance with compromised sensations and reducing fear of falling (FF) among older nonfallers. Sixty-one participants (70 ± 3 years) at risk for falling were randomly allocated to receive ExBP practice for 16 weeks, Tai Chi (TC), or no treatment (CON) with an 8-week follow-up. The ExBP group exhibited significant improvements in DB (2.18, 95% CI = 1.16-3.19), static balance with compromised vision and somatosensation (ECSS; 0.46, 95% CI = 0.06-0.85), and FF (8.65, 95% CI = 0.52-16.8). After the intervention, the ExBP group showed significantly more improvement than did the CON group in DB, static balance with compromised somatosensation, and ECSS. No significant difference was observed between the ExBP and TC groups. Therefore, the ExBP can be applied as an effective alternative exercise regimen for improving balance and fall efficacy for older nonfallers.

  2. Enhanced measurement sensitivity of hopeless ideation among older adults at risk of self-harm: Reliability and validity of Likert-type responses to the Beck Hopelessness Scale.

    PubMed

    Neufeld, Eva; O'Rourke, Norm; Donnelly, Martha

    2010-08-01

    Responses to the Beck Hopelessness Scale (BHS) have been identified as a significant predictor of suicide-related ideation and self-harm, of note, to a greater degree than severity of depressive symptoms. The BHS is the most widely used instrument to assess this construct, yet concern has been expressed about the traditional true/false response format of this instrument. For this study, we obtained responses from older adults to a revised four-point Likert-type BHS response format. A national sample of 117 older Canadians at risk of self-harm was recruited from multiple sources for this study over a one-year period. Most participants were women (65%) with an average age of 68.47 years (SD = 9.02, range 50-92). Exploratory factor analysis suggests the existence of two factors labeled Powerlessness/Disappointment and Negative Future Expectancies. Concurrent validity of this two-factor model of BHS responses is provided vis-a-vis suicide-related ideation subsequent to statistical control for socio-demographic factors, physical health, and depressive symptomatology. Of note, the relative contribution to the measurement of BHS factors is proportionately equal and greater than all other independent variables. We contend that this revised BHS response format may be appropriate for use in clinical and research applications though replication with other samples and populations is warranted.

  3. Validity and reliability of the modified Chinese version of the Older People's Quality of Life Questionnaire (OPQOL) in older people living alone in China.

    PubMed

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

    2014-12-01

    This study aimed to test the validity and reliability of a modified Chinese version of the OPQOL among older people living alone in China. China has an ageing population with an increasing number of older people living alone who may have a poorer quality of life (QoL) in the light of the traditional culture of collectivism and filial piety. An appropriate instrument is important to assess their QoL. The Older People's Quality of Life Questionnaire (OPQOL) was developed directly from the views of older people and has been validated in England. There has been no psychometric evaluation of the scale in China. The OPQOL was translated and modified prior to being administered to a stratified random cluster sample of 521 older people living alone. Validity was assessed through convergent validity, discriminant validity and construct validity. Reliability was assessed through internal consistency and test-retest reliability. Exploratory factor analysis indicated eight factors accounting for 63.77% of the variance. The convergent validity was supported by moderate correlations with functional ability, social support and loneliness with Spearman's rho of -0.50, 0.49 and -0.53, respectively. The discriminant validity was confirmed by differentiating QoL scores between the depressed and non-depressed groups. The Cronbach's α coefficient was 0.90 for the total scale and over 0.70 for most of its dimensions. The 2-week test-retest reliability ranged from 0.53 to 0.87. The modified Chinese version of the Older People's Quality of Life has acceptable validity and reliability as a useful instrument to measure the QoL of older people living alone in China. © 2013 John Wiley & Sons Ltd.

  4. Still "at risk": An examination of how street-involved young people understand, experience, and engage with "harm reduction" in Vancouver's inner city.

    PubMed

    Bozinoff, Nikki; Small, Will; Long, Cathy; DeBeck, Kora; Fast, Danya

    2017-07-01

    Vancouver is an international leader in implementing interventions to reduce harms related to drug use. However, street-involved young people who use drugs continue to be vulnerable to overdose death, hepatitis C (HCV) infection, and high rates of syringe sharing. To better understand this in the context of the intensive public health response, we examined how young people, who are involved in the 'street drug scene', understood, experienced and engaged with harm reduction. Twelve semi-structured interviews were conducted in 2013 with 13 young people (ages 17-28) recruited from the At-Risk Youth Study, a prospective cohort of street-involved and drug-using young people. These interviews were embedded within a larger, eight-year program of ethnographic research and explored participants' understandings of harm reduction, their use of specific services, and their ideas about improving their day-to-day lives. Interviews were transcribed verbatim and a thematic analysis was performed. Young peoples' ideas about harm reduction were diverse and expansive. They articulated the limitations of existing programs, indicating that while they are positioned to reduce the risk of HIV and HCV transmission, they offer little meaningful support to improve young peoples' broader life chances. Young people described strategies to mitigate risk and harm in their own lives, including transitioning to drugs deemed less harmful and attempting to gain access to drug treatment. Finally, young people indicated that spatial considerations (e.g., distance from Vancouver's Downtown Eastside) strongly determined access to services. In Vancouver, a large, well established harm reduction infrastructure seeks to reduce HIV and HCV transmission among street-involved young people. However, young peoples' multiple understandings, experiences and engagements with harm reduction in this setting illustrate the limitations of the existing infrastructure in improving their broader life chances. Copyright

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

    PubMed Central

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

    2009-01-01

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

  6. Factors associated with third-party disability in spouses of older people with hearing impairment.

    PubMed

    Scarinci, Nerina; Worrall, Linda; Hickson, Louise

    2012-01-01

    hearing-impaired partner had done all they could to help with hearing were not associated with third-party disability. This research study shows that spouses of older people with hearing impairment experience third-party disability as a result of their partners' hearing impairment and that the SOS-HEAR could be used to identify the nature of the disability. The three factors found to be associated with third-party disability could identify spouses at risk of third-party disability related to hearing impairment and form the basis of an intervention.

  7. Effect of preventive primary care outreach on health related quality of life among older adults at risk of functional decline: randomised controlled trial

    PubMed Central

    Brazil, Kevin; Hutchison, Brian; Kaczorowski, Janusz; Dalby, Dawn M; Goldsmith, Charles H; Furlong, William

    2010-01-01

    Objective To evaluate the impact of a provider initiated primary care outreach intervention compared with usual care among older adults at risk of functional decline. Design Randomised controlled trial. Setting Patients enrolled with 35 family physicians in five primary care networks in Hamilton, Ontario, Canada. Participants Patients were eligible if they were 75 years of age or older and were not receiving home care services. Of 3166 potentially eligible patients, 2662 (84%) completed the validated postal questionnaire used to determine risk of functional decline. Of 1724 patients who met the risk criteria, 769 (45%) agreed to participate and 719 were randomised. Intervention The 12 month intervention, provided by experienced home care nurses in 2004-6, consisted of a comprehensive initial assessment using the resident assessment instrument for home care; collaborative care planning with patients, their families, and family physicians; health promotion; and referral to community health and social support services. Main outcome measures Quality adjusted life years (QALYs), use and costs of health and social services, functional status, self rated health, and mortality. Results The mean difference in QALYs between intervention and control patients during the study period was not statistically significant (0.017, 95% confidence interval −0.022 to 0.056; P=0.388). The mean difference in overall cost of prescription drugs and services between the intervention and control groups was not statistically significant, (−$C165 (£107; €118; $162), 95% confidence interval −$C16 545 to $C16 214; P=0.984). Changes over 12 months in functional status and self rated health were not significantly different between the intervention and control groups. Ten patients died in each group. Conclusions The results of this study do not support adoption of this preventive primary care intervention for this target population of high risk older adults. Trial registration Clinical

  8. Effect of preventive primary care outreach on health related quality of life among older adults at risk of functional decline: randomised controlled trial.

    PubMed

    Ploeg, Jenny; Brazil, Kevin; Hutchison, Brian; Kaczorowski, Janusz; Dalby, Dawn M; Goldsmith, Charles H; Furlong, William

    2010-04-16

    To evaluate the impact of a provider initiated primary care outreach intervention compared with usual care among older adults at risk of functional decline. Randomised controlled trial. Patients enrolled with 35 family physicians in five primary care networks in Hamilton, Ontario, Canada. Patients were eligible if they were 75 years of age or older and were not receiving home care services. Of 3166 potentially eligible patients, 2662 (84%) completed the validated postal questionnaire used to determine risk of functional decline. Of 1724 patients who met the risk criteria, 769 (45%) agreed to participate and 719 were randomised. The 12 month intervention, provided by experienced home care nurses in 2004-6, consisted of a comprehensive initial assessment using the resident assessment instrument for home care; collaborative care planning with patients, their families, and family physicians; health promotion; and referral to community health and social support services. Quality adjusted life years (QALYs), use and costs of health and social services, functional status, self rated health, and mortality. The mean difference in QALYs between intervention and control patients during the study period was not statistically significant (0.017, 95% confidence interval -0.022 to 0.056; P=0.388). The mean difference in overall cost of prescription drugs and services between the intervention and control groups was not statistically significant, (-$C165 ( pound107; euro118; $162), 95% confidence interval -$C16 545 to $C16 214; P=0.984). Changes over 12 months in functional status and self rated health were not significantly different between the intervention and control groups. Ten patients died in each group. The results of this study do not support adoption of this preventive primary care intervention for this target population of high risk older adults. Trial registration Clinical trials NCT00134836.

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

    PubMed

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

    2014-04-01

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

  10. Primary Sarcopenia in Older People with Normal Nutrition.

    PubMed

    Yadigar, S; Yavuzer, H; Yavuzer, S; Cengiz, M; Yürüyen, M; Döventaş, A; Erdinçler, D S

    2016-03-01

    The aim of this study was to investigate the presence of primary sarcopenia in older patients with normal nutrition and to assess the relationships between the primary sarcopenia with anthropometric measurements. In this prospective clinical cross-sectional study, six-hundred patients who applied to Polyclinic of Geriatrics between dates 2010 and 2011 have been evaluated. The 386 patients who were supposed to have potential secondary sarcopenia were excluded from the study. Age, gender, weight, height, BMI, calf and waist circumference, ongoing medications, additional diseases of the 214 patients included in the study have been surveyed. The sarcopenia criteria of EWSGOP have been applied. Two hundred fourteen cases included in the study were composed of 148 female and 66 male subjects. Mean age was 71.8 ± 2.1 years. Sarcopenia was detected in 105 (49%) subjects while 109 (51%) were normal. Sixty-four female (61%) and 41 (39%) male subjects were sarcopenic. Normal group included 84 female (77%) and 25 male (23%) subjects. Incidence of sarcopenia was found higher in the female patients (p<0.001). No statistically significant difference was detected between sarcopenic and normal groups with respect to age, height, weight, calf circumference and evaluation tests. Waist circumference was higher in the sarcopenic group than the normal group (p=0.02). When both groups were analyzed for BMI; 53 (51%) of the 105 sarcopenic patients had BMI over 30 kg/m2 while 29 (27%) and 23 (22%) patients had BMI of 25-30 kg/m2 and below 25 kg/m2, respectively. Incidence of sarcopenia was significantly higher in the group with BMI over 30 kg/m2 when compared with the groups with BMI of 25-30 kg/m2 and below 25 kg/m2 (p=0.01). Sarcopenia that makes older people physically dependent and decreases their quality of life that receive sufficient nutritional support and are also obese should be comprehensively investigated with respect to presence of sarcopenia.

  11. HIV viral sequences in seronegative people at risk detected by in situ hybridisation and polymerase chain reaction.

    PubMed

    Pezzella, M; Rossi, P; Lombardi, V; Gemelli, V; Mariani Costantini, R; Mirolo, M; Fundaro, C; Moschese, V; Wigzell, H

    1989-03-18

    A study was conducted to assess the occurrence of latent infection with the human immunodeficiency virus (HIV) among seronegative people at high risk of infection. The presence of HIV genomes was analysed by molecular techniques in two seronegative children born to mothers infected with HIV and in three regular sexual partners of seropositive drug addicts. The adults were selected from a seronegative cohort at high risk of infection because of their sexual contacts and the children selected because of impaired growth. HIV retroviral sequences were detected in four of the five subjects directly at the cellular level by in situ hybridisation in peripheral blood mononuclear cells. HIV genomic sequences were confirmed by in vitro amplification of viral DNA with the polymerase chain reaction technique. The existence of a latent viral infection state in these seronegative subjects indicates the unreliability of standard serological analysis in people who have been in regular contact with infected patients.

  12. Healthcare professionals' perceptions of neglect of older people in Mexico: A qualitative secondary analysis.

    PubMed

    Caceres, Billy A; Bub, Linda; Negrete, Maria Isabel; Giraldo Rodríguez, Liliana; Squires, Allison P

    2017-09-15

    To describe healthcare professionals' perceptions of neglect of older people in Mexico. Mistreatment of older people, particularly neglect, has emerged as a significant public health concern worldwide. However, few studies have been conducted to examine neglect of older people in low- and middle-income countries. Most research has focused on estimating the prevalence of neglect in older populations with little emphasis on the perceptions of healthcare professionals and their role in addressing neglect of older people. Qualitative secondary analysis. The parent study consisted of nine focus groups conducted with healthcare professionals at five public hospitals in Mexico. The purpose of the parent study was to perform a needs assessment to determine the feasibility of adapting the Nurses Improving Care for Healthsystem Elders programme to Mexico. A qualitative secondary analysis with directed content analysis approach was used to extract data related to neglect of older people. A total of 89 participants representing healthcare professionals from several disciplines were interviewed. Three themes emerged: (i) The main point is not here; (ii) We feel hopeless; and (iii) We need preparation. Participants reported distress and hopelessness related to neglect of older people. Lack of community-based resources was noted as contributing to neglect. Increased education regarding care of older people for both caregivers and healthcare professionals and greater interdisciplinary collaboration were identified as potential solutions to combat neglect. Community-based services and resource allocation need to be re-evaluated to improve the care of older Mexicans. Interdisciplinary models of care should be developed to address concerns related to neglect of older people. Neglect negatively impacts healthcare professionals' ability to adequately care for older patients. There is a need to invest in community-based services and models of care to address these concerns. © 2017

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

    PubMed

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

    2014-03-01

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

  14. Improving access to optometry services for people at risk of preventable sight loss: a qualitative study in five UK locations

    PubMed Central

    Leamon, S.; Hayden, C.; Lee, H.; Trudinger, D.; Appelbee, E.; Hurrell, D.-L.; Richardson, I.

    2014-01-01

    Background Reducing preventable sight loss is an increasing priority for public health and health care providers. We examined the factors affecting people's use of optometry services in population groups at increased risk of sight loss. Methods This is a qualitative study in five UK locations. In England, participants were from the Pakistani and Black Caribbean communities; in Scotland from the Pakistani community; and in Northern Ireland and Wales from white socio-economically deprived communities. Thirty-four focus groups were conducted (n = 289). The study included people who attend optometry services and people not engaged with services. Results Barriers to access included limited awareness of eye health and eye disease, concern about the cost of spectacles and the appropriateness of optometry in a commercial setting. Attendance at the optometrist was primarily symptom led. A positive previous experience or continuing relationship with the optometrist helped to alleviate the barriers and promote attendance. Conclusion Addressing the disparity between the broader messages about eye health and the current perception of the function of optometry could help improve access to services. Uptake may be improved through the co-production of interventions that better resonate with local communities. Non-retail service delivery options should be explored. PMID:24408903

  15. Depression among older people in Europe: the EURODEP studies

    PubMed Central

    Copeland, John RM; Beekman, Aartjan TF; Braam, Arjan W; Dewey, Michael E; Delespaul, Philippe; Fuhrer, Rebecca; Hooijer, Christopher; Lawlor, Brian A; Kivela, Sirkka-Liisa; Lobo, Anthony; Magnusson, Halgrimur; Mann, Anthony H; Meller, Ingeborg; Prince, Martin J; Reischies, Friedel; Roelands, Marc; Skoog, Ingmar; Turrina, Cesare; deVries, Marten W; Wilson, Kenneth CM

    2004-01-01

    The data from nine centres in Europe which had used the Geriatric Mental Scale (GMS) AGECAT were analysed to compare prevalence of diagnoses in subjects aged 65 years and over living in the community. Levels of depressive illness were: Iceland 8.8%, Liverpool 10.0%; Zaragoza 10.7%; Dublin 11.9%; Amsterdam 12.0%; Berlin 16.5%; London 17.3%; Verona 18.3% and Munich 23.6%. Taking all levels of depression, five high (Amsterdam, Berlin, Munich, London and Verona) and four low (Dublin, Iceland, Liverpool, Zaragoza) scoring centres were identified. Meta-analysis of all 13,808 subjects yielded a mean level of depression of 12.3% (95% CI 11.8-12.9), 14.1% for women (95% CI 13.5-14.8) and 8.6% for men (95% CI 7.9-9.3). Symptom levels varied between centres: 40% of the total study population in Amsterdam reported depressive mood against only 26% in Zaragoza. To incorporate studies from other centres using other methods for depression identification, the EURO-D scale was developed from 12 items of the GMS and validated against other scales and expert diagnosis. A two factor solution emerged, an 'affective suffering factor' and a 'motivation factor'. The EURO-D scale was applied to 14 population based surveys. Depression score tended to increase with age unlike levels of prevalence of depression. Large between centre differences were evident in levels of depression unexplained by age, gender or marital status. These data show that depressive illness defined as suitable for intervention is common among older people in Europe. Opportunities for effective treatment are almost certainly being lost. Levels of depressive symptoms vary significantly between high and low scoring centres, prompting the next phase of this study, an examination of risk factors in Europe. PMID:16633454

  16. Investigating polypharmacy and drug burden index in hospitalised older people.

    PubMed

    Best, O; Gnjidic, D; Hilmer, S N; Naganathan, V; McLachlan, A J

    2013-08-01

    To investigate the changes in polypharmacy and the drug burden index (DBI) occurring during hospitalisation for older people. The secondary aim was to examine the associations of these two measures with the length of hospital stay and admission for falls or delirium. A retrospective analysis of patients' medical records was undertaken at a large university teaching hospital (Sydney, Australia) for patients with the age of ≥ 65 years and admitted under the care of the geriatric medicine or rehabilitation teams. Polypharmacy was defined as the use of more than five regular medications. The DBI measures exposure to drugs with anticholinergic and sedative effects. Logistic regression analysis was conducted to investigate the associations between polypharmacy and DBI with outcome measures. Data are presented using odds ratios with 95% confidence intervals. A total of 329 patients was included in this study. The mean (± standard deviation) age of the population was 84.6 ± 7.0 years, 62% were female and 40% were admitted from residential aged-care facilities. On admission, polypharmacy was observed in 60% of the cohort and DBI exposure for 50%. DBI and polypharmacy exposure decreased during hospitalisation, but only the number of medications taken decreased by a statistically significant margin (P = 0.02). Patients with a high DBI (≥ 1) were approximately three times more likely to be admitted for delirium than those with no DBI exposure (odds ratio, 2.95; 95% confidence interval, 1.34-6.51). In the present study, DBI was associated with an increased risk of hospital admission for delirium only. Polypharmacy was not associated with any of the clinical measures. © 2013 The Authors; Internal Medicine Journal © 2013 Royal Australasian College of Physicians.

  17. Understanding of Placebo Controls Among Older People With Schizophrenia

    PubMed Central

    Dunn, Laura B; Palmer, Barton W; Keehan, Monique

    2006-01-01

    Research protocols frequently necessitate procedures or design elements that differ from those used in routine clinical care. An example is the inclusion of a placebo arm in many randomized clinical trials. Because there are risks to taking a placebo when one has a chronic disorder such as schizophrenia, ascertaining how well people with severe mental illness understand placebos is an important task for empirical research ethics. We investigated whether schizophrenia patients' understanding of placebo controls could be improved with a brief educational intervention. We randomized 49 middle-aged and older patients with schizophrenia or schizoaffective disorder to receive either (1) a routine explanation of placebos in the context of consent for a hypothetical double-blind placebo-controlled clinical trial, or (2) the consent for the hypothetical trial plus a brief educational module explaining placebos in more depth. Understanding of placebos was assessed with a 12-item questionnaire, and we examined demographic, clinical, neurocognitive, and decision-making correlates of understanding of placebos. Those participants who received the intervention obtained higher scores on the placebo post-test compared to those who received the standard information alone. Performance on the placebo post-test was positively correlated with measures of decisional capacity and neurocognitive abilities and negatively correlated with severity of negative symptoms, but it showed no relationship with positive or general symptoms. Some participants interpreted the common phrase “sugar pill” as relating somehow to diabetes. We conclude that the level of understanding of important research design–related information is not static but may be influenced by how investigators approach the consent process. PMID:16177271

  18. Social Inequality and Visual Impairment in Older People.

    PubMed

    Whillans, Jennifer; Nazroo, James

    2016-02-03

    Visual impairment is the leading cause of age-related disability, but the social patterning of loss of vision in older people has received little attention. This study's objective was to assess the association between social position and onset of visual impairment, to empirically evidence health inequalities in later life. Visual impairment was measured in 2 ways: self-reporting fair vision or worse (moderate) and self-reporting poor vision or blindness (severe). Correspondingly, 2 samples were drawn from the English Longitudinal Study on Ageing (ELSA). First, 7,483 respondents who had good vision or better at Wave 1; second, 8,487 respondents who had fair vision or better at Wave 1. Survival techniques were used. Cox proportional hazards models showed wealth and subjective social status (SSS) were significant risk factors associated with the onset of visual impairment. The risk of onset of moderate visual impairment was significantly higher for the lowest and second lowest wealth quintiles, whereas the risk of onset of severe visual impairment was significantly higher for the lowest, second, and even middle wealth quintiles, compared with the highest wealth quintile. Independently, lower SSS was associated with increased risk of onset of visual impairment (both measures), particularly so for those placing themselves on the lowest rungs of the social ladder. The high costs of visual impairment are disproportionately felt by the worst off elderly. Both low wealth and low SSS significantly increase the risk of onset of visual impairment. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  19. Pain in older people with cancer: attitudes and self-management strategies.

    PubMed

    Chatwin, J; Closs, J; Bennett, M

    2009-03-01

    Cancer is predominantly a disease of older people. It is also frequently a painful condition. However, the ageing process brings with it any number of other painful conditions, so it can be difficult to quantify the number of older people who are in pain solely because of cancer. In this article, we present a review of the literature concerning issues specifically related to the management of pain in older people. Three main areas are considered: the use of analgesics; the attitudes of older people in relation to pain management and their utilization of pain management strategies. We suggest that although a great deal is known about the efficacy of analgesia, there is relatively little information relating to the subjective experience of older individuals as they engage with treatment processes. This is important because social, psychological and cultural factors can have a significant influence on the effective management of cancer pain in this age group.

  20. Subjective perceived impact of Tai Chi training on physical and mental health among community older adults at risk for ischemic stroke: a qualitative study.

    PubMed

    Zheng, Guohua; Xiong, Zhenyu; Zheng, Xin; Li, Junzhe; Duan, Tingjin; Qi, Dalu; Ling, Kun; Chen, Lidian

    2017-04-20

    Evidence from quantitative studies suggest that Tai Chi produces a variety of health-related benefits, but few qualitative studies have investigated how older adults perceive the benefit of Tai Chi. The objective of the current study was to qualitatively evaluate the perceived benefits of Tai Chi practice among community older population. This study was conducted with participants from a trial examining the effects of a 12-week Tai Chi training on ischemic stroke risk in community older adults (n = 170). A total of 20 participants were randomly selected from a convenience sample of participants who had completed 12-week Tai Chi training (n = 68) were interviewed regarding their perceived benefit on physical and mental health and whether Tai Chi exercise was suitable for the elderly. All participants agreed that Tai Chi training could relax their body and make them comfortable. Most of them thought Tai Chi training could promote physical health, including relieving pain, enhancing digestion, strengthening immunity, enhancing energy and improving sleep quality, enhancing their mental and emotional state (e.g. improving mood and reducing anxiety, improving concentration and promoting interpersonal relationship). Most of participants also agreed that Tai Chi exercise was appropriate for community older people. Three primary themes emerged from content analysis: Improving physical health; Enhancing mental and emotional state; Conforming with the request of the elderly. The findings indicate that regular Tai Chi exercise may have positive benefits in terms of improved physical health and mental state among community elderly population, and may be useful and feasible body-mind exercise to community elderly population for its positive effects and advantages. ChiCTR ChiCTR-TRC-13003601 . Registered 23 July 2014.

  1. Barriers to providing palliative care for older people in acute hospitals.

    PubMed

    Gardiner, Clare; Cobb, Mark; Gott, Merryn; Ingleton, Christine

    2011-03-01

    the need for access to high-quality palliative care at the end of life is becoming of increasing public health concern. The majority of deaths in the UK occur in acute hospitals, and older people are particularly likely to die in this setting. However, little is known about the barriers to palliative care provision for older people within acute hospitals. to explore the perspectives of health professionals regarding barriers to optimal palliative care for older people in acute hospitals. fifty-eight health professionals participated in eight focus groups and four semi-structured interviews. participants identified various barriers to palliative care provision for older people, including attitudinal differences to the care of older people, a focus on curative treatments within hospitals and a lack of resources. Participants also reported differing understandings of whose responsibility it was to provide palliative care for older people, and uncertainly over the roles of specialist and generalist palliative care providers in acute hospitals. numerous barriers exist to the provision of high-quality palliative care for older people within acute hospital settings. Additional research is now required to further explore age-related issues contributing to poor access to palliative care.

  2. Nutritional self-care among a group of older home-living people in rural Southern Norway

    PubMed Central

    Dale, Bjørg; Söderhamn, Ulrika

    2015-01-01

    Background Older home-living people are an at-risk group for undernutrition, particularly those who are living alone. Lack of knowledge about healthy dietary habits, altered taste sensation, and declined health status are shown to be some of the factors related to undernutrition. The aims of this study were to explore how a small group of older people in Southern Norway perceived their nutritional self-care. Methods An exploratory qualitative approach, combined with a simple self-report questionnaire, was used. Five persons living in rural areas in Southern Norway, who in a former study were screened and found to be at risk for undernutrition, participated. Qualitative data assessed by means of individual self-care talks in the persons’ own homes were analyzed using directed content analysis. A simple self-report questionnaire containing demographic variables, two health-related questions, and the Nutritional Form For the Elderly (NUFFE-NO) instrument was filled out at baseline and 6 months after the self-care talks. Results The qualitative data showed that the participants had adequate knowledge about healthy and nutritious diets. They were aware of and motivated to adapt their diet to their current state of health and to perform the necessary actions to maintain an optimal nutritional status and nutritional self-care. Conclusion Older people living at home are a diverse group. However, this study showed that they may have sufficient knowledge, willingness, and ability to perform nutritional self-care, even if they live alone and have several chronic illnesses and impaired health. PMID:25670905

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

    ERIC Educational Resources Information Center

    Quine, Susan

    1998-01-01

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

  4. Health and functional status among older people with HIV/AIDS in Uganda

    PubMed Central

    2011-01-01

    Background In sub-Saharan Africa, little is known about the health and functional status of older people who either themselves are HIV infected or are affected by HIV and AIDS in the family. This aim of this study was to describe health among older people in association with the HIV epidemic. Methods The cross-sectional survey consisted of 510 participants aged 50 years and older, equally divided into five study groups including; 1) HIV infected and on antiretroviral therapy (ART) for at least 1 year; 2) HIV infected and not yet eligible for ART; 3) older people who had lost a child due to HIV/AIDS; 4) older people who have an adult child with HIV/AIDS; 5) older people not known to be infected or affected by HIV in the family. The participants were randomly selected from ongoing studies in a rural and peri-urban area in Uganda. Data were collected using a WHO standard questionnaire and performance tests. Eight indicators of health and functioning were examined in an age-adjusted bivariate and multivariate analyses. Results In total, 198 men and 312 women participated. The overall mean age was 65.8 and 64.5 years for men and women respectively. Men had better self-reported health and functional status than women, as well as lower self-reported prevalence of chronic diseases. In general, health problems were common: 35% of respondents were diagnosed with at least one of the five chronic conditions, including 15% with depression, based on algorithms; 31% of men and 35% of women had measured hypertension; 25% of men and 21% of women had poor vision test results. HIV-positive older people, irrespective of being on ART, and HIV-negative older people in the other study groups had very similar results for most health status and functioning indicators. The main difference was a significantly lower BMI among HIV-infected older people. Conclusion The systematic exploration of health and well being among older people, using eight self-reported and objective health indicators

  5. No Evidence That Short-Term Cognitive or Physical Training Programs or Lifestyles Are Related to Changes in White Matter Integrity in Older Adults at Risk of Dementia

    PubMed Central

    Fissler, Patrick; Müller, Hans-Peter; Küster, Olivia C.; Laptinskaya, Daria; Thurm, Franka; Woll, Alexander; Elbert, Thomas; Kassubek, Jan; von Arnim, Christine A. F.; Kolassa, Iris-Tatjana

    2017-01-01

    Cognitive and physical activities can benefit cognition. However, knowledge about the neurobiological mechanisms underlying these activity-induced cognitive benefits is still limited, especially with regard to the role of white matter integrity (WMI), which is affected in cognitive aging and Alzheimer’s disease. To address this knowledge gap, we investigated the immediate and long-term effects of cognitive or physical training on WMI, as well as the association between cognitive and physical lifestyles and changes in WMI over a 6-month period. Additionally, we explored whether changes in WMI underlie activity-related cognitive changes, and estimated the potential of both trainings to improve WMI by correlating training outcomes with WMI. In an observational and interventional pretest, posttest, 3-month follow-up design, we assigned 47 community-dwelling older adults at risk of dementia to 50 sessions of auditory processing and working memory training (n = 13), 50 sessions of cardiovascular, strength, coordination, balance and flexibility exercises (n = 14), or a control group (n = 20). We measured lifestyles trough self-reports, cognitive training skills through training performance, functional physical fitness through the Senior Fitness Test, and global cognition through a cognitive test battery. WMI was assessed via a composite score of diffusion tensor imaging-based fractional anisotropy (FA) of three regions of interest shown to be affected in aging and Alzheimer’s disease: the genu of corpus callosum, the fornix, and the hippocampal cingulum. Effects for training interventions on FA outcomes, as well as associations between lifestyles and changes in FA outcomes were not significant. Additional analyses did show associations between cognitive lifestyle and global cognitive changes at the posttest and the 3-month follow-up (β ≥ 0.40, p ≤ 0.02) and accounting for changes in WMI did not affect these relationships. The targeted training outcomes were

  6. No Evidence That Short-Term Cognitive or Physical Training Programs or Lifestyles Are Related to Changes in White Matter Integrity in Older Adults at Risk of Dementia.

    PubMed

    Fissler, Patrick; Müller, Hans-Peter; Küster, Olivia C; Laptinskaya, Daria; Thurm, Franka; Woll, Alexander; Elbert, Thomas; Kassubek, Jan; von Arnim, Christine A F; Kolassa, Iris-Tatjana

    2017-01-01

    Cognitive and physical activities can benefit cognition. However, knowledge about the neurobiological mechanisms underlying these activity-induced cognitive benefits is still limited, especially with regard to the role of white matter integrity (WMI), which is affected in cognitive aging and Alzheimer's disease. To address this knowledge gap, we investigated the immediate and long-term effects of cognitive or physical training on WMI, as well as the association between cognitive and physical lifestyles and changes in WMI over a 6-month period. Additionally, we explored whether changes in WMI underlie activity-related cognitive changes, and estimated the potential of both trainings to improve WMI by correlating training outcomes with WMI. In an observational and interventional pretest, posttest, 3-month follow-up design, we assigned 47 community-dwelling older adults at risk of dementia to 50 sessions of auditory processing and working memory training (n = 13), 50 sessions of cardiovascular, strength, coordination, balance and flexibility exercises (n = 14), or a control group (n = 20). We measured lifestyles trough self-reports, cognitive training skills through training performance, functional physical fitness through the Senior Fitness Test, and global cognition through a cognitive test battery. WMI was assessed via a composite score of diffusion tensor imaging-based fractional anisotropy (FA) of three regions of interest shown to be affected in aging and Alzheimer's disease: the genu of corpus callosum, the fornix, and the hippocampal cingulum. Effects for training interventions on FA outcomes, as well as associations between lifestyles and changes in FA outcomes were not significant. Additional analyses did show associations between cognitive lifestyle and global cognitive changes at the posttest and the 3-month follow-up (β ≥ 0.40, p ≤ 0.02) and accounting for changes in WMI did not affect these relationships. The targeted training outcomes were related

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

    PubMed

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

    2010-11-01

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

  8. Perceptions of older people among Chinese adolescents: conceptual and methodological issues.

    PubMed

    So, Ka Man; Shek, Daniel T L

    2011-01-01

    Ageism against older people exists worldwide almost among all age groups and adolescents are of no exception. Numerous studies with specific reference to adolescents of different age, gender, educational level, socioeconomic background, knowledge about aging and experiences with older people showed that they had different perceptions of and attitudes toward older people, but such findings are not entirely conclusive. The situation of Hong Kong is even more confused as there are few studies examining this topic. It is argued that the conflicting findings are largely due to conceptual and methodological problems in the studies. This paper examines the conceptual and methodological issues in this area and outlines suggestions for future research.

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

    PubMed

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

    2010-09-01

    Genetic discrimination may be experienced in the day-to-day lives of people at risk for Huntington disease (HD), encompassing occurrences in the workplace, when seeking insurance, within social relationships, and during other daily encounters. At-risk individuals who have tested either positive or negative for the genetic expansion that causes HD, as well as at-risk persons with a 50% chance for developing the disorder but have not had DNA testing completed the International RESPOND-HD (I-RESPOND-HD) survey. One of the study's purposes was to examine perceptions of genetic stigmatization and discrimination. A total of 412 out of 433 participants provided narrative comments, and 191 provided related codable narrative data. The core theme, Information Control, refers to organizational policies and interpersonal actions. This theme was found in narrative comments describing genetic discrimination perceptions across employment, insurance, social, and other situations. These reports were elaborated with five themes: What They Encountered, What They Felt, What Others Did, What They Did, and What Happened. Although many perceptions were coded as hurtful, this was not true in all instances. Findings document that reports of genetic discrimination are highly individual, and both policy as well as interpersonal factors contribute to the outcome of potentially discriminating events. (c) 2010 Wiley-Liss, Inc.

  10. Alcohol service provision for older people in an area experiencing high alcohol use and health inequalities.

    PubMed

    McCabe, Karen E; Ling, Jonathan; Wilson, Graeme B; Crosland, Ann; Kaner, Eileen F S; Haighton, Catherine A

    2016-03-01

    UK society is ageing. Older people who drink alcohol, drink more than those from previous generations, drink more frequently than other age groups and are more likely to drink at home and alone. Alcohol problems in later life however are often under-detected and under-reported meaning older people experiencing alcohol problems have high levels of unmet need. This study sought to identify existing services within South of Tyne, North East England to capture the extent of service provision for older drinkers and identify any gaps. The Age UK definition of 'older people' (aged 50 and over) was used. Services were contacted by telephone, managers or their deputy took part in semi-structured interviews. Forty six service providers were identified. Only one provided a specific intervention for older drinkers. Others typically provided services for age 18+. Among providers, there was no definitive definition of an older person. Data collection procedures within many organisations did not enable them to confirm whether older people were accessing services. Where alcohol was used alongside other drugs, alcohol use could remain unrecorded. To enable alcohol services to meet the needs of older people, greater understanding is needed of the patterns of drinking in later life, the experiences of older people, the scale and scope of the issue and guidance as to the most appropriate action to take. An awareness of the issues related to alcohol use in later life also needs to be integrated into commissioning of other services that impact upon older people. © Royal Society for Public Health 2015.

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

    ERIC Educational Resources Information Center

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

    2015-01-01

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

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

    ERIC Educational Resources Information Center

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

    2015-01-01

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

  13. Why do some people look older than they should?

    PubMed

    Bulpitt, C J; Markowe, H L; Shipley, M J

    2001-09-01

    As a component of studies on biological age, the age of subjects from their appearance (perceived age) was estimated. To determine the factors associated with looking older. Cross sectional study of London civil servants (318 men, 129 women) in the Department of the Environment study. Perceived age was recorded by an observer and the difference between this age and chronological age was analysed according to 20 different variables. Men had an average perceived age of 0.37 years older than their actual age and women a perceived age of 0.54 years younger. In men, looking older was related to greying of the hair, grade of arcus senilis, and grade of baldness. Less expected, looking older was positively related to total serum cholesterol (p=0.03) and blood haemoglobin (p<0.01). In women, looking older was related to greying of the hair, positively to blood erythrocyte sedimentation rate (ESR), and negatively to serum bilirubin (p=0.01). Looking older was not related to alcohol consumption, employment grade, serum high density lipoprotein cholesterol, glucose, albumin, and calcium in either sex. The relationships between looking older and total cholesterol and haemoglobin in men and ESR and bilirubin in women, require further investigation.

  14. Why do some people look older than they should?

    PubMed Central

    Bulpitt, C; Markowe, H; Shipley, M

    2001-01-01

    BACKGROUND—As a component of studies on biological age, the age of subjects from their appearance (perceived age) was estimated.
OBJECTIVE—To determine the factors associated with looking older.
METHODS—Cross sectional study of London civil servants (318 men, 129 women) in the Department of the Environment study. Perceived age was recorded by an observer and the difference between this age and chronological age was analysed according to 20 different variables.
RESULTS—Men had an average perceived age of 0.37 years older than their actual age and women a perceived age of 0.54 years younger. In men, looking older was related to greying of the hair, grade of arcus senilis, and grade of baldness. Less expected, looking older was positively related to total serum cholesterol (p=0.03) and blood haemoglobin (p<0.01). In women, looking older was related to greying of the hair, positively to blood erythrocyte sedimentation rate (ESR), and negatively to serum bilirubin (p=0.01). Looking older was not related to alcohol consumption, employment grade, serum high density lipoprotein cholesterol, glucose, albumin, and calcium in either sex.
CONCLUSION—The relationships between looking older and total cholesterol and haemoglobin in men and ESR and bilirubin in women, require further investigation.
 PMID:11524516

  15. Young people at risk of psychosis: their subjective experiences of monitoring and cognitive behaviour therapy in the early detection and intervention evaluation 2 trial.

    PubMed

    Byrne, Rory E; Morrison, Anthony P

    2014-09-01

    To explore participants' experiences of 'enhanced monitoring' and cognitive behaviour therapy (CBT) within a randomized controlled trial evaluating early detection and prevention of psychosis ('early detection and intervention evaluation [EDIE] 2'). Semi-structured qualitative interviews were conducted with a sample of participants at the end of their involvement with the trial. Ten young people were interviewed; six males and four females, with a mean age of 27.5. Nine participants identified themselves as White British and one Black British. All participants had received 'enhanced monitoring' during the trial, and 8 of 10 also received CBT. Interviews were transcribed verbatim and analysed using thematic analysis to identify central themes within and among participants' accounts. Three super-ordinate thematic areas were identified: 'a chance to talk', monitoring-specific themes, and CBT-specific themes. The central theme ('a chance to talk') was drawn from across all participants' accounts and represents the most consistently valued attribute of participants' experiences of the EDIE 2 trial. Sub-themes of this topic were identified as follows: interpersonal engagement, informality and normalization, and 'opening up'. Sub-themes related to monitoring include the following: clarity and reassurance, 'a therapeutic process', and challenges. CBT experience was most consistently conceptualized as 'rethinking things', and two additional CBT-specific sub-themes were identified: hard work and moving forward. Our findings suggest that for young people at risk of psychosis, a normalizing psychosocially oriented assessment and monitoring process may have benefits for many, while CBT may help to reduce the negative impact of unusual psychological experiences for both the short- and long term. Young people considered at risk of psychosis highly value normalizing, collaborative, and flexible approaches when engaging with research or clinical staff. All of our participants

  16. Towards multidisciplinary assessment of older people: exploring the change process.

    PubMed

    Ross, Fiona; O'Tuathail, Claire; Stubberfield, Debbie

    2005-04-01

    This paper discusses the process of change that took place in an intervention study of standardized multidisciplinary assessment guidelines implemented in a female ward for older people in a District General Hospital in South London. This study was one of nine implementation projects in the South Thames Evidence-Based Practice Project. The relationship between the worlds of research and healthcare practice is uneasy and contested and, as such, is a breeding ground for challenging questions about how evidence can be used to foment change in clinical practice. Recent literature on change highlights the importance of understanding complexity, which informed our approach and analysis. A multifaceted approach to change that comprised evidence-based guidelines, leadership (project leader) and change management was evaluated before and after the implementation by telephone interviews with patients, a postal survey of community staff and interviews with ward staff. A diagnostic analysis of current assessment practice informed the change process. The project leader collected data on adherence. This paper draws on descriptive and qualitative data and addresses the links between contextual issues and the processes and pathways of change, informed by theoretical ideas from the change literature. Key themes emerged: working through others and across boundaries, managing uncertainty and unanticipated challenges. Adherence of ward staff to using the multidisciplinary assessment guidelines was high, with evidence of some dissemination to community staff at follow-up. Three years after the project finished the multidisciplinary assessment is still part of routine clinical practice. The analysis contributes to understanding about the nursing leadership of change within an interprofessional arena of practice. It highlights the importance of understanding the context in relation to the impact and sustainability of change and thus the utility of conducting a diagnostic analysis in the

  17. Public engagement workshop: how to improve medicines for older people?

    PubMed

    Orlu-Gul, Mine; Raimi-Abraham, Bahijja; Jamieson, Elizabeth; Wei, Li; Murray, Macey; Stawarz, Katarzyna; Stegemann, Sven; Tuleu, Catherine; Smith, Felicity J

    2014-01-01

    Public engagement in medication management has become more and more important in promoting population health. A public engagement workshop attended by 78 members of the geriatric community, family carers as well as professionals from academic research, industry and regulatory agencies entitled 'How to improve medicines for older people?' took place on the 2nd July 2013 at the University College London (UCL) School of Pharmacy. The main aim of the event was to provide a dynamic environment for information exchange and to identify ways of improving current and future geriatric drug therapy. The day opened with presentations from UCL School of Pharmacy researchers on the use of medicines at home, formulations, administration devices and multi-component compliance aids (MCAs) whilst a representative from UCL Interaction Centre gave an insightful presentation on human errors and resilience strategies regarding medication use. These opening presentations encouraged participants to share their own experiences as well as initiating a lively debate. Following the plenary presentations, the workshop was divided into 8 groups for parallel discussion session. These opinion sharing sessions witnessed fruitful discussions between patients, carers and researchers. The day closed with a panel session of representatives from the European Medicines Agency (EMA), the Medicines and Healthcare products Regulatory Agency (MHRA), the Geriatric Medicines Society and Guy's and St. Thomas' NHS Foundation Trust (GSTT). Participants were encouraged to voice their questions, concerns and recommendations about medications. The main concern expressed by both patients and carers from the workshop were (but are not limited to) formulation changes, MCA accessibility difficulties, interactions of different medicines, carers' concerns with the administration of medicines and not having enough knowledge of services provided by community pharmacists i.e. medicines use reviews (MURs) or new medicine

  18. Factors associated with variations in older people's use of community-based continence services.

    PubMed

    Peters, Tim J; Horrocks, Sue; Stoddart, Helen; Somerset, Maggie

    2004-01-01

    Many people who have urinary incontinence and who may benefit from healthcare and professional advice do not currently access UK National Health Service services, even though effective treatments are available in the community. Older people have an increased prevalence of incontinence and a correspondingly increased need for continence services. Therefore, increasing older people's access to continence services has the potential to reduce inequalities and improve quality of life. The present study aimed to identify older people with urinary incontinence living in the community, to describe and compare the characteristics of users and non-users of continence services, and to identify factors which prevent older people seeking help. A cross-sectional postal survey of patients aged over 65 years registered with four general practices in an urban area found an overall prevalence of 39% of older people with urinary incontinence, only 15% of whom had accessed services. Two-thirds of respondents who reported that they experienced urinary leakage several times per week to all the time, and up to two-thirds of those reporting leakage of moderate or large volumes of leakage had not accessed services. The majority of older people are in regular contact with health professionals, and the greatest single influence on use of services was that of being asked whether there were continence problems by a health professional. Being married or having a partner, experiencing less pain generally, and suffering relatively high frequency and volumes of urinary leakage also appeared to be associated independently with continence service use. In conclusion, there appears to be considerable unmet need for continence services. Health professionals should be aware that incontinence is an important health problem for older people, and by asking older people specifically about urinary leakage, they could reduce inequalities in use of services.

  19. Age-associated changes in head jerk while walking reveal altered dynamic stability in older people.

    PubMed

    Brodie, Matthew A D; Menz, Hylton B; Lord, Stephen R

    2014-01-01

    Many older people have impaired dynamic stability, and up to one in three people over 65 fall each year. It is thought that older people walk more slowly to compensate for reduced capabilities. Here, we investigate whether head jerk, the first time derivative of acceleration, can further our understanding of age-associated changes in dynamic stability while walking. Gait parameters including cadence, step length, walking speed, harmonic ratios, step time variability, and jerk were measured in 43 young and 100 older people using accelerometers securely attached to the head and pelvis. Older people presented significantly (p ≤ 0.004) more mediolateral (ML) head jerk, but significantly less vertical (VT) head jerk. The dimensionless ratio, ML/VT jerk, demonstrated superior ability (89 % accuracy) in differentiating older from younger people. Principal component analysis indicated that ML/VT jerk was a distinct gait construct. ML/VT jerk was highly reliable, normally distributed, independent of stature or gender, and relatively unaffected by walking speed. In older people, reduced VT head jerk may indicate reduced gait vigour, and increased ML head jerk may indicate age-associated changes to dynamic stability. The smoother head movements evident in our younger group may be because they were more able to rely on automatic control and the dynamic (pendulum-like) stability of their systems.

  20. Interrelations of stress, optimism and control in older people's psychological adjustment.

    PubMed

    Bretherton, Susan Jane; McLean, Louise Anne

    2015-06-01

    To investigate the influence of perceived stress, optimism and perceived control of internal states on the psychological adjustment of older adults. The sample consisted of 212 older adults, aged between 58 and 103 (M = 80.42 years, SD = 7.31 years), living primarily in retirement villages in Melbourne, Victoria. Participants completed the Perceived Stress Scale, Life Orientation Test-Revised, Perceived Control of Internal States Scale and the World Health Organisation Quality of Life-Bref. Optimism significantly mediated the relationship between older people's perceived stress and psychological health, and perceived control of internal states mediated the relationships among stress, optimism and psychological health. The variables explained 49% of the variance in older people's psychological adjustment. It is suggested that strategies to improve optimism and perceived control may improve the psychological adjustment of older people struggling to adapt to life's stressors. © 2014 ACOTA.

  1. Identifying frailty risk profiles of home-dwelling older people: focus on sociodemographic and socioeconomic characteristics.

    PubMed

    Dury, Sarah; De Roeck, Ellen; Duppen, Daan; Fret, Bram; Hoeyberghs, Lieve; Lambotte, Deborah; Van der Elst, Michaël; van der Vorst, Anne; Schols, Jos; Kempen, Gertrudis; Rixt Zijlstra, G A; De Lepeleire, Jan; Schoenmakers, Birgitte; Kardol, Tinie; De Witte, Nico; Verté, Dominique; De Donder, Liesbeth; De Deyn, Peter Paul; Engelborghs, Sebastiaan; Smetcoren, An-Sofie; Dierckx, Eva

    2017-10-01

    This paper investigates risk profiles of frailty among older people, as these are essential for detecting those individuals at risk for adverse outcomes and to undertake specific preventive actions. Frailty is not only a physical problem, but also refers to emotional, social, and environmental hazards. Using data generated from the Belgian Ageing Studies, a cross-sectional study (n = 28,049), we tested a multivariate regression model that included sociodemographic and socioeconomic indicators as well as four dimensions of frailty, for men and women separately. The findings indicated that for both men and women, increased age, having no partner, having moved house in the previous 10 years, having a lower educational level and having a lower household income are risk characteristics for frailty. Moreover, when looking at the different frailty domains, different risk profiles arose, and gender-specific risk characteristics were detected. This paper elaborates on practical implications, and formulates a number of future research recommendations to tackle frailty in an aging society. The conclusion demonstrates the necessity for a thorough knowledge of risk profiles of frailty, as this will save both time and money and permit preventive actions to be more individually tailored.

  2. Teaching about Older People with Mental Retardation: An Educational Model.

    ERIC Educational Resources Information Center

    Kropf, Nancy P.; And Others

    1993-01-01

    The University of Georgia model curriculum to prepare students to work with mentally retarded older adults has six units: population overview, physiological issues, mental health issues, social support systems, service delivery networks, and legal/ethical issues. (SK)

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

    ERIC Educational Resources Information Center

    Bluford, Verada; Dillon, Conley Hall, Jr.

    1995-01-01

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

  4. Entitlement to concessionary public transport and wellbeing: a qualitative study of young people and older citizens in London, UK.

    PubMed

    Jones, Alasdair; Goodman, Anna; Roberts, Helen; Steinbach, Rebecca; Green, Judith

    2013-08-01

    Access to transport is an important determinant of health, and concessionary fares for public transport are one way to reduce the 'transport exclusion' that can limit access. This paper draws on qualitative data from two groups typically at risk of transport exclusion: young people (12-18 years of age, n = 118) and older citizens (60+ years of age, n = 46). The data were collected in London, UK, where young people and older citizens are currently entitled to concessionary bus travel. We focus on how this entitlement is understood and enacted, and how different sources of entitlement mediate the relationship between transport and wellbeing. Both groups felt that their formal entitlement to travel for free reflected their social worth and was, particularly for older citizens, relatively unproblematic. The provision of a concessionary transport entitlement also helped to combat feelings of social exclusion by enhancing recipients' sense of belonging to the city and to a 'community'. However, informal entitlements to particular spaces on the bus reflected less valued social attributes such as need or frailty. Thus in the course of travelling by bus the enactment of entitlements to space and seats entailed the negotiation of social differences and personal vulnerabilities, and this carried with it potential threats to wellbeing. We conclude that the process, as well as the substance, of entitlement can mediate wellbeing; and that where the basis for providing a given entitlement is widely understood and accepted, the risks to wellbeing associated with enacting that entitlement will be reduced.

  5. Pedestrian and motorized mobility scooter safety of older people.

    PubMed

    Jancey, Jonine; Cooper, Lisa; Howat, Peter; Meuleners, Lynn; Sleet, David; Baldwin, Grant

    2013-01-01

    After driving, walking is older adults' second most preferred mode of transport and preferred recreational activity. This leads to greater exposure to traffic, increasing their risk of pedestrian-vehicle crashes, with older adults being more likely to die as a pedestrian compared to when using other modes of transport. However, less focus has been placed on this particularly vulnerable group. This review summarizes issues associated with older adult pedestrian and motorized mobility scooters (MMS) safety and interventions that have been conducted. A literature search was undertaken from PubMed, MUARC publications, the Curtin University Library Catalogue, and Google Scholar. Keywords included older pedestrians, older adult road injury, mobility scooter injury, and injury prevention. Publications from 2000 and later were used, unless an earlier publication had significant relevance and worth. Maintaining older adults' mobility and independence during a time of decreasing physical and mental capacity is a priority. Walking provides a key mode of transport that needs to be given higher priority within the road environment by policy makers, transport planners, and drivers. Therefore, governments need to consider appropriate and comprehensive urban planning and road safety policies that accommodate active aging to provide pedestrians and MMS users with environments that facilitate active living and safe transport. In addition, there is a need for community programs that raise awareness about safe road crossing for this growing vulnerable age group.

  6. Knowledge of aging and attitudes toward older people. A survey of Australian podiatric medical students.

    PubMed

    Menz, Hylton B; Stewart, Francis A; Oates, Matthew J

    2003-01-01

    Podiatric medical students in Australia were surveyed to evaluate their reasons for entering podiatric medicine, knowledge of aging, attitudes toward older people, perceptions of treatment efficacy, and desire to specialize in geriatrics. Few students plan to specialize in geriatrics upon graduation (4%), with most preferring general practice (25%) or sports medicine (21%). However, knowledge of aging was good, and students had favorable attitudes toward older people and considered treatment of older people to be effective. Few age- or gender-related effects were observed. It is concluded that students' lack of desire to specialize in geriatrics may be due not to unfavorable perceptions of older people but rather to the low profile and limited development of geriatrics as a specialty area within the podiatric medical profession.

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

    PubMed

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

    2015-01-01

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

  8. Nurses' perceptions of ethical issues in the care of older people.

    PubMed

    Rees, Jenny; King, Lindy; Schmitz, Karl

    2009-07-01

    The aim of this thematic literature review is to explore nurses' perceptions of ethical issues in the care of older people. Electronic databases were searched from September 1997 to September 2007 using specific key words with tight inclusion criteria, which revealed 17 primary research reports. The data analysis involved repeated reading of the findings and sorting of those findings into four themes. These themes are: sources of ethical issues for nurses; differences in perceptions between nurses and patients/relatives; nurses' personal responses to ethical issues; and the patient-nurse relationship. The findings reveal that ageism is one of the major sources of the ethical issues that arise for nurses caring for older people. Education and organizational change can combat ageist attitudes. Wider training is required in the care of older people, workplace skills, palliative care and pain management for older people. The demands of a changing global demography will necessitate further research in this field.

  9. Motivators and Barriers for Older People Participating in Resistance Training: A Systematic Review.

    PubMed

    Burton, Elissa; Farrier, Kaela; Lewin, Gill; Pettigrew, Simone; Hill, Anne-Marie; Airey, Phil; Bainbridge, Liz; Hill, Keith D

    2017-04-01

    Regular participation in resistance training is important for older people to maintain their health and independence, yet participation rates are low. The study aimed to identify motivators and barriers to older people participating in resistance training. A systematic review was conducted including quantitative, qualitative, and mixed-method studies. Searches generated 15,920 citations from six databases, with 14 studies (n = 1,937 participants) included. In total, 92 motivators and 24 barriers were identified. Motivators specific to participating in resistance training included preventing deterioration (disability), reducing risk of falls, building (toning) muscles, feeling more alert, and better concentration. Looking too muscular and thinking participation increased the risk of having a heart attack, stroke, or death, despite the minimal likelihood of these occurring, were barriers. The analysis indicates that increasing participation in resistance training among older people should focus on the specific benefits valued by older people and the dissemination of accurate information to counter misperceptions.

  10. New analysis of existing data finds that flu vaccine is of benefit to older people.

    PubMed

    2013-11-20

    The case for vaccinating older people against influenza appeared to be weakened in 2010 when a Cochrane review confirmed the vaccine's safety, but found no evidence of its effectiveness in this group.

  11. Improving oral health for older people in the home care setting: An exploratory implementation study.

    PubMed

    Lewis, Adrienne; Kitson, Alison; Harvey, Gill

    2016-12-01

    To explore how home care providers can support older people to maintain good oral health through implementing a model called Better Oral Health in Home Care (BOHHC). A mixed method, pre- to post-implementation design was used. The Promoting Action on Research Implementation in Health Services framework informed the model's implementation process. High levels of dental need were identified at pre-implementation. Older people self-reported significant oral health improvements following the introduction of tailored home care strategies by care workers, who in turn reported a better understanding and knowledge of the importance of oral care for older people. The BOHHC Model provided an evidence-based approach for community-based prevention and early detection of oral health problems. Improving oral health for older people in the home care setting has significant practice and policy implications which require ongoing intersectoral facilitation involving aged care, vocational health education and dental sectors. © 2016 AJA Inc.

  12. Influences of satisfaction with telecare and family trust in older Taiwanese people.

    PubMed

    Tsai, Chung-Hung; Kuo, Yu-Ming; Uei, Shu-Lin

    2014-01-27

    The level of trust given towards telecare by the family members of older people using the service is extremely important. Family trust may be an influential factor in deciding whether to use such services. This study focuses on older people's satisfaction with telecare and examines their family's trust in telecare services. Influences on intention to continue using telecare services are also explored. A questionnaire-based survey on 60 communities dwelling older people who had been receiving telecare services in the past two years was employed. This study developed a satisfaction and trust scale based on previous studies. Our results show that older people's satisfaction with telecare services and families' trust were influential in decided whether to continue to use of telecare services. These findings can help medical institutions to better insight into the user experience of telecare to help them provide future services that better comply with clients' desires and requirements.

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

    PubMed

    Theunissen, Kevin A T M; Hoebe, Christian J P A; Crutzen, Rik; Kara-Zaïtri, Chakib; de Vries, Nanne K; van Bergen, Jan E A M; van der Sande, Marianne A B; Dukers-Muijrers, Nicole H T M

    2013-10-22

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

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

    ERIC Educational Resources Information Center

    Jang, Miseon; Lee, Yeunsook

    2015-01-01

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

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

    ERIC Educational Resources Information Center

    Burholt, Vanessa; Scharf, Thomas; Walsh, Kieran

    2013-01-01

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

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

    ERIC Educational Resources Information Center

    Burholt, Vanessa; Scharf, Thomas; Walsh, Kieran

    2013-01-01

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

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

    ERIC Educational Resources Information Center

    Jang, Miseon; Lee, Yeunsook

    2015-01-01

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

  18. Older people's perspectives on an elderly-friendly hospital environment: an exploratory study.

    PubMed

    Karki, Sushmita; Bhatta, Dharma Nand; Aryal, Umesh Raj

    2015-01-01

    Many older people are vulnerable with multiple health problems and need of extensive care and support for quality of life. The main objective of this study was to explore the older people's perspectives on an "elderly-friendly" hospital. Hospital was stratified by four domains including government, semi-government, community, and private. We interviewed 33 hospitalized older patients and four hospital managers between June and December 2014 in Kathmandu, Nepal, using purposive sampling technique. We executed a qualitative content analysis step with extensive review of the interviews. Final name of the theme was given after the agreement between the research team and experts to improve trustworthiness. Elderly-friendly services, expectation from government and hospital, and health policy related to senior citizen were developed as main themes. Most of the participants were satisfied with the behavior of health personnel. However, none of the health personnel were trained with geriatric health care. Elderly-friendly hospital guidelines and policy were not developed by any hospitals. Older people health card, advocacy for older people's health and benefit, and hospital environment were the common expectations of older patients. Government policy and budget constraint were the main obstacles to promote elderly-friendly health care services. Elderly-related health policies, physical environments of hospital, elderly-friendly health manpower, advocacy, and other facilities and benefits should be improved and developed. There are urgent needs to develop elderly-friendly hospital policies and guidelines that focus on older people's health benefits and friendly services.

  19. Effects of physical exercise programme on happiness among older people.

    PubMed

    Khazaee-Pool, M; Sadeghi, R; Majlessi, F; Rahimi Foroushani, A

    2015-02-01

    This randomized-controlled trial investigated the effect of physical exercise programme (PEP) on happiness among older adults in Nowshahr, Iran. Results of this study on 120 male and female volunteers showed that an 8-week group physical exercise programme was significantly effective in older adults' happiness. Findings showed that physical exercise programme is so beneficial for increasing older adults' happiness. Physical activity is associated with well-being and happiness. The purpose of this study was to determine the effects of an 8-week long physical exercise programme (PEP) on happiness among older adults in Nowshahr, Iran. This was a randomized control trial study. The participants consisted of a group of 120 male and female volunteers (mean ± SD age: 71 ± 5.86 years) in a convenience sampling among older adults in public parks in Nowshahr, Iran. We randomly allocated them into experimental (n = 60) and control (n = 60) groups. A validated instrument was used to measure well-being and happiness [Oxford Happiness Inventory (OHI)]. Respondents were asked to complete the OHI before and 2 months after implementing PEP. The 8-week PEP was implemented with the intervention group. The statistical analysis of the data was conducted using paired t-test, Fisher's exact test and χ(2). Before the intervention, there was no significant difference in the happiness mean score between the case and control groups; however, after implementing PEP, happiness significantly improved among the experimental group (P = 0.001) and did not improve within the control group (P = 0.79). It can be concluded that PEP had positive effects on happiness among older adults. Planning and implementing of physical activity is so important for older happiness. © 2014 John Wiley & Sons Ltd.

  20. An examination of assessment arrangements and service use for older people in receipt of care management.

    PubMed

    Sutcliffe, Caroline; Hughes, Jane; Abendstern, Michele; Clarkson, Paul; Chester, Helen; Challis, David

    2014-01-01

    With anticipated greater demand for formal care services globally, this article examines the sociodemographic and health characteristics of frail older people in receipt of community support. Data were collected from audits of case files of older people receiving care management at two time points during which two government policy initiatives were implemented to promote greater standardization in health and social care provision for older people in England. Findings at Time 2 revealed that there were higher levels of physical and mental impairment and more health care assessments undertaken. There was a slight decrease in home care receipt but a marginal increase of more intensive home care provision. Service users living with a carer were less likely to receive home care but more likely to receive respite care or day care than those living alone. The policy goal of widening access to specialist health and social care services for older people with mental health problems was achieved. Guidance that focused eligibility criteria on the identification of older people with complex needs required the availability of appropriate support and services. Irrespective of policy initiatives, the sociodemographic characteristics of older people and the availability of informal support are principal determinants of service provision.

  1. Self-rated health and associated factors among older people living alone in Shanghai.

    PubMed

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

    2015-04-01

    Self-rated health is a reliable and important health measure related to older people's mortality and quality of life. Few studies regarding the self-rated health of older people living alone have been carried out in Mainland China. The present study aimed to investigate the self-rated health of older people living alone in Shanghai and its associated factors. A stratified random cluster sample of 521 community-dwelling older people living alone in Shanghai completed structured questionnaires through face-to-face interviews. The data collected included self-rated health, physical health, depression, functional ability, physical activity, health services satisfaction, loneliness, social support and sociodemographic variables. More than two-fifths of the participants (43.2%) reported good self-rated health. Multinomial logistic regression analyses found that chronic disease, acute disease, functional ability, satisfaction with health services, depression and age were predictors of self-rated health. Identifying factors associated with the self-rated health of older people living alone could inform the delivery of appropriate health and social care interventions to promote older people's health. © 2014 Japan Geriatrics Society.

  2. Health Impact of Climate Change in Older People: An Integrative Review and Implications for Nursing.

    PubMed

    Leyva, Erwin William A; Beaman, Adam; Davidson, Patricia M

    2017-10-10

    Older people account for the highest proportion of mortality from extreme weather events associated with climate change. This article aims to describe the health impacts of climate change on older people. An integrative review was conducted with 30 studies retrieved from PubMed, EBSCO, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) on climate stressors, determinants of resilient capacity, risk factors, and health outcomes. Heat, temperature variability, and air pollution increase mortality risk in older people, especially from cardiovascular and respiratory diseases. Floods are linked with increasing incidence of post-traumatic stress disorder, depression, and anxiety. Facing these adversities, older people exhibit both vulnerability and resilience. Research gaps exist in understanding the full spectrum of the resilience experience of older people, and appreciating areas wherein nursing can play a pivotal role. Recognizing the vulnerabilities of older people in the context of climate change is important. Identifying opportunities to promote resilience is an important focus for nurses to develop tailored and targeted nursing interventions. © 2017 Sigma Theta Tau International.

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

    PubMed

    Kam, Ping-kwong

    2003-01-01

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

  4. 'Growing Old' in Shelters and 'On the Street': Experiences of Older Homeless People.

    PubMed

    Grenier, Amanda; Sussman, Tamara; Barken, Rachel; Bourgeois-Guérin, Valerie; Rothwell, David

    2016-01-01

    Homelessness among older people in Canada is both a growing concern, and an emerging field of study. This article reports thematic results of qualitative interviews with 40 people aged 46 to 75, carried out as part of a mixed-methods study of older people who are homeless in Montreal, Quebec, Canada. Our participants included people with histories of homelessness (n = 14) and persons new to homelessness in later life (n = 26). Interviews focused on experiences at the intersections of aging and homelessness including social relationships, the challenges of living on the streets and in shelters in later life, and the future. This article outlines the 5 main themes that capture the experience of homelessness for our participants: age exacerbates worries; exclusion and isolation; managing significant challenges; shifting needs and realities; and resilience, strength, and hope. Together, these findings underscore the need for specific programs geared to the unique needs of older people who are homeless.

  5. Older people's views of a good death in heart failure: implications for palliative care provision.

    PubMed

    Gott, M; Small, Neil; Barnes, Sarah; Payne, Sheila; Seamark, David

    2008-10-01

    Palliative care in the UK has been developed to meet the needs of predominantly middle aged and younger old people with cancer. Few data are available regarding the extent to which services respond to the specific needs of an older group of people with other illnesses. This paper draws on in-depth interviews conducted with 40 people (median age 77) with advanced heart failure and poor prognosis to explore the extent to which older people's views and concerns about dying are consistent with the prevalent model of the 'good death' underpinning palliative care delivery. That prevalent model is identified as the "revivalist" good death. Our findings indicate that older people's views of a 'good death' often conflict with the values upon which palliative care is predicated. For example, in line with previous research, many participants did not want an open awareness of death preceded by acknowledgement of the potential imminence of dying. Similarly, concepts of autonomy and individuality appeared alien to most. Indeed, whilst there was evidence that palliative care could help improve the end of life experiences of older people, for example in initiating discussions around death and dying, the translation of other aspects of specialist palliative care philosophy appear more problematic. Ultimately, the study identified that improving the end of life experiences of older people must involve addressing the problematised nature of ageing and old age within contemporary society, whilst recognising the cohort and cultural effects that influence attitudes to death and dying.

  6. Discriminative ability and predictive validity of the timed up and go test in identifying older people who fall: systematic review and meta-analysis.

    PubMed

    Schoene, Daniel; Wu, Sandy M-S; Mikolaizak, A Stefanie; Menant, Jasmine C; Smith, Stuart T; Delbaere, Kim; Lord, Stephen R

    2013-02-01

    To investigate the discriminative ability and diagnostic accuracy of the Timed Up and Go Test (TUG) as a clinical screening instrument for identifying older people at risk of falling. Systematic literature review and meta-analysis. People aged 60 and older living independently or in institutional settings. Studies were identified with searches of the PubMed, EMBASE, CINAHL, and Cochrane CENTRAL data bases. Retrospective and prospective cohort studies comparing times to complete any version of the TUG of fallers and non-fallers were included. Fifty-three studies with 12,832 participants met the inclusion criteria. The pooled mean difference between fallers and non-fallers depended on the functional status of the cohort investigated: 0.63 seconds (95% confidence (CI) = 0.14-1.12 seconds) for high-functioning to 3.59 seconds (95% CI = 2.18-4.99 seconds) for those in institutional settings. The majority of studies did not retain TUG scores in multivariate analysis. Derived cut-points varied greatly between studies, and with the exception of a few small studies, diagnostic accuracy was poor to moderate. The findings suggest that the TUG is not useful for discriminating fallers from non-fallers in healthy, high-functioning older people but is of more value in less-healthy, lower-functioning older people. Overall, the predictive ability and diagnostic accuracy of the TUG are at best moderate. No cut-point can be recommended. Quick, multifactorial fall risk screens should be considered to provide additional information for identifying older people at risk of falls. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.

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

    PubMed

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

    2015-08-20

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

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

    ERIC Educational Resources Information Center

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

    2008-01-01

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

  9. Dimensions of Housing Deprivation for Older People in Ireland

    ERIC Educational Resources Information Center

    Nolan, Brian; Winston, Nessa

    2011-01-01

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

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

    ERIC Educational Resources Information Center

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

    2008-01-01

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

  11. Dimensions of Housing Deprivation for Older People in Ireland

    ERIC Educational Resources Information Center

    Nolan, Brian; Winston, Nessa

    2011-01-01

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

  12. Intergenerational Contact, Attitudes, and Stereotypes of Adolescents and Older People

    ERIC Educational Resources Information Center

    Meshel, David; Mcglynn, Richard

    2004-01-01

    Contradictory findings characterize the literature on the efficacy of intergenerational programs that bring children and older persons together for joint activities to promote more positive attitudes and stereotypes. Nor is it clear whether cross-generational attitudes are negative to begin with. The research reported in this paper operationalized…

  13. Fall prevention services for older Aboriginal people: investigating availability and acceptability.

    PubMed

    Lukaszyk, Caroline; Coombes, Julieann; Keay, Lisa; Sherrington, Catherine; Tiedemann, Anne; Broe, Tony; Lovitt, Lorraine; Ivers, Rebecca

    2016-12-14

    Falls and fall-related injury are emerging issues for older Aboriginal people. Despite this, it is unknown whether older Aboriginal people access available fall prevention programs, or whether these programs are effective or acceptable to this population. To investigate the use of available fall prevention services by older Aboriginal people and identify features that are likely to contribute to program acceptability for Aboriginal communities in New South Wales (NSW), Australia. A questionnaire was distributed to Aboriginal and mainstream health and community services across NSW to identify the fall prevention and healthy ageing programs currently used by older Aboriginal people. Services with experience in providing fall prevention interventions for Aboriginal communities, and key Aboriginal health services that delivered programs specifically for older Aboriginal people, were followed up and staff members were nominated from within each service to be interviewed. Service providers offered their suggestions as to how a fall prevention program could be designed and delivered to meet the health and social needs of their older Aboriginal clients. Of the 131 services that completed the questionnaire, four services (3%) had past experience in providing a mainstream fall prevention program to Aboriginal people; however, there were no programs being offered at the time of data collection. From these four services, and from a further five key Aboriginal health services, 10 staff members experienced in working with older Aboriginal people were interviewed. Barriers preventing services from offering appropriate fall prevention programs to their older Aboriginal clients were identified, including limited funding, a lack of available Aboriginal staff, and communication difficulties between health services and sectors. According to the service providers, an effective and acceptable fall prevention intervention would be evidence based, flexible, community-oriented and social

  14. Older persons with dementia at risk for institutionalization in eight European countries: a cross-sectional study on the perceptions of informal caregivers and healthcare professionals.

    PubMed

    Stephan, Astrid; Afram, Basema; Koskenniemi, Jaana; Verbeek, Hilde; Soto, Maria E; Bleijlevens, Michel H C; Sutcliffe, Caroline; Lethin, Connie; Risco, Ester; Saks, Kai; Hamers, Jan P H; Meyer, Gabriele

    2015-06-01

    To explore the perceptions of informal caregivers and healthcare professionals regarding potential reasons for the institutionalization of older persons with dementia in eight European countries. Healthcare professionals may have an important role in facilitating informal caregivers' decision-making regarding institutionalization. Little is known about the perceptions of informal caregivers and healthcare professionals prior to institutionalization. Cross-sectional survey in eight European countries (November 2010-January 2012). Healthcare professionals reported why they clinically judged persons with dementia at risk for institutionalization. Informal caregivers reported potential reasons from their perspectives. Answers were openly coded and categorized. Variation between informal caregivers and healthcare professionals was investigated (agreement on at least one potential reason per case/proportion of maximum attainable kappa). Judgements of healthcare professionals and informal caregivers on 1160 persons with dementia were included. A total of 22 categories emerged. Approximately 90% of informal caregivers reported potential reasons. In 41% of the cases, informal caregivers and healthcare professionals agreed on at least one reason. Discrepancy was high for potential reasons related to caregiver burden. For the most frequent categories (caregiver burden, caregiver unable to provide care, neuropsychiatric symptoms, overall deterioration, care dependency), 24-41% of the attainable kappa was achieved. Differences between countries emerged indicating more favourable agreement in Finland, Sweden and Estonia and lowest agreement in England and Spain. Agreement between healthcare professionals and informal caregivers on potential reasons for institutionalization was low-to-moderate. Healthcare professionals are challenged to develop a detailed understanding of the perspectives and perceived burden of informal caregivers. © 2014 John Wiley & Sons Ltd.

  15. 'Living within your limits': activity restriction in older people experiencing chronic pain.

    PubMed

    Mackichan, Fiona; Adamson, Joy; Gooberman-Hill, Rachael

    2013-11-01

    although maintaining activity is key to successful pain management, and important to health and wellbeing, it is known that older people in pain frequently alter or reduce activity levels. A 'fear-avoidance' model is often used to explain avoidance of activity in the face of pain. However, this model is not intended to take account of the wider context in which activity changes take place, nor older people's own explanations for their behaviour. to investigate the reasons why older people in the community adjust their activity levels when living with chronic pain. thirty-one people aged between 67 and 92 were purposively sampled from respondents to a community-based cross-sectional survey. All participants had reported long-term pain and were interviewed about this. Data were collected and analysed using a qualitative constructivist grounded theory approach. explanations for deliberative reduction or ceasing of activities reflected a desire to prevent pain exacerbation, thereby avoiding medical intervention. It also reflected a desire to safeguard autonomy in the face of pain in older age. Restrictions were often rationalised as normal in older age, although co-existing accounts of perseverance and frustration with limitation were also evident. a rational desire to avoid pain exacerbation and medical intervention motivated restrictions to activity. However, deliberative limitation of activity has the potential to compromise autonomy by increasing social isolation and de-conditioning. Supporting older people with pain to be active requires sensitivity to the function of activity restriction, especially as a means of preventing deterioration.

  16. Understanding older peoples' decisions about the use of sleeping medication: issues of control and autonomy.

    PubMed

    Venn, Susan; Arber, Sara

    2012-11-01

    Poor sleep is known to impact on health and wellbeing in later life and has implications for the ability of older people to remain active during the day. Medical treatments for chronic poor sleep have primarily included the regular, long-term prescribing of hypnotics, which are known to impact on older people's health, cognitive function and quality of life. Therefore, recent policy and practice has focused on reducing such prescribing, on encouraging older people to stop taking long-term hypnotics and on finding alternative, non-pharmacological ways to manage poor sleep. However, little research has been undertaken to understand the perspectives of older people who choose not to seek professional help for their poor sleep, despite the potential impact of poor sleep on their health and ability to remain active. Through in-depth interviews with 62 older men and women living in their own homes in England, this article explores the factors that deter older people from seeking professional help for their poor sleep. We argue that these are located in their perceptions of the normativity of poor sleep in later life, their beliefs about prescription sleeping medications and their desire to maintain control and autonomy over their everyday and night lives.

  17. A randomised controlled study of the effects of music on sleep quality in older people.

    PubMed

    Chan, Moon Fai

    2011-04-01

    To determine the effect of music on sleep quality in older people. Sleep disturbance is common in older people and its impacts on older adults along with its conventional treatment merit our attention as our population ages. Conventional pharmacological method might result dependence and impairment in psychomotor and cognitive function. Listening to music, which is a non-pharmacological method, might promote relaxation, induce distraction responses and promote sleep quality. A randomised controlled study. The study was conducted from December 2006-January 2007. Forty-two older people (21 using music and 21 controls) completed the study in Hong Kong. Physiological (blood pressure and heart rate) and sleep quality variables were collected once a week for one month. For all vital signs' results, no significant differences were found between both music and control groups within the four weeks. In the music group, there was statistically significant reduction in sleep scores at week 4. In control group, there was no statistically significant improvement of sleep scores in the four weeks. However, no significant difference was found between groups over the four weeks. Whilst there were no statistical differences between groups, there was some indication that music yielder higher improvement on sleep scores, which are worthier of further investigation in larger trials. The implication of this study is that music listening can help nurses build therapeutic relationships with older people. Nurses are recommended to use music as part of their holistic caring for older people. © 2011 Blackwell Publishing Ltd.

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

    PubMed

    Chen, Chin-Hui

    2015-01-01

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

  19. Oral health and access to dental care: a qualitative investigation among older people in the community.

    PubMed

    Slack-Smith, Linda; Lange, Andrea; Paley, Glenys; O'Grady, Martin; French, Davina; Short, Leonie

    2010-06-01

    The aim of this study was to explore older persons' beliefs and attitudes towards oral health and access to and use of dental care services. As the proportion of dentate older people increases, the need and demand for dental services will rise (J Public Health Dent, 60, 2000, 276). Focus groups and semi-structured interviews were used for data collection. The study participants included 63 older people in Perth, WA. Five major themes emerged from the interviews - the need for information and knowledge; accessibility of services; cost and affordability of oral care; fear and anxiety regarding dental visits and relationships with dentists. Attitudes and behaviours were slow to change in this group. This investigation provided important perspectives regarding oral health and dental access for older people residing in the community and demonstrated the importance of understanding this group when considering provision and use of services.

  20. Designing 'older' rather than denying ageing: problematizing anti-ageing discourse in relation to cosmetic surgery undertaken by older people.

    PubMed

    Garnham, Bridget

    2013-01-01

    This paper problematizes anti-ageing discourse and interpretations that cosmetic surgery is an ageist practice and older people who undergo cosmetic surgery are denying ageing. It argues that conceptions of cosmetic surgery as anti-ageing are premised on an essentialist conception of the 'naturally ageing body'. Interview data and media texts are used to demonstrate how, through the notion of "re" suggested by terms such as rejuvenation, reversal and renewal, anti-ageing discourses inscribe 'ageing' in the practice of cosmetic surgery by older people. The oppressive interpretation that older people who undergo cosmetic surgery are 'denying ageing,' and associated subjection to moral critique, are effects of this discourse. To counter interpretations of cosmetic surgery as 'anti-ageing', the paper takes up the idea that cosmetic surgery is undertaken to look better not younger. To advance this argument, the paper suggests that the forms of rationality associated with cosmetic surgery constitute a contemporary regimen of 'care of the self' which enable ethical agency and creative self-stylisation. Through this framework cosmetic surgery can be re-imagined as a practice for designing 'older' rather than denying ageing.

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

    ERIC Educational Resources Information Center

    Gilroy, Rose

    2005-01-01

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

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

    ERIC Educational Resources Information Center

    Cherry, Katie E.; Palmore, Erdman

    2008-01-01

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

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

    ERIC Educational Resources Information Center

    Gilroy, Rose

    2005-01-01

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

  4. Expanding the Circle of Knowledge: Reconceptualizing Successful Aging Among North American Older Indigenous Peoples.

    PubMed

    Pace, Jessica E; Grenier, Amanda

    2017-03-01

    Indigenous older peoples' voices and experiences remain largely absent in the dominant models and critical scholarship on aging and late life. This article examines the relevance of the model of successful aging for Indigenous peoples in North America. This article presents the results of a review of the published conceptual literature on successful aging among Indigenous peoples. Our intent was to explore the current state of the field of successful aging among Indigenous peoples and suggest dimensions that may be more reflective of Indigenous voices and experiences that leads to a more inclusive model of successful aging. Based on our review, we suggest four dimensions that may broaden understandings of successful aging to be more inclusive of Indigenous older people: health and wellness, empowerment and resilience, engagement and behavior, and connectedness. Our review suggests that Indigenous peoples' voices and experiences are beginning to be included in academic literature on successful aging. However, we suggest that understandings of successful aging be broadened based on our summative findings and a process of community involvement. Such processes can lead to the development of models that are more inclusive to a wide range of older people, including Indigenous older peoples.

  5. Disentangling the health benefits of walking from increased exposure to falls in older people using remote gait monitoring and multi-dimensional analysis.

    PubMed

    Brodie, Matthew A; Okubo, Yoshiro; Annegarn, Janneke; Wieching, Rainer; Lord, Stephen R; Delbaere, Kim

    2017-01-01

    Falls and physical deconditioning are two major health problems for older people. Recent advances in remote physiological monitoring provide new opportunities to investigate why walking exercise, with its many health benefits, can both increase and decrease fall rates in older people. In this paper we combine remote wearable device monitoring of daily gait with non-linear multi-dimensional pattern recognition analysis; to disentangle the complex associations between walking, health and fall rates. One week of activities of daily living (ADL) were recorded with a wearable device in 96 independent living older people prior to completing 6 months of exergaming interventions. Using the wearable device data; the quantity, intensity, variability and distribution of daily walking patterns were assessed. At baseline, clinical assessments of health, falls, sensorimotor and physiological fall risks were completed. At 6 months, fall rates, sensorimotor and physiological fall risks were re-assessed. A non-linear multi-dimensional analysis was conducted to identify risk-groups according to their daily walking patterns. Four distinct risk-groups were identified: The Impaired (93% fallers), Restrained (8% fallers), Active (50% fallers) and Athletic (4% fallers). Walking was strongly associated with multiple health benefits and protective of falls for the top performing Athletic risk-group. However, in the middle of the spectrum, the Active risk-group, who were more active, younger and healthier were 6.25 times more likely to be fallers than their Restrained counterparts. Remote monitoring of daily walking patterns may provide a new way to distinguish Impaired people at risk of falling because of frailty from Active people at risk of falling from greater exposure to situations were falls could occur, but further validation is required. Wearable device risk-profiling could help in developing more personalised interventions for older people seeking the health benefits of walking

  6. Older Chinese people's views on food: implications for supportive cancer care.

    PubMed

    Payne, Sheila Alison; Seymour, Jane E; Chapman, Alice; Holloway, Margaret

    2008-11-01

    As people face cancer and the end of life, the social, cultural and therapeutic role of food takes on an increasing significance. As part of a larger study involving older Chinese people resident in the UK, we investigated their beliefs about the influence of food on cancer and its role in supportive cancer care. A two-phase qualitative research study involved older Chinese people identified via Chinese community groups. In phase one, 46 older Chinese people participated in seven focus group discussions. In phase two, semi-structured interviews were conducted in Cantonese or Mandarin with 46 different older Chinese people to elicit their understandings of the role of food in health and illness generally and specifically for those with cancer. The analyses revealed four main themes: (1) food as 'therapeutic'; (2) food as 'risky'; (3) food as supportive and comforting; and (4) beliefs about the lack of culturally appropriate and acceptable food in hospitals. Expectations about the lack of Chinese food and the poor quality and perceived unsuitability of 'western' food were regarded as major concerns in relation to hospital admission. Understanding the perceived cultural and therapeutic significance of food and its functions in social exchange is one important aspect of promoting supportive and end-of-life cancer care for minority communities. These views helped explain the diversity and salience of food use in illness for older Chinese people resident in the UK.

  7. Caring for older people with an intellectual disability: a systematic review.

    PubMed

    Innes, Anthea; McCabe, Louise; Watchman, Karen

    2012-08-01

    This review critically evaluates the available research literature on aging among people with an intellectual disability. 42 papers meeting the review inclusion criteria are presented under three themes: studies with a service user perspective (13), studies of carers of older people with ID (14) and studies of service provision for older people with ID (15). User view specific findings relate to concerns about accommodation; experiences of services; and perceptions of aging; with a common underlying finding from all user focused themes that of unmet need. Carer specific findings relate to fear of the future; experiences of older carers; and planning for the future. Services themes reflect the debate over specialist or generalist services as people age; accommodation; retirement from day services; and staff training. Overall this review reveals a lack of robust research evidence concerning the lives of older people with ID and a need for more research that directly engages with older people with ID and their carers. Crown Copyright © 2012. Published by Elsevier Ireland Ltd. All rights reserved.

  8. Multiple drug use by older people: exploring the health development and political economy perspectives.

    PubMed

    Legge, D G; Bammer, G

    1993-01-01

    The use of multiple medications by a large number of older people provides grounds for concern in terms of quality of life as well as cost. We argue that problems faced by older people are being over-medicalized in a manner that palliates and obscures social causes such as loss of income, the falling away of social support and a discounted role in society. Primary health care is a policy model for the development of health services which offers a credible strategy for addressing clinical problems associated with growing old in ways that also contribute to recognizing and addressing social and structural problems that may be expressed in people's private troubles.

  9. Preparing young people for future decision-making about cancer risk in families affected or at risk from hereditary breast cancer: A qualitative interview study.

    PubMed

    Rowland, Emma; Plumridge, Gill; Considine, Anna-Marie; Metcalfe, Alison

    2016-12-01

    Women carrying the mutated BRCA gene, have approximately an 80% life-time risk of developing breast cancer with 50% risk of their children inheriting the gene mutation. Many parents find it difficult to know when and how to disclose this information to their children and how such disclosure might affect their child's future decision-making. This study explored the communication of genetic risk information in families using qualitative semi-structured interviews conducted with parents, children (7-11years) and young people (12-18years) affected or at risk from a BRCA gene mutation. Thematic analysis was applied to coded transcripts producing four themes; family communication, perception of cancer risks, risk management strategies and impact of genetic risk communication in children and young people's decision making. Twenty-seven individuals from 11 families took part, recruited through purposive sampling techniques. Cancer risk caused by a BRCA gene mutation induced a sense of fear in parents about their children's future. As a result, parents with hereditary breast cancer disclosed limited information about the risks associated with prophylactic surgery and/or the psychological and emotional impacts of surgery on body image. This had implications to children and young people's perceptions of prophylactic procedures, which were already influenced by cultural understandings of the 'desirable body' and increasing acceptance and proliferation cosmetic surgery. Lack of risk management information and the acculturation of cosmetic surgery combined to limit children and young people's understanding of the impact of hereditary breast cancer; reducing their ability to actualise the physiological, psychological and emotional consequences of surgery. Copyright © 2016. Published by Elsevier Ltd.

  10. Service use of older people who participate in primary care health promotion: a latent class analysis.

    PubMed

    Ford, John A; Kharicha, Kalpa; Clarke, Caroline S; Clark, Allan; Iliffe, Steve; Goodman, Claire; Manthorpe, Jill; Steel, Nick; Walters, Kate

    2017-03-06

    Recruiting patients to health promotion programmes who will benefit is crucial to success. A key policy driver for health promotion in older people is to reduce health and social care use. Our aim was to describe service use among older people taking part in the Multi-dimensional Risk Appraisal for Older people primary care health promotion programme. A random sample of 1 in 3 older people (≥65 years old) was invited to participate in the Multi-dimensional Risk Appraisal for Older people project across five general practices in London and Hertfordshire. Data collected included socio-demographic characteristics, well-being and functional ability, lifestyle factors and service use. Latent class analysis (LCA) was used to identify groups based on use of the following: secondary health care, primary health care, community health care, paid care, unpaid care, leisure and local authority resources. Differences in group characteristics were assessed using univariate logistic regression, weighted by probability of class assignation and clustered by GP practice. Response rate was 34% (526/1550) with 447 participants presenting sufficient data for analysis. LCA using three groups gave the most meaningful interpretation and best model fit. About a third (active well) were fit and active with low service use. Just under a third (high NHS users) had high impairments with high primary, secondary and community health care contact, but low non-health services use. Just over a third (community service users) with high impairments used community health and other services without much hospital use. Older people taking part in the Multi-dimensional Risk Appraisal for Older people primary care health promotion can be described as three groups: active well, high NHS users, and community service users.

  11. The role of digital health technologies in management of pain in older people: An integrative review.

    PubMed

    Bhattarai, Priyanka; Phillips, Jane L

    Pain is one of the most distressing and debilitating health issues faced by older people. The burden of unrelieved pain experienced by older people and its associated high symptom and economic costs demands consideration of new strategies to better this condition. As the global uptake of digital technology increases, exploring its potential to impact positively on older peoples' pain self-management practices warrants investigation. This integrative review aimed to evaluate the use of digital health technology for management of older people's pain across care-settings. Searches were conducted to identify relevant English language studies published in CINHAL, Medline, Academic Search Complete, EMBASE, Cochrane library databases, and Google and Google Scholar websites. A total of 1003 papers were identified, 9 met the inclusion criteria. The highest level of evidence (Level II) was generated by three Phase II randomized controlled trials. These trials demonstrated the feasibility of computer based interactive or instructive video interventions however there was limited evidence to support their use for reduction of pain intensity and interference. Qualitative evidence demonstrated older people's willingness to use mobile technologies (iPhone or digital pen) to help manage their pain, however, the need of device-use training and connectedness with clinicians were highlighted. In conclusion, there is some evidence that integrating digital health technology into older peoples' pain self-management plan is feasible and acceptable. However, the provision of high-quality technological interventions informed by a thorough understanding of older people's digital technology pain management needs is required to ensure greater integration of this technology in clinical practice. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  12. Therapeutic effects of an indoor gardening programme for older people living in nursing homes.

    PubMed

    Tse, Mimi Mun Yee

    2010-04-01

    To explore the activities of daily living and psychological well-being of older people living in nursing homes and also to examine the effectiveness of a gardening programme in enhancing socilaisation and life satisfaction, reducing loneliness and promoting activities of daily living for older people living in nursing homes. Life in nursing homes can mean very limited physical and social activity, leading to further decline in function for many older people. This was a quasi-experimental pre and posttest control group design. Older people from nursing homes were invited to join the eight week indoor gardening programme (experimental group), while older people in other nursing homes were treated as the control group; they received regular care without the eight week indoor gardening programme. There were 26 older people (25 female and one male; mean age 85 years) in the experimental group and 27 (20 female and seven male; mean age 82 years) in the control group. Demographic data including age, gender, educational level and financial situation were collected, in addition to information regarding life satisfaction, loneliness, physical activity and social network situation, before and after the eight week indoor gardening programme for both the experimental and control groups. Also, details of experimental group subjects' experience of the indoor gardening programme were elicited using open-ended questions. There were significant improvements in life satisfaction and social network and a significant decrease in perception of loneliness for older people in the experimental group after the eight week indoor gardening programme, while the activities of daily living were unchanged for both groups after the programme. Given the positive effects of gardening activities, it is suggested that they be promoted more widely among nursing home residents.

  13. 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 o