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

PubMed Central

2013-01-01

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

Measuring the Experience and Perception of Suffering

ERIC Educational Resources Information Center

Schulz, Richard; Monin, Joan K.; Czaja, Sara J.; Lingler, Jennifer H.; Beach, Scott R.; Martire, Lynn M.; Dodds, Angela; Hebert, Randy S.; Zdaniuk, Bozena; Cook, Thomas B.

2010-01-01

Purpose: Assess psychometric properties of scales developed to assess experience and perception of physical, psychological, and existential suffering in older individuals. Design and Methods: Scales were administered to 3 populations of older persons and/or their family caregivers: individuals with Alzheimer's disease (AD) and their family…

Fall risk and prevention needs assessment in an older adult Latino population: a model community global health partnership.

PubMed

Hanlin, Erin R; Delgado-Rendón, Angélica; Lerner, E Brooke; Hargarten, Stephen; Farías, René

2013-01-01

The impact of falls in older adults presents a significant public health burden. Fall risk is not well-described in Latino populations nor have fall prevention programs considered the needs of this population. The objectives of this study were to develop a needs assessment of falls in older adult Latinos at a community center (CC), determine fall prevention barriers and strengths in this population, determine the level of interest in various fall prevention methods, and provide medical students an opportunity for participation in a culturally diverse community project. A cross-sectional survey was conducted with a convenience sample of older adult program participants. The survey was developed in collaboration with both partners. CC participants were approached by the interviewer and asked to participate. They were read the survey in their preferred language and their answers were recorded. Data were analyzed using descriptive statistics. We conducted 103 interviews. We found that 54% of participants had fallen in the last year, and of those 21% required medical care, 81% were afraid of falling again, and 66% considered themselves at risk for falling again. Of all respondents, 52% had 5 or more of the 10 surveyed risk factors for falling; 4% had no risk factors. Of all respondents, 75% were afraid of falling. Talking with health care providers and participating in an exercise class were the preferred methods of health information delivery (78% and 65%, respectively). Older adult Latinos in this selected population frequently fall and are worried about falling. Risk factors are prevalent. A fall prevention program is warranted and should include exercise classes and a connection with local primary care providers. A partnership between an academic organization and a CC is an ideal collaboration for the future development of prevention program.

Physical Activity among Rural Older Adults with Diabetes

ERIC Educational Resources Information Center

Arcury, Thomas A.; Snively, Beverly M.; Bell, Ronny A.; Smith, Shannon L.; Stafford, Jeanette M.; Wetmore-Arkader, Lindsay K.; Quandt, Sara A.

2006-01-01

Purpose: This analysis describes physical activity levels and factors associated with physical activity in an ethnically diverse (African American, Native American, white) sample of rural older adults with diabetes. Method: Data were collected using a population-based, cross-sectional stratified random sample survey of 701 community-dwelling…

Nutritional Strategies Facing an Older Demographic: The Nutrition UP 65 Study Protocol

PubMed Central

2016-01-01

Background The population of Portugal is aging. The lack of data on older adults’ nutritional status and the lack of nutrition knowledge amongst health professionals, caregivers, and older adults themselves, remains a challenge. Objective The Nutrition UP 65 study aims to reduce nutritional inequalities in the older Portuguese adult population and improve knowledge regarding older Portuguese adults’ nutritional status, specifically relating to undernutrition, obesity, sarcopenia, frailty, hydration, sodium, and vitamin D statuses. Methods A representative sample of older Portuguese adults was selected. Sociodemographic, lifestyle, anthropometric, functional, and clinical data were collected. Sodium excretion, hydration, and vitamin D statuses were assessed. Results Data collection (n=1500) took place between December, 2015 and June, 2016. Results will be disseminated in national and international scientific journals, and via Portuguese media. Conclusions Nutrition UP 65 results will provide evidence for the design and implementation of effective preventive public health strategies regarding the elderly. These insights may represent relevant health gains and costs savings. PMID:27628097

Dynamics of Volunteering in Older Europeans

ERIC Educational Resources Information Center

Hank, Karsten; Erlinghagen, Marcel

2010-01-01

Purpose: To investigate the dynamics of volunteering in the population aged 50 years or older across 11 Continental European countries. Design and Methods: Using longitudinal data from the first 2 waves of the Survey of Health, Ageing and Retirement in Europe, we run multivariate regressions on a set of binary-dependent variables indicating…

An eHealth Intervention to Promote Physical Activity and Social Network of Single, Chronically Impaired Older Adults: Adaptation of an Existing Intervention Using Intervention Mapping

PubMed Central

Peels, Denise A; Berendsen, Brenda AJ; Bolman, Catherine AW; Lechner, Lilian

2017-01-01

Background Especially for single older adults with chronic diseases, physical inactivity and a poor social network are regarded as serious threats to their health and independence. The Active Plus intervention is an automated computer-tailored eHealth intervention that has been proven effective to promote physical activity (PA) in the general population of adults older than 50 years. Objective The aim of this study was to report on the methods and results of the systematic adaptation of Active Plus to the wishes and needs of the subgroup of single people older than 65 years who have one or more chronic diseases, as this specific target population may encounter specific challenges regarding PA and social network. Methods The Intervention Mapping (IM) protocol was used to systematically adapt the existing intervention to optimally suit this specific target population. A literature study was performed, and quantitative as well as qualitative data were derived from health care professionals (by questionnaires, n=10) and the target population (by focus group interviews, n=14), which were then systematically integrated into the adapted intervention. Results As the health problems and the targeted behavior are largely the same in the original and adapted intervention, the outcome of the needs assessment was that the performance objectives remained the same. As found in the literature study and in data derived from health professionals and focus groups, the relative importance and operationalization of the relevant psychosocial determinants related to these objectives are different from the original intervention, resulting in a refinement of the change objectives to optimally fit the specific target population. This refinement also resulted in changes in the practical applications, program components, intervention materials, and the evaluation and implementation strategy for the subgroup of single, chronically impaired older adults. Conclusions This study demonstrates that the adaptation of an existing intervention is an intensive process in which adopting the IM protocol is an invaluable tool. The study provides a broad insight in adapting interventions aimed at single older adults with a chronic disease. It is concluded that even when the new target population is a sizable segment of the original target population, the adapted intervention still needs considerable changes to optimally fit the needs and situational differences of the narrower target population. PMID:29170146

Correlates of, and barriers to, Internet use among older adults.

PubMed

Chang, Janet; McAllister, Carolyn; McCaslin, Rosemary

2015-01-01

Older adults constitute the group with the greatest increase in Internet usage in the past decade; however, usage varies greatly within this population. Services to older adults require a current understanding of Internet-use trends. This study utilized a quantitative survey method to examine correlates of, and barriers to, current Internet use in a demographically diverse county in Southern California. Findings indicate that the presence of a computer at home, a job requiring computer use, age, education, and ethnicity are important factors in predicting Internet use in older adults. Implications for social work practice with older adults is discussed.

Older adults and substance-related disorders: trends and associated costs.

PubMed

Rosen, Daniel; Heberlein, Emily; Engel, Rafael J

2013-01-01

Purpose. The aim of this study is to examine the changing service profile of older adults receiving substance abuse services over the past decade and the increased costs of treating this population. Design and Methods. Medicaid claims for mental health and substance abuse services data from a medium sized county in an eastern state were analyzed for individuals aged 50 years and older in calendar year 2000 or 2009. Univariate statistics are presented to describe the substance abuse and mental health services used by older adults in these two years. Results. The number of low-income older adults who accessed services for treatment and who had a substance-related diagnosis grew from 545 individuals in 2000 to 1,653 individuals in 2009. Costs for services utilized by older adults with a substance-related diagnosis rose by 358% from $2.1 million in 2000 to $9.5 million in 2009. Implications. The increase in the number of low-income older adults with a substance-related disorder and the concomitant rise in total spending for Medicaid reimbursed services indicate that local and state social service providers need to prepare for an older adult population who will need appropriate substance abuse prevention and treatment programs.

Older Adults and Substance-Related Disorders: Trends and Associated Costs

PubMed Central

Heberlein, Emily; Engel, Rafael J.

2013-01-01

Purpose. The aim of this study is to examine the changing service profile of older adults receiving substance abuse services over the past decade and the increased costs of treating this population. Design and Methods. Medicaid claims for mental health and substance abuse services data from a medium sized county in an eastern state were analyzed for individuals aged 50 years and older in calendar year 2000 or 2009. Univariate statistics are presented to describe the substance abuse and mental health services used by older adults in these two years. Results. The number of low-income older adults who accessed services for treatment and who had a substance-related diagnosis grew from 545 individuals in 2000 to 1,653 individuals in 2009. Costs for services utilized by older adults with a substance-related diagnosis rose by 358% from $2.1 million in 2000 to $9.5 million in 2009. Implications. The increase in the number of low-income older adults with a substance-related disorder and the concomitant rise in total spending for Medicaid reimbursed services indicate that local and state social service providers need to prepare for an older adult population who will need appropriate substance abuse prevention and treatment programs. PMID:25938120

Health insurance education strategies for increasing the insured among older population – a quasi experimental study in rural Kenya

PubMed Central

Nyagero, Josephat; Gakure, Roslyn; Keraka, Magaret

2012-01-01

Introduction The older population in most developing countries are uninsured and lack access to health services. This study assessed the extent to which a multi-strategy health insurance education intervention would increase the number of insured among the older population in rural Kenya. Methods The quasi-experimental study prospectively followed 1,104 unpaired older persons (60 years or more) in a 10-month health insurance education and enrolment intervention. The adjusted odds ratios computed at 95% confidence interval using a binary logistic regression tested the association between being insured and the multi-strategies. Results At baseline, the lack of adequate knowledge on health insurance (52.9%) and high premiums (38.1%) were the main reasons for being uninsured. The insured older persons increased three-fold (from 7.7% to 23.8%) in the experimental site but remained almost unchanged (from 4.0% to 4.6%) in the control. The computed adjusted odds ratio for variables with significance (p < 0.05) show that the older people who obtained health insurance education through the chief's public meeting, an adult daughter, an adult son, a relative-sister/brother, an agent of the National Hospital Insurance Fund, and a health insurance beneficiary were 2.6, 4.2, 2.8, 2.3, 2.5 and 2.5 times respectively more likely to be insured. Access to health insurance education using a combination of 1-3 strategies and >3 strategies predisposed the older people 14.3 times and 52.2 times respectively to being insured. Conclusion Health insurance education through multiple strategies and their intensity and frequency were pivotal in increasing being insured among the older population in rural Kenya. PMID:22826733

Racial Differences in Suicidality in an Older Urban Population

ERIC Educational Resources Information Center

Cohen, Carl I.; Colemon, Yolonda; Yaffee, Robert; Casimir, Georges J.

2008-01-01

Purpose: This study used epidemiological data of older African Americans and Caucasians living in an urban community to compare those factors associated with active or passive suicidal ideation in each racial group. Design and Methods: Using 1990 census data for Brooklyn, New York, we attempted to interview all cognitively intact adults aged 55 or…

A Review of Observational Pain Scales in Nonverbal Elderly with Cognitive Impairments

ERIC Educational Resources Information Center

Park, Juyoung; Castellanos-Brown, Karen; Belcher, John

2010-01-01

Objective: Pain assessment for nonverbal older adults with cognitive impairments or dementia presents many challenges, and it is important to determine which scales are most useful in assessing pain among this population. Method: In this review 11 observational scales for assessment of pain in older adults with dementia or cognitive impairments…

A novel accelerometer-based method to describe day-to-day exposure to potentially osteogenic vertical impacts in older adults: findings from a multi-cohort study.

PubMed

Hannam, K; Deere, K C; Hartley, A; Clark, E M; Coulson, J; Ireland, A; Moss, C; Edwards, M H; Dennison, E; Gaysin, T; Cooper, R; Wong, A; McPhee, J S; Cooper, C; Kuh, D; Tobias, J H

2017-03-01

This observational study assessed vertical impacts experienced in older adults as part of their day-to-day physical activity using accelerometry and questionnaire data. Population-based older adults experienced very limited high-impact activity. The accelerometry method utilised appeared to be valid based on comparisons between different cohorts and with self-reported activity. We aimed to validate a novel method for evaluating day-to-day higher impact weight-bearing physical activity (PA) in older adults, thought to be important in protecting against osteoporosis, by comparing results between four cohorts varying in age and activity levels, and with self-reported PA levels. Participants were from three population-based cohorts, MRC National Survey of Health and Development (NSHD), Hertfordshire Cohort Study (HCS) and Cohort for Skeletal Health in Bristol and Avon (COSHIBA), and the Master Athlete Cohort (MAC). Y-axis peaks (reflecting the vertical when an individual is upright) from a triaxial accelerometer (sampling frequency 50 Hz, range 0-16 g) worn at the waist for 7 days were classified as low (0.5-1.0 g), medium (1.0-1.5 g) or higher (≥1.5 g) impacts. There were a median of 90, 41 and 39 higher impacts/week in NSHD (age 69.5), COSHIBA (age 76.8) and HCS (age 78.5) participants, respectively (total n = 1512). In contrast, MAC participants (age 68.5) had a median of 14,322 higher impacts/week. In the three population cohorts combined, based on comparison of beta coefficients, moderate-high-impact activities as assessed by PA questionnaire were suggestive of stronger association with higher impacts from accelerometers (0.25 [0.17, 0.34]), compared with medium (0.18 [0.09, 0.27]) and low impacts (0.13 [0.07,0.19]) (beta coefficient, with 95 % CI). Likewise in MAC, reported moderate-high-impact activities showed a stronger association with higher impacts (0.26 [0.14, 0.37]), compared with medium (0.14 [0.05, 0.22]) and low impacts (0.03 [-0.02, 0.08]). Our new accelerometer method appears to provide valid measures of higher vertical impacts in older adults. Results obtained from the three population-based cohorts indicate that older adults generally experience very limited higher impact weight-bearing PA.

A healthy aging program for older adults: effects on self-efficacy and morale.

PubMed

Scult, Matthew; Haime, Vivian; Jacquart, Jolene; Takahashi, Jonathan; Moscowitz, Barbara; Webster, Ann; Denninger, John W; Mehta, Darshan H

2015-01-01

As of 2012, 810 million people worldwide were older than 60 y, accounting for 11% of the population. That number is expected to rise to 2 billion by 2050 or to 22% of the overall population. As a result, a growing need exists to understand the factors that promote mental and physical health in older populations. The purpose of this study was to develop a healthy aging program for older adults and to measure the changes from baseline to the end of the program in participants' relevant psychosocial outcomes (ie, self-efficacy and morale). The study's healthy aging mind-body intervention (MBI) was adapted from the Relaxation Response Resiliency Program (3RP) at the Benson-Henry Institute for Mind Body Medicine, which incorporates elements from the fields of stress management, cognitive behavioral therapy, and positive psychology. That program was modified with examples and exercises targeted to an older population and evaluated in the current single-arm pilot study. The program took place at the Massachusetts General Hospital (MGH). The 9-wk healthy aging MBI was developed for participants aged 65 y and older. Fifty-one older adults from the surrounding community participated in the study's groups. A new intervention group began the program every 3 mo, with a maximum of 12 individuals per group. For each group, the MBI consisted of weekly 90-min sessions for 9 consecutive wk, directed by a psychologist. The program included sessions that taught participants (1) a variety of methods to elicit the relaxation response (RR), (2) the practice of adaptive coping and cognitions, (3) behaviors necessary to create a healthy lifestyle, and (4) methods of building social support. The research team chose to focus on 2 psychological variables of interest for aging populations: morale and self-efficacy. The study used 2 questionnaires to measure those outcomes, the Philadelphia Geriatric Center Morale Scale (PGCMS), a multidimensional measure of the psychological state of older people, and the Coping Self-efficacy Scale (CSES), a measure that addresses the multiple dimensions of self-efficacy. Data from 5 intervention groups were combined for the current analysis. Forty-six participants enrolled and completed questionnaires. Of those participants, 41 attended at least 7 of the 9 sessions. Significant increases in self-efficacy and morale were observed for program completers. After a highly conservative sensitivity analysis, the change for the measure of self-efficacy remained significant, and the change for the measure of morale trended toward significance. The study's healthy aging program appears to be a feasible intervention for older adults, with the potential to increase levels of self-efficacy and morale in participants. Further research is warranted to determine its effects on other psychosocial outcomes and health care utilization in aging populations.

Social Engagement Among U.S. Chinese Older Adults—Findings From the PINE Study

PubMed Central

Li, Yu; Simon, Melissa A.

2014-01-01

Background. Social engagement is a key indicator of older adults’ later life quality and health status, but few studies have comprehensively examined social engagement patterns of U.S. Chinese older adults. This study assesses social engagement patterns among U.S. Chinese older adults. Methods. Data were collected by the Population Study of Chinese Elderly project, a cross-sectional population-based study of 3,159U.S. Chinese older adults aged 60 and older in the greater Chicago area. Social engagement patterns were examined with a list of 16 social engagement activity related questions. Analysis of variance and Pearson or Spearman correlation coefficients were used to examine correlations between sociodemographic and health characteristics and social engagement. Results. Age was negatively associated with social engagement actives for Chinese older adults. Although education had a significant positive correlation on older adults’ participation in social engagement activities, income did not show any significant correlation. Perceived health status and quality of life were also positively correlated with social engagement. Chinese older adults were more likely to visit community centers than any other social or cultural venues. Conclusions. This study highlights the important role community centers play in the lives of Chinese older adults. Further, longitudinal studies are also necessary to understand the predictors and outcomes of social engagement levels among Chinese older adults. PMID:25378453

Chamomile Consumption and Mortality: A Prospective Study of Mexican Origin Older Adults

PubMed Central

Howrey, Bret T.; Peek, M. Kristen; McKee, Juliet M.; Raji, Mukaila A.; Ottenbacher, Kenneth J.; Markides, Kyriakos S.

2016-01-01

Purpose: Approximately 20% of adults use some kind of herbal; however, little data exists from population-based study or clinical trials to support effectiveness of most herbal products. Chamomile is a commonly used herb among older adults of Mexican origin. We examined the effects of herbal chamomile consumption on mortality among older adults of Mexican origin. Methods and Design. A sample from the Hispanic Established Populations for Epidemiologic Study of the Elderly, a population-based study of noninstitutionalized Mexican Americans aged 65 and older from five Southwestern states (Texas, California, New Mexico, Colorado, and Arizona). We included all men and women from 2000 to 2007 (n = 1,677). Results. Chamomile was used by 14% of the sample. Cox proportional hazards regression analyses showed that chamomile was associated with a decreased risk of mortality in the total sample (hazard ratio [HR] 0.71, 95% confidence interval [CI] 0.55–0.92) and for women (HR 0.67, 95% CI 0.49–0.92) but not for men. In models adjusted for sociodemographic variables, health behaviors, and chronic conditions, chamomile remained significantly associated with reduced mortality in women (HR 0.72, 95% CI 0.53–0.98). Implications. The use of chamomile shows protective effects against mortality in this sample of older adults of Mexican origin for women. Further research is warranted in other populations to determine if these effects are consistent. PMID:26035879

Walking and the Preservation of Cognitive Function in Older Populations

ERIC Educational Resources Information Center

Prohaska, Thomas R.; Eisenstein, Amy R.; Satariano, William A.; Hunter, Rebecca; Bayles, Constance M.; Kurtovich, Elaine; Kealey, Melissa; Ivey, Susan L.

2009-01-01

Purpose: This cross-sectional study takes a unique look at the association between patterns of walking and cognitive functioning by examining whether older adults with mild cognitive impairment differ in terms of the community settings where they walk and the frequency, intensity, or duration of walking. Design and Methods: The sample was based on…

Birth Outcomes among Older Mothers in Rural versus Urban Areas: A Residence-Based Approach

ERIC Educational Resources Information Center

Lisonkova, Sarka; Sheps, Samuel B.; Janssen, Patricia A.; Lee, Shoo K.; Dahlgren, Leanne; MacNab, Ying C.

2011-01-01

Purpose: We examined the association between rural residence and birth outcomes in older mothers, the effect of parity on this association, and the trend in adverse birth outcomes in relation to the distance to the nearest hospital with cesarean-section capacity. Methods: A population-based retrospective cohort study, including all singleton…

Experience of elder abuse among older Korean immigrants.

PubMed

Chang, Miya

2016-01-01

Studies on the scope and nature of Asian American elder abuse conducted with older immigrants are extremely limited. The overall purpose of this study was to examine the extent and type of elder abuse among older Korean immigrants, and to investigate critical predictors of elder abuse in this population. The sample consisted of 200 older Korean immigrants aged 60 to 90 years who resided in Los Angeles County in 2008. One of the key findings indicated that 58.3% of respondents experienced one or more types of elder abuse. Logistic regression indicated that the victims' health status and educational level were statistically significant predictors of the likelihood of experiencing abuse. The present study, although limited in sample size, measures, sampling methods, and population representation, has contributed to this important area of knowledge. It is recommended that future studies conduct research on elder abuse with more representative national samples that can measure the extent of abuse and neglect more accurately.

Struggling for existence—Life situation experiences of older persons with mental disorders

PubMed Central

Fagerberg, Ingegerd; Lindholm, Christina; Wiklund-Gustin, Lena

2012-01-01

Older persons with mental disorders represent a vulnerable group of people with extensive and complex needs. The older population is rapidly increasing worldwide and, as a result of deinstitutionalization in mental health care, older persons are remaining at home to a greater extent. Although they constitute a large proportion of the population, older persons with mental disorders have been neglected in research as well as in care organizations. As there is little previous knowledge concerning older persons’ experiences of their own situations, this study aimed to illuminate the meaning of the life situation as experienced by older persons with mental disorders (excluding dementia disorders). Interviews were conducted with seven older persons and the text was analyzed using a phenomenological hermeneutical research method, inspired by the philosophy of Paul Ricoeur. “Struggling for existence” emerged as a main theme in the older persons’ narratives, understood as a loss of dignity of identity and involving being troubled and powerless as well as yearning for respect. The older persons fought to master their existence and to be seen for who they are. The study highlights the importance for caregivers, both formal and informal, to avoid focusing on the diagnoses and rather acknowledge the older persons and their lifeworld, be present in the relation and help them rebuild their dignity of identity. This study brings a new understanding about older persons with mental disorders that may help reduce stigma and contribute to planning future mental health care. PMID:22693537

A Lead User Approach to Universal Design - Involving Older Adults in the Design Process.

PubMed

Raviselvam, Sujithra; Wood, Kristin L; Hölttä-Otto, Katja; Tam, Victoria; Nagarajan, Kamya

2016-01-01

The concept of Universal Design has received increasing appreciation over the past two decades. Yet, there are very few existing designs that cater to the needs of extraordinary users who experience some form of physical challenge. Previous work has shown promising results on involving users with physical challenges as lead users - users who have the potential to identify needs that could be latent among the general population. It has also been shown that older adults can act as such lead users. They can help design universal product ideas that satisfy both older adults and the general population. In this paper we build on this and examine if involving older adults in the design phase can result in universal products, products preferred by both older adults and the general population over a current option. Eighty-nine older adult participants and thirty-four general population participants took part in the study. Products were redesigned and prototyped based on the needs of older adults and tested among both populations. Results show that, although older adults and the general population did share certain needs and demands, the majority of older adults had needs and demands that were different from those of the general population. However, even though the needs differed between the populations, on average 89% of the general population participants preferred products designed based on design needs expressed by older adults over the current option. This provides further evidence supporting the use of older adults in designing products for all.

Depression, disability and functional status among community dwelling older adults in South Africa: Evidence from the first South African National Income Dynamics Study

PubMed Central

Tomita, Andrew; Burns, Jonathan K

2013-01-01

Objectives This study examined the relationship between depression and functional status among a community-dwelling elderly population of 65 years and older in South Africa. Method Data from the first wave of the South African National Income Dynamics Study (SA-NIDS) was used, this being the first longitudinal panel survey of a nationally representative sample of households. The study focused on the data for resident adults 65 years and older (n=1,429). Depression was assessed using the 10-item version of the Center for Epidemiologic Studies Depression Scale (CES-D). Functional status, pertaining to both difficulty and dependency in activities of daily living (ADL), instrumental activities of daily living (IADL), and physical functioning and mobility (PFM), were assessed using 11 items. Results Functional challenges were generally higher in the older age group. There was a significant association between depression and functional dependency in ADL (adjusted OR=2.57 [CI: 1.03-6.41]), IADL (adjusted OR=2.76 [CI: 1.89-4.04]) and PFM (adjusted OR=1.66 [CI: 1.18-2.33]) but the relationship between depression and functional status, particularly PFM, appeared weaker in older age. Conclusion The relationship between depression symptoms and function is complex. Functional characteristics between older and younger older populations are diverse, and caution is indicated against overgeneralizing the challenges related to depression and function among this target population. PMID:23512338

Odor Detection Thresholds in a Population of Older Adults

PubMed Central

Schubert, Carla R.; Fischer, Mary E.; Pinto, A. Alex; Klein, Barbara E.K.; Klein, Ronald; Cruickshanks, Karen J.

2016-01-01

OBJECTIVE To measure odor detection thresholds and associated nasal and behavioral factors in an older adult population. STUDY DESIGN Cross-sectional cohort study METHODS Odor detection thresholds were obtained using an automated olfactometer on 832 participants, aged 68–99 (mean age 77) years in the 21-year (2013–2016) follow-up visit of the Epidemiology of Hearing Loss Study. RESULTS The mean odor detection threshold (ODT) score was 8.2 (range: 1–13; standard deviation = 2.54), corresponding to a n-butanol concentration of slightly less than 0.03%. Older participants were significantly more likely to have lower (worse) ODT scores than younger participants (p<0.001). There were no significant differences in mean ODT scores between men and women. Older age was significantly associated with worse performance in multivariable regression models and exercising at least once a week was associated with a reduced odds of having a low (≤5) ODT score. Cognitive impairment was also associated with poor performance while a history of allergies or a deviated septum were associated with better performance. CONCLUSION Odor detection threshold scores were worse in older age groups but similar between men and women in this large population of older adults. Regular exercise was associated with better odor detection thresholds adding to the evidence that decline in olfactory function with age may be partly preventable. PMID:28000220

Comparison of Well-being of Older Adult Choir Singers and the General Population in Finland: A Case-Control Study.

PubMed

Johnson, Julene K; Louhivuori, Jukka; Siljander, Eero

2017-06-01

Previous research suggests that singing in a choir as an older adult is associated with better quality of life (QOL). However, the degree to which sociodemographic variables and level of engagement in hobbies contribute to this relationship is largely unknown. The aim of the study was to compare quality of life (QOL) of older adult choir singers with a matched sample of older adults from the general population in Finland, taking into consideration sociodemographic, satisfaction with health, and level of engagement in hobbies (active, inactive). Case-control methods were used to match a sample of 109 older adult singers with a sample of 307 older adults from the general population. Tobit regression analysis with sociodemographic covariates was used to explore observed group differences in QOL as measured by two WHOQOL-Bref domains (psychological and physical). Probit regression analysis was used to examine the effect of sociodemographic variables and engagement in hobbies and on overall QOL and satisfaction with health. As expected, sociodemographic variables were strongly associated with physical and psychological QOL. After controlling for sociodemographic variables, the older choir singers reported significantly higher ratings on physical QOL, but not psychological QOL, compared to matched controls. Additional adjustment for satisfaction for health attenuated the results. When considering level of engagement in hobbies, older adult choir singers reported significantly higher overall QOL and satisfaction with health when compared to either controls who were either actively engaged in hobbies or not active in hobbies. These results suggest that singing in a choir as an older adult may promote well-being, even after accounting for sociodemographic and level of engagement in hobbies.

Comparison of Well-being of Older Adult Choir Singers and the General Population in Finland: A Case-Control Study

PubMed Central

Johnson, Julene K; Louhivuori, Jukka; Siljander, Eero

2017-01-01

Previous research suggests that singing in a choir as an older adult is associated with better quality of life (QOL). However, the degree to which sociodemographic variables and level of engagement in hobbies contribute to this relationship is largely unknown. The aim of the study was to compare quality of life (QOL) of older adult choir singers with a matched sample of older adults from the general population in Finland, taking into consideration sociodemographic, satisfaction with health, and level of engagement in hobbies (active, inactive). Case-control methods were used to match a sample of 109 older adult singers with a sample of 307 older adults from the general population. Tobit regression analysis with sociodemographic covariates was used to explore observed group differences in QOL as measured by two WHOQOL-Bref domains (psychological and physical). Probit regression analysis was used to examine the effect of sociodemographic variables and engagement in hobbies and on overall QOL and satisfaction with health. As expected, sociodemographic variables were strongly associated with physical and psychological QOL. After controlling for sociodemographic variables, the older choir singers reported significantly higher ratings on physical QOL, but not psychological QOL, compared to matched controls. Additional adjustment for satisfaction for health attenuated the results. When considering level of engagement in hobbies, older adult choir singers reported significantly higher overall QOL and satisfaction with health when compared to either controls who were either actively engaged in hobbies or not active in hobbies. These results suggest that singing in a choir as an older adult may promote well-being, even after accounting for sociodemographic and level of engagement in hobbies. PMID:28736492

Redefining Racial Residential Segregation and its Association With Physical Activity Among African Americans 50 years and Older: A Mixed Methods Approach

PubMed Central

Armstrong-Brown, Janelle; Eng, Eugenia; Hammond, Wizdom Powell; Zimmer, Catherine; Bowling, J. Michael

2016-01-01

Physical inactivity is one of the factors contributing to disproportionate disease rates among older African Americans. Previous literature indicates that older African Americans are more likely to live in racially segregated neighborhoods and that racial residential segregation is associated with limited opportunities for physical activity. A cross-sectional mixed methods study was conducted guided by the concept of therapeutic landscapes. Multilevel regression analyses demonstrated that racial residential segregation was associated with more minutes of physical activity and greater odds of meeting physical activity recommendations. Qualitative interviews revealed the following physical activity related themes: aging of the neighborhood, knowing your neighbors, feeling of safety, and neighborhood racial identity. Perceptions of social cohesion enhanced participants’ physical activity, offering a plausible explanation to the higher rates of physical activity found in this population. Understanding how social cohesion operates within racially segregated neighborhoods can help to inform the design of effective interventions for this population. PMID:24812201

City Governments and Aging in Place: Community Design, Transportation and Housing Innovation Adoption

PubMed Central

Lehning, Amanda J.

2012-01-01

Purpose of the study: To examine the characteristics associated with city government adoption of community design, housing, and transportation innovations that could benefit older adults. Design and methods: A mixed-methods study with quantitative data collected via online surveys from 62 city planners combined with qualitative data collected via telephone interviews with a subsample of 18 survey respondents. Results: Results indicate that advocacy is an effective strategy to encourage city government adoption of these innovations. Percent of the population with a disability was positively associated, whereas percent of the population aged 65 and older was not associated or negatively associated, with innovation adoption in the regression models. Qualitative interviews suggest that younger individuals with disabilities are more active in local advocacy efforts. Implications: Results suggest that successful advocacy strategies for local government adoption include facilitating the involvement of older residents, targeting key decision makers within government, emphasizing the financial benefits to the city, and focusing on cities whose aging residents are vulnerable to disease and disability. PMID:21900505

The care of and communication with older people from the perspective of student nurses. A mixed method study.

PubMed

Hammar, Lena Marmstål; Holmström, Inger K; Skoglund, Karin; Meranius, Martina Summer; Sundler, Annelie J

2017-05-01

Undergraduate nurse education needs to prepare student nurses to meet the demands and to have the necessary communication skills for caring for an increasing older population. The challenges involve how best to support and empower student nurses to learn the communication skills needed to care for older people. The aim of this study was to investigate student nurses' views on the care of and communication with older people. A descriptive study with a mixed-method approach was conducted. Quantitative and qualitative data were collected from a questionnaire completed by third-year Swedish student nurses in 2015. The student nurses reported positive attitudes to the care of and communication with older people. The findings focus on the central aspects related to relationship building, techniques for communication and external prerequisites. Despite positive attitudes, student nurses had a limited view of communication with older people. Educators need to increase student nurses' capacity to communicate effectively with older people. Educational interventions to improve and evaluate the communication competency of nurses and student nurses are needed. Copyright © 2017 Elsevier Ltd. All rights reserved.

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

ERIC Educational Resources Information Center

Stewart, Susan T.

2004-01-01

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

The Association of Health and Functional Status with Private and Public Religious Practice among Rural, Ethnically Diverse, Older Adults with Diabetes

ERIC Educational Resources Information Center

Arcury, Thomas A.; Stafford, Jeanette M.; Bell, Ronny A.; Golden, Shannon L.; Snively, Beverly M.; Quandt, Sara A.

2007-01-01

Purpose: This analysis describes the association of health and functional status with private and public religious practice among ethnically diverse (African American, Native American, white) rural older adults with diabetes. Methods: Data were collected using a population-based, cross-sectional, stratified, random sample survey of 701…

Late-life Depression in Older African Americans: A Comprehensive Review of Epidemiological and Clinical Data

PubMed Central

Pickett, Yolonda R.; Bazelais, Kisha N.; Bruce, Martha L.

2013-01-01

Objective The population of older African Americans is expected to triple by 2050, highlighting the public health importance of understanding their mental health needs. Despite evidence of the negative impact of late-life depression, less is known of how this disorder affects the lives of older African Americans. Lack of studies focusing on how depression presents in older African Americans and their subsequent treatment needs lead to a gap in epidemiologic and clinical knowledge for this population. In this review, we aim to present a concise report of prevalence, correlates, course, outcomes, symptom recognition, and treatment of depression for these individuals. Method We performed a literature review of English-language articles identified from PubMed and Medline published between January 1990 and June 2012. Studies included older adults and contained the key words “geriatric depression in African Americans,” “geriatric depression in Blacks,” and geriatric depression in minorities.” Results Although in most studies older African Americans had higher or equivalence prevalence of depression compared to Caucasian Americans, we also found lower rates of recognition of depression and treatment. Many studies reported worse outcomes associated for depression among older African Americans compared older Caucasians. Conclusions Serious racial and ethnic disparities persist in the management of older African Americans with depression. Understanding their unmet needs and improving depression care for these individuals is necessary to reduce these disparities. PMID:23225736

Advancing the science of recruitment and retention of ethnically diverse populations.

PubMed

Nápoles, Anna M; Chadiha, Letha A

2011-06-01

We highlight several critical challenges that must be addressed to accelerate the advancement of the science on recruitment and retention of ethnically diverse older adults into health research. These include the relative lack of attention by researchers to methodological issues related to recruitment and retention of ethnically diverse populations and the inadequacy of funding to advance systematically this field. We describe strategies used by the Resource Centers on Minority Aging Research and other National Institute of Aging-funded programs to advance the science of recruitment of ethnically diverse older adults. Finally, we propose a set of broad recommendations designed to generate a body of evidence on successful methods of recruitment and retention of ethnically diverse populations in health research. To eliminate health disparities and better understand aging processes in ethnically diverse populations, much more research is needed on effective strategies for increasing minority enrollment in health research. Comparative effectiveness research on more intensive recruitment and retention methods, which are often needed for including diverse populations, will require dedicated funding and concerted efforts by investigators.

Older People's Experiences of Mobility and Mood in an Urban Environment: A Mixed Methods Approach Using Electroencephalography (EEG) and Interviews.

PubMed

Tilley, Sara; Neale, Chris; Patuano, Agnès; Cinderby, Steve

2017-02-04

There are concerns about mental wellbeing in later life in older people as the global population becomes older and more urbanised. Mobility in the built environment has a role to play in improving quality of life and wellbeing, as it facilitates independence and social interaction. Recent studies using neuroimaging methods in environmental psychology research have shown that different types of urban environments may be associated with distinctive patterns of brain activity, suggesting that we interact differently with varying environments. This paper reports on research that explores older people's responses to urban places and their mobility in and around the built environment. The project aim was to understand how older people experience different urban environments using a mixed methods approach including electroencephalography (EEG), self-reported measures, and interview results. We found that older participants experience changing levels of "excitement", "engagement" and "frustration" (as interpreted by proprietary EEG software) whilst walking between a busy built urban environment and an urban green space environment. These changes were further reflected in the qualitative themes that emerged from transcribed interviews undertaken one week post-walk. There has been no research to date that has directly assessed neural responses to an urban environment combined with qualitative interview analysis. A synergy of methods offers a deeper understanding of the changing moods of older people across time whilst walking in city settings.

Strategies for Preventing Cognitive Decline in Healthy Older Adults

PubMed Central

2017-01-01

Objective: Many advances have been made in the understanding of age-related changes in cognition. As research details the cognitive and neurobiological changes that occur in aging, there is increased interest in developing and understanding methods to prevent, slow, or reverse the cognitive decline that may occur in normal healthy older adults. The Institute of Medicine has recently recognized cognitive aging as having important financial and public health implications for society with the increasing older adult population worldwide. Cognitive aging is not dementia and does not result in the loss of neurons but rather changes in neurotransmission that affect brain functioning. The fact that neurons are structurally intact but may be functionally affected by increased age implies that there is potential for remediation. Method and Results: This review article presents recent work using medication-based strategies for slowing cognitive changes in aging. The primary method presented is a hormonal approach for affecting cognition in older women. In addition, a summary of the work examining modifiable lifestyle factors that have shown promise in benefiting cognition in both older men and women is described. Conclusions: Much work remains to be done so that evidence-based recommendations can be made for slowing cognitive decline in healthy older adults. The success of some of these methods thus far indicates that the brains of healthy older adults are plastic enough to be able to respond to these cognitive decline prevention strategies, and further work is needed to define the most beneficial methods. PMID:28703016

Access to transportation for Chittenden County Vermont older adults.

PubMed

Hadley Strout, Emily; Fox, Leah; Castro, Alejandro; Haroun, Pishoy; Leavitt, Blake; Ross, Cordelia; Sayan, Mutlay; Delaney, Thomas; Platzer, Alyson; Hutchins, Jeanne; Carney, Jan K

2016-08-01

Aging often leads to decreased independence and mobility, which can be detrimental to health and well-being. The growing population of older adults will create a greater need for reliable transportation. Explore whether and how lack of transportation has compromised areas of daily lives in older adults. 1221 surveys with 36 questions assessing transportation access, usage, and impact on activities were distributed to Chittenden County, Vermont older adults; 252 met criteria for analysis. Older adults reported overwhelming difficulty getting to activities considered important, with 69 % of participants delaying medical appointments due to transportation barriers. Although family and friends represent a primary method of transportation, older adults reported difficulty asking them for help. Lack of accessible transportation leads to missed healthcare appointments and social isolation, which may have detrimental effects on older adults' quality of life. Many older adults face significant transportation challenges that negatively affect their health and well-being.

Reducing the Digital Divide: Connecting Older Adults to iPad Technology.

PubMed

Delello, Julie A; McWhorter, Rochell R

2017-01-01

America's older adult population is increasing at a dramatic rate due to better health care, technology, and improved living conditions. However, as individuals 65 years and older begin to live longer and experience multiple life changes, there is a larger incidence of social isolation leading to loneliness, depression, and a general decline in health. This mixed-method study aimed to explore whether information and communication technologies, specifically iPads, improved the lives of older adults. Our findings suggest that the use of technology increased knowledge, elicited closer family ties, and led to a greater overall connection to society. © The Author(s) 2015.

A Wii Bit of Fun: A Novel Platform to Deliver Effective Balance Training to Older Adults.

PubMed

Whyatt, Caroline; Merriman, Niamh A; Young, William R; Newell, Fiona N; Craig, Cathy

2015-12-01

Falls and fall-related injuries are symptomatic of an aging population. This study aimed to design, develop, and deliver a novel method of balance training, using an interactive game-based system to promote engagement, with the inclusion of older adults at both high and low risk of experiencing a fall. Eighty-two older adults (65 years of age and older) were recruited from sheltered accommodation and local activity groups. Forty volunteers were randomly selected and received 5 weeks of balance game training (5 males, 35 females; mean, 77.18 ± 6.59 years), whereas the remaining control participants recorded levels of physical activity (20 males, 22 females; mean, 76.62 ± 7.28 years). The effect of balance game training was measured on levels of functional balance and balance confidence in individuals with and without quantifiable balance impairments. Balance game training had a significant effect on levels of functional balance and balance confidence (P < 0.05). This was further demonstrated in participants who were deemed at high risk of falls. The overall pattern of results suggests the training program is effective and suitable for individuals at all levels of ability and may therefore play a role in reducing the risk of falls. Commercial hardware can be modified to deliver engaging methods of effective balance assessment and training for the older population.

Physical Function Assessment in a Community-Dwelling Population of U.S. Chinese Older Adults

PubMed Central

Chang, E-Shien; Simon, Melissa A.

2014-01-01

Background. This report describes the levels of physical function in U.S. Chinese older adults utilizing self-reported and performance-based measures, and examines the association between sociodemographic characteristics and physical function. Methods. The Population Study of Chinese Elderly in Chicago enrolled an epidemiological cohort of 3,159 community-dwelling Chinese older adults aged 60 and older. We collected self-reported physical function using Katz activities of daily living and Lawton instrumental activities of daily living items, the Index of Mobility scale, and the Index of Basic Physical Activities scale. Participants were also asked to perform tasks in chair stand, tandem stand, and timed walk. We computed Pearson and Spearman correlation coefficients to examine the correlation between sociodemographic and physical function variables. Results. A total of 7.8% of study participants experienced activities of daily living impairment, and 50.2% experienced instrumental activities of daily living impairment. With respect to physical performance testing, 11.4% of the participants were not able to complete chair stand for five times, 8.5% of the participants were unable to do chair stands at all. Older age, female gender, lower education level, being unmarried, living with fewer people in the same household, having fewer children, living fewer years in the United States, living fewer years in the community, and worsening health status were significantly correlated with lower levels of physical function. Conclusions. Utilizing self-reported and performance-based measures of physical function in a large population-based study of U.S. Chinese older adults, our findings expand current understanding of minority older adults’ functional status. PMID:25378446

Perceived Income Adequacy among Older Adults in 12 Countries: Findings from the Survey of Health, Ageing, and Retirement in Europe

ERIC Educational Resources Information Center

Litwin, Howard; Sapir, Eliyahu V.

2009-01-01

Purpose: To validate a survey research measure of subjective income, as measured by perceived income adequacy, in an international context. Design and Methods: The study population comprised persons aged 50 years and older in 12 countries from the Survey of Health, Ageing and Retirement in Europe (n = 28,939). Perceived difficulty in making ends…

Group discussions with structured reminiscence and a problem-based method as an intervention to prevent depressive symptoms in older people.

PubMed

Djukanović, Ingrid; Carlsson, Jörg; Peterson, Ulla

2016-04-01

To evaluate the effect of group discussions, in which structured reminiscence and a problem-based method were used, on depressive symptoms, quality of life and self-rated health among older people. Depressive symptoms in older people have a considerable impact on self-rated health and quality of life, with a high rate of co-morbidity and mortality. As the ageing population is growing, late-life depression is becoming an important public health problem and there is a need to find preventive interventions to avert unnecessary suffering. The study was quasi-experimental, with a one-group pretest-post-test design and follow-up after one year. Initially, a questionnaire was sent to the total population of 55-80-year-old retirees in a community in the northeast of Sweden, (n = 679). The questionnaire concerned demographics and covered areas such as health, depression and quality of life. The intervention consisted of group discussions where structured reminiscence and a problem-based method were used. The participants (n = 18) met 10 times under the guidance of a group-leader, a registered nurse educated in the method. Each session had different themes with a focus on positive memories but also on the present situation and the future. Parametric, nonparametric tests and content analysis were used. Participants evaluated the intervention positively, showed a decrease in depressive symptoms, an increase in self-rated health and experienced an increased autonomy. No long- lasting effect was seen. Group discussions where structured reminiscence and a problem-based method are used might be an option to prevent depressive symptoms in older people. This method might provide an opportunity for older people with depressive symptoms to improve their quality of life, however, to maintain the positive outcome the intervention should probably be continuous. © 2016 John Wiley & Sons Ltd.

Self-care in older adults with heart failure: an integrative review.

PubMed

Zavertnik, Jean Ellen

2014-01-01

The aims of this integrative review were to examine the evidence specific to self-care in older adults, 65 years or older, with heart failure and to indicate best nursing practice interventions for use in this population. Self-care is a complex set of activities involving self-care maintenance and self-care management. Age-related and psychosocial factors impact older patients' ability to engage effectively in self-care practices. Although self-care processes are the focus of the investigation, few studies provide implications specific for the older adult population. Limited research on heart failure self-care in the older adult meets the age criterion of 65 years or older. A comprehensive search of the literature was performed using Medline, CINAHL, and the Cochrane Library, as well as an ancestry approach of reference lists of selected studies. Eligible studies were randomized controlled trial, qualitative, quantitative, and mixed-method design studies on older adults with heart failure related to self-care for the years 2002-2012. Three themes of self-care were noted in the selected studies: patient-related factors, patient education, and telemonitoring. The patient-related factors identified were barriers to self-care such as age-related symptoms, cognitive factors, and social issues. The interventions promoting self-care were patient education (self-care knowledge) and telemonitoring (augmenting symptom recognition). Patient education tailored to older adults may be beneficial. Telemonitoring is an appropriate self-care enhancement tool for selected older adults. More emphasis needs to be placed on interventions to assist older adults with heart failure in symptom recognition and early notification of healthcare providers. As the population ages, a need for evidence-based care for older adults with heart failure is warranted. Heart failure self-care interventions do not address the special considerations of the older heart failure patient. To determine the best approaches for promoting effective self-care, older adults with heart failure need to be studied as a cohort. Older adults with heart failure face many challenges engaging in self-care practices. These older adults need individualized self-care instructions and home care follow-up. Identifying special needs of the patient, such as sensory or cognitive impairment, is necessary when providing instructions and follow-up care for the older adult.

Mortality inequality in populations with equal life expectancy: Arriaga's decomposition method in SAS, Stata, and Excel.

PubMed

Auger, Nathalie; Feuillet, Pascaline; Martel, Sylvie; Lo, Ernest; Barry, Amadou D; Harper, Sam

2014-08-01

Life expectancy is used to measure population health, but large differences in mortality can be masked even when there is no life expectancy gap. We demonstrate how Arriaga's decomposition method can be used to assess inequality in mortality between populations with near equal life expectancy. We calculated life expectancy at birth for Quebec and the rest of Canada from 2005 to 2009 using life tables and partitioned the gap between both populations into age and cause-specific components using Arriaga's method. The life expectancy gap between Quebec and Canada was negligible (<0.1 years). Decomposition of the gap showed that higher lung cancer mortality in Quebec was offset by cardiovascular mortality in the rest of Canada, resulting in identical life expectancy in both groups. Lung cancer in Quebec had a greater impact at early ages, whereas cardiovascular mortality in Canada had a greater impact at older ages. Despite the absence of a gap, we demonstrate using decomposition analyses how lung cancer at early ages lowered life expectancy in Quebec, whereas cardiovascular causes at older ages lowered life expectancy in Canada. We provide SAS/Stata code and an Excel spreadsheeet to facilitate application of Arriaga's method to other settings. Copyright © 2014 Elsevier Inc. All rights reserved.

Survival Differences among Native-Born and Foreign-Born Older Adults in the United States

PubMed Central

Dupre, Matthew E.; Gu, Danan; Vaupel, James W.

2012-01-01

Background Studies show that the U.S. foreign-born population has lower mortality than the native-born population before age 65. Until recently, the lack of data prohibited reliable comparisons of U.S. mortality by nativity at older ages. This study provides reliable estimates of U.S. foreign-born and native-born mortality at ages 65 and older at the end of the 20th century. Life expectancies of the U.S. foreign born are compared to other developed nations and the foreign-born contribution to total life expectancy (TLE) in the United States is assessed. Methods Newly available data from Medicare Part B records linked with Social Security Administration files are used to estimate period life tables for nearly all U.S. adults aged 65 and older in 1995. Age-specific survival differences and life expectancies are examined in 1995 by sex, race, and place of birth. Results Foreign-born men and women had lower mortality at almost every age from 65 to 100 compared to native-born men and women. Survival differences by nativity were substantially greater for blacks than whites. Foreign-born blacks had the longest life expectancy of all population groups (18.73 [95% confidence interval {CI}, 18.15–19.30] years at age 65 for men and 22.76 [95% CI, 22.28–23.23] years at age 65 for women). The foreign-born population increased TLE in the United States at older ages, and by international comparison, the U.S. foreign born were among the longest-lived persons in the world. Conclusion Survival estimates based on reliable Medicare data confirm that foreign-born adults have longer life expectancy at older ages than native-born adults in the United States. PMID:22615929

The rural bite in population pyramids: what are the implications for responsiveness of health systems in middle income countries?

PubMed Central

2014-01-01

Background Health services can only be responsive if they are designed to service the needs of the population at hand. In many low and middle income countries, the rate of urbanisation can leave the profile of the rural population quite different from the urban population. As a consequence, the kinds of services required for an urban population may be quite different from that required for a rural population. This is examined using data from the South East Asia Community Observatory in rural Malaysia and contrasting it with the national Malaysia population profile. Methods Census data were collected from 10,373 household and the sex and age of household members was recorded. Approximate Malaysian national age and sex profiles were downloaded from the US Census Bureau. The population pyramids, and the dependency and support ratios for the whole population and the SEACO sub-district population are compared. Results Based on the population profiles and the dependency ratios, the rural sub-district shows need for health services in the under 14 age group similar to that required nationally. In the older age group, however, the rural sub-district shows twice the need for services as the national data indicate. Conclusion The health services needs of an older population will tend towards chronic conditions, rather than the typically acute conditions of childhood. The relatively greater number of older people in the rural population suggest a very different health services mix need. Community based population monitoring provides critical information to inform health systems. PMID:25081203

Safety from Crime and Physical Activity among Older Adults: A Population-Based Study in Brazil

PubMed Central

Weber Corseuil, Maruí; Hallal, Pedro Curi; Xavier Corseuil, Herton; Jayce Ceola Schneider, Ione; d'Orsi, Eleonora

2012-01-01

Objective. To evaluate the association between safety from crime and physical activity among older adults. Methods. A population-based survey including 1,656 older adults (60+ years) took place in Florianopolis, Brazil, in 2009-2010. Commuting and leisure time physical activity were assessed through the long version of the International Physical Activity Questionnaire. Perception of safety from crime was assessed using the Neighbourhood Environment Walkability Scale. Results. Perceiving the neighbourhood as safe during the day was related to a 25% increased likelihood of being active in leisure time (95% CI 1.02–1.53); general perception of safety was also associated with a 25% increase in the likelihood of being active in leisure time (95% CI 1.01–1.54). Street lighting was related to higher levels of commuting physical activity (prevalence ratio: 1.89; 95% CI 1.28–2.80). Conclusions. Safety investments are essential for promoting physical activity among older adults in Brazil. PMID:22291723

LGBT Older Adults and Nurse Administrators: An Opportunity for Advocacy.

PubMed

Thornton, Marleen

One of the greatest health care challenges of the 21st century is the rapidly growing number of older adults in the United States. This aging population is also becoming increasingly diverse, and with this diversity comes an increased number of older adults who identify as lesbian, gay, bisexual, and transgender (LGBT). The needs and health outcomes of this specific subgroup of the older adult population cannot be extrapolated from the more general population of older adults. Nurses have the opportunity to lead health care providers in improving care for this vulnerable and sometimes invisible population. Leading this charge will require nurse executives who advocate, create care environments that are inclusive, and staff with nurses who can care for the specific needs of LGBT older adults. The purpose of this article is to raise awareness of the health needs of LGBT older adults and identify how nurse executives can advocate to improve care for this overlooked population.

Successful ageing in lesbian, gay and bisexual older people: a concept analysis.

PubMed

Caceres, Billy A; Frank, Mayu O

2016-09-01

The aim of this study was to report on an analysis of the concept of successful ageing in lesbian, gay and bisexual older people. Research indicates that lesbian, gay and bisexual older people experience significant health disparities. Yet there is a lack of understanding on what factors contribute to successful ageing in this population. Nursing has lagged behind other disciplines in investigating the health of lesbian, gay and bisexual older people. A concept analysis using Rodgers' evolutionary method. Twenty studies were retrieved by searching PubMed, CINAHL, PsycInfo, EMBASE, Cochrane Library and Scopus for English-language peer-reviewed studies published from January 2004 to March 2014. The antecedents, attributes and consequences of the concept were identified through the Rodgers' method of concept analysis. Attributes included support from families of origin and/or families of choice, access to lesbian, gay, and bisexual-friendly services and crisis competence. Self-realisation of lesbian, gay and bisexual identity (coming out to oneself) and age >50 were identified as antecedents. Three consequences of successful ageing in lesbian, gay and bisexual older people were social engagement, optimism and resilience. Successful ageing in lesbian, gay and bisexual older people is defined as a subjective and multifactorial concept that is characterised by support from families of origin/families of choice, access to lesbian, gay, and bisexual-friendly services and the development of crisis competence skills which impact the ageing experience of LGB individuals. Successful ageing models can provide a roadmap for developing culturally competent interventions to address key healthcare issues present in this population. The nursing profession's multidisciplinary knowledge and competence in providing health promotion makes nurses well positioned to take a leading role in reducing disparities of lesbian, gay and bisexual older people. © 2016 John Wiley & Sons Ltd.

Protein and exercise in the prevention of sarcopenia and aging.

PubMed

Naseeb, Manal A; Volpe, Stella L

2017-04-01

Aging is associated with a progressive decline in skeletal muscle mass and strength. The decline, known as sarcopenia, could lead to physical disability, poor quality of life, and death. In addition, the older population usually experiences age-related muscle changes that affect muscle mass, muscular strength, and functional abilities. The purpose of this review is to describe the role of protein and exercise in slowing the progression of sarcopenia. It will also discuss whether age-related changes can be attenuated by dietary protein and exercise in the older population. This review will also cover one of the possible mechanisms of how dietary protein and exercise are involved in sarcopenia prevention, as well as the available measurement tools. Based on the findings of this review, the adequate amount of protein required for older men and women needs to be revised and likely be higher. Moreover, studies are required to explore some inconclusive findings concerning sarcopenia in the older population. Further research is required to investigate the following: (1) the safety and effectiveness concerning the consumption of 1.4 g of protein/kg of body weight (or more) in this vulnerable population; (2) the effectiveness of amino acid supplementation in reducing progression of sarcopenia over time through longitudinal studies; (3) the preferred source and timing of protein for the older population to maintain muscular strength and attenuate sarcopenia; (4) exercise interventions, especially those of longer duration, in the attenuation of sarcopenia; (5) other types of exercise and their effects on age-related muscle changes; (6) the mechanism of how protein and exercise prevent muscle loss with aging; and (7) determine the best method to diagnose sarcopenia. Copyright © 2017 Elsevier Inc. All rights reserved.

Injury mechanisms, patterns and outcomes of older polytrauma patients—An analysis of the Dutch Trauma Registry

PubMed Central

Reininga, Inge H. F.; Pieske, Oliver; Lefering, Rolf; El Moumni, Mostafa; Wendt, Klaus

2018-01-01

Background Polytrauma patients nowadays tend to be older due to the growth of the elderly population and its improved mobility. The aim of this study was to compare demographics, injury patterns, injury mechanisms and outcomes between younger and older polytrauma patients. Methods Data from polytrauma (ISS≥16) patients between 2009 and 2014 were extracted from the Dutch trauma registry (DTR). Younger (Group A: ages 18–59) and older (Group B: ages ≥60) polytrauma patients were compared. Differences in injury severity, trauma mechanism (only data for the year 2014), vital signs, injury patterns, ICU characteristics and hospital mortality were analyzed. Results Data of 25,304 polytrauma patients were analyzed. The older patients represented 47.8% of the polytrauma population. Trauma mechanism in the older patients was more likely to be a bicycle accident (A: 17%; B: 21%) or a low-energy fall (A: 13%; B: 43%). Younger polytrauma patients were more likely to have the worst scores on the Glasgow coma scale (EMV = 3, A: 20%, B: 13%). However, serious head injuries were seen more often in the older patients (A: 53%; B: 69%). The hospital mortality was doubled for the older polytrauma patients (19.8% vs. 9.6%). Conclusion Elderly are involved more often in polytrauma. Although injury severity did not differ between groups, the older polytrauma patients were at a higher risk of dying than their younger counterparts despite sustaining less high-energy accidents. PMID:29304054

Sharing is caring: The potential of the sharing economy to support aging in place.

PubMed

Miller, Julie; Ward, Carley; Lee, Chaiwoo; D'Ambrosio, Lisa; Coughlin, Joseph

2018-01-24

This article explores innovative applications of sharing economy services that have the potential to support a population aging in place, especially the "oldest old," aged 85 and older, and their caregivers. A mixed-methods study conducted by the MIT AgeLab examined perceptions of and experiences with sharing economy services, ultimately finding opportunities and barriers to use. Thus, although sharing economy services have potential to support aging in place, to do so successfully will require reconstructing how older adults, family caregivers, aging service professionals, gerontology educators, and gerontology students conceptualize and deliver care to an aging population. We suggest examples for gerontology educators to integrate into their classrooms to further cultivate an appreciation among students of multiple approaches to intervention, including those that leverage sharing economy and technology-enabled platforms to support older adults and their caregivers.

Older People’s Experiences of Mobility and Mood in an Urban Environment: A Mixed Methods Approach Using Electroencephalography (EEG) and Interviews

PubMed Central

Tilley, Sara; Neale, Chris; Patuano, Agnès; Cinderby, Steve

2017-01-01

There are concerns about mental wellbeing in later life in older people as the global population becomes older and more urbanised. Mobility in the built environment has a role to play in improving quality of life and wellbeing, as it facilitates independence and social interaction. Recent studies using neuroimaging methods in environmental psychology research have shown that different types of urban environments may be associated with distinctive patterns of brain activity, suggesting that we interact differently with varying environments. This paper reports on research that explores older people’s responses to urban places and their mobility in and around the built environment. The project aim was to understand how older people experience different urban environments using a mixed methods approach including electroencephalography (EEG), self-reported measures, and interview results. We found that older participants experience changing levels of “excitement”, “engagement” and “frustration” (as interpreted by proprietary EEG software) whilst walking between a busy built urban environment and an urban green space environment. These changes were further reflected in the qualitative themes that emerged from transcribed interviews undertaken one week post-walk. There has been no research to date that has directly assessed neural responses to an urban environment combined with qualitative interview analysis. A synergy of methods offers a deeper understanding of the changing moods of older people across time whilst walking in city settings. PMID:28165409

Performance of an Abbreviated Version of the Lubben Social Network Scale among Three European Community-Dwelling Older Adult Populations

ERIC Educational Resources Information Center

Lubben, James; Blozik, Eva; Gillmann, Gerhard; Iliffe, Steve; von Renteln-Kruse, Wolfgang; Beck, John C.; Stuck, Andreas E.

2006-01-01

Purpose: There is a need for valid and reliable short scales that can be used to assess social networks and social supports and to screen for social isolation in older persons. Design and Methods: The present study is a cross-national and cross-cultural evaluation of the performance of an abbreviated version of the Lubben Social Network Scale…

Official statistics and claims data records indicate non-response and recall bias within survey-based estimates of health care utilization in the older population

PubMed Central

2013-01-01

Background The validity of survey-based health care utilization estimates in the older population has been poorly researched. Owing to data protection legislation and a great number of different health care insurance providers, the assessment of recall and non-response bias is challenging to impossible in many countries. The objective of our study was to compare estimates from a population-based study in older German adults with external secondary data. Methods We used data from the German KORA-Age study, which included 4,127 people aged 65–94 years. Self-report questions covered the utilization of long-term care services, inpatient services, outpatient services, and pharmaceuticals. We calculated age- and sex-standardized mean utilization rates in each domain and compared them with the corresponding estimates derived from official statistics and independent statutory health insurance data. Results The KORA-Age study underestimated the use of long-term care services (−52%), in-hospital days (−21%) and physician visits (−70%). In contrast, the assessment of drug consumption by postal self-report questionnaires yielded similar estimates to the analysis of insurance claims data (−9%). Conclusion Survey estimates based on self-report tend to underestimate true health care utilization in the older population. Direct validation studies are needed to disentangle the impact of recall and non-response bias. PMID:23286781

Socioeconomic determinants of health inequalities among the older population in India: a decomposition analysis.

PubMed

Goli, Srinivas; Singh, Lucky; Jain, Kshipra; Pou, Ladumai Maikho Apollo

2014-12-01

This study quantified and decomposed health inequalities among the older population in India and analyzes how health status varies for populations between 60 to 69 years and 70 years and above. Data from the 60th round of the National Sample Survey (NSS) was used for the analyses. Socioeconomic inequalities in health status were measured by using Concentration Index (CI) and further decomposed to find critical determinants and their relative contributions to total health inequality. Overall, CI estimates were negative for the older population as a whole (CI = -0.1156), as well as for two disaggregated groups, 60 to 69 years (CI = -0.0943) and 70 years and above (CI = -0.08198). This suggests that poor health status is more concentrated among the socioeconomically disadvantaged older population. Decomposition analyses revealed that poor economic status (54 %) is the dominant contributor to total health inequalities in the older population, followed by illiteracy (24 %) and rural place of residence (20 %). Other indicators, such as religion, gender and marital status were positive, while Caste was negatively associated with health inequality in the older populations. Finally, a comparative assessment of decomposition results suggest that critical contributors for health inequality vary for the older population of 60 to 69 years and 70 years and above. These findings provide important insights on health inequalities among the older population in India. Implications are advanced.

FastStats: Births -- Method of Delivery

MedlinePlus

... Accidents or Unintentional Injuries All Injuries Assault or Homicide Suicide and Self-Inflicted Injury Life Stages and Populations Age Groups Adolescent Health Child Health Infant Health Older Persons’ Health Births Birth Defects or ...

Understanding Older Adult's Perceptions of Factors that Support Trust in Human and Robot Care Providers.

PubMed

Stuck, Rachel E; Rogers, Wendy A

2017-06-01

As the population of older adults increase so will the need for care providers, both human and robot. Trust is a key aspect to establish and maintain a successful older adult-care provider relationship. However, due to trust volatility it is essential to understand it within specific contexts. This proposed mixed methods study will explore what dimensions of trust emerge as important within the human-human and human-robot dyads in older adults and care providers. First, this study will help identify key qualities that support trust in a care provider relationship. By understanding what older adults perceive as needing to trust humans and robots for various care tasks, we can begin to provide recommendations based on user expectations for design to support trust.

Prevalence of diabetes type 2 in older adults: Findings from a large population-based survey in Tehran, Iran (Urban HEART-2).

PubMed

Rashedi, Vahid; Asadi-Lari, Mohsen; Delbari, Ahmad; Fadayevatan, Reza; Borhaninejad, Vahidreza; Foroughan, Mahshid

2017-11-01

Diabetes is a common problem in older adults, as they increasingly comprise a larger proportion of patients newly diagnosed with diabetes. The evidence on the prevalence and distribution of type 2 diabetes (DT2) and its related factors among older adults in Iran is sparse. The aim of the present study was to determine the prevalence of DT2 among Iranian older adults aged ≥60years. The study was part of a comprehensive survey (Urban HEART-2) which was a large population-based cross-sectional study. A multistage cluster random sampling method was used to select the participants in Tehran in 2011. All the participants were interviewed by trained personnel using a standard questionnaire on diabetes as well as a socio-demographic checklist. Logistic regression and chi-square were used to investigate the association between diabetes and the demographic characteristics. A total of 15069 older adults were included in this analysis. The mean age of the participants was 68.93±7.27years (SE: 0.059) and the mean of BMI was 26.21±4.40kg/m 2 (SE: 0.036). Prevalence of DT2 was 14.4% among Iranian older adults. Factors such as age, being female, high BMI, and education were significantly associated with DT2. Given the high prevalence of diabetes among older people, more population based research is needed to quantify the ramifications of diabetes, and to monitor the effects of prevention and health system strengthening strategies on the prevalence, treatment, and control of DT2. Copyright © 2017 Diabetes India. Published by Elsevier Ltd. All rights reserved.

Effect of the conditional cash transfer program Oportunidades on vaccination coverage in older Mexican people

PubMed Central

2013-01-01

Background Immunization is one of the most effective ways of preventing illness, disability and death from infectious diseases for older people. However, worldwide immunization rates are still low, particularly for the most vulnerable groups within the elderly population. The objective of this study was to estimate the effect of the Oportunidades -an incentive-based poverty alleviation program- on vaccination coverage for poor and rural older people in Mexico. Methods Cross-sectional study, based on 2007 Oportunidades Evaluation Survey, conducted in low-income households from 741 rural communities (localities with <2,500 inhabitants) of 13 Mexican states. Vaccination coverage was defined according to three individual vaccines: tetanus, influenza and pneumococcal, and for complete vaccination schedule. Propensity score matching and linear probability model were used in order to estimate the Oportunidades effect. Results 12,146 older people were interviewed, and 7% presented cognitive impairment. Among remaining, 4,628 were matched. Low coverage rates were observed for the vaccines analyzed. For Oportunidades and non-Oportunidades populations were 46% and 41% for influenza, 52% and 45% for pneumococcal disease, and 79% and 71% for tetanus, respectively. Oportunidades effect was significant in increasing the proportion of older people vaccinated: for complete schedule 5.5% (CI95% 2.8-8.3), for influenza 6.9% (CI95% 3.8-9.6), for pneumococcal 7.2% (CI95% 4.3-10.2), and for tetanus 6.6% (CI95% 4.1-9.2). Conclusions The results of this study extend the evidence on the effect that conditional transfer programs exert on health indicators. In particular, Oportunidades increased vaccination rates in the population of older people. There is a need to continue raising vaccination rates, however, particularly for the most vulnerable older people. PMID:23835202

Which measure of quality of life performs best in older age? A comparison of the OPQOL, CASP-19 and WHOQOL-OLD

PubMed Central

Stenner, Paul

2010-01-01

Background Most measures of quality of life (QoL) are based on ‘expert’ opinions. This study describes a new measure of QoL in older age, the Older People's QoL Questionnaire (OPQOL), which is unique in being derived from the views of lay people, cross-checked against theoretical models for assessment of comprehensiveness. Its performance was assessed cross-sectionally and longitudinally. It was compared with two existing QoL measures in the cross-sectional studies in order to identify the optimal measure for use with older populations. Methods Data were taken from three surveys of older people living at home in Britain in 2007–2008: one population survey of people aged 65+, one focused enumeration survey of ethnically diverse older people aged 65+, one follow-up of a population survey of people aged 65+ at baseline in 1999/2000. Measures were QoL (using OPQOL, Control, Autonomy, Satisfaction, Pleasure - 19 items (CASP-19), World Health Organization Quality of Life questionnaire - version for older people (WHOQOL-OLD)), health, social and socioeconomic circumstances. The CASP-19 and WHOQOL-OLD were not administered to the longitudinal sample in order to reduce respondent burden. Results Psychometric tests were applied to each QoL measure. The OPQOL, CASP-19 and WHOQOL-OLD performed well with the cross-sectional samples; however, only the OPQOL met criteria for internal consistency in the Ethnibus samples. Conclusion The OPQOL is of potential value in the outcome assessment of health and social interventions, which can have a multidimensional impact on people's lives. Further research is needed to examine whether differences by ethnicity reflect real differences in QoL, methodological issues, variations in expectations or cultural differences in reporting. PMID:20719807

Physical activity in the older adults related to commuting and leisure, Maceió, Brazil

PubMed Central

Mourão, Ana Raquel de Carvalho; Novais, Francini Vilela; Andreoni, Solange; Ramos, Luiz Roberto

2013-01-01

OBJECTIVE To evaluate the level of physical activity of older adults by commuting and leisure time and associated factors. METHODS This was a cross-sectional study carried out with a population-based sample of 319 older individuals in Maceió, AL, Northeastern Brazil, in 2009. The level of physical activity in leisure and commuting was measured by applying the International Physical Activity Questionnaire, long version. The variables analyzed were: age, schooling, sex, per capita income and perceived health. We used descriptive analysis, Fisher's exact test and multiple regression analysis of prevalence rates. RESULTS We classified 87.5% as insufficiently active in commuting, being significantly higher among those individuals with older ages, with more education and who feel dissatisfied with their physical health. The prevalence of older people who are insufficiently active in leisure time activity was 76.2%, being more frequent in women, in men with advanced age; older adults with lower per capita income, and dissatisfaction with comparative physical health and self-perceived mental health. CONCLUSIONS The prevalence of insufficiently active was high in commuting and leisure time activities. Factors such as age, gender and income should be considered, especially with regards leisure, in order to ensure fairness in the development of policies to promote health and physical activity in this population. PMID:24626549

Acceptance and Commitment Therapy with Older Adults: Rationale and Considerations

ERIC Educational Resources Information Center

Petkus, Andrew J.; Wetherell, Julie Loebach

2013-01-01

Older adults are the fastest growing segment of the population. With these changing demographics, mental health professionals will be seeing more older clients. Additionally, older adults are an underserved population in that most older adults in need of mental health services do not receive treatment. Thus, it is essential that treatments for…

A Wii Bit of Fun: A Novel Platform to Deliver Effective Balance Training to Older Adults

PubMed Central

Merriman, Niamh A.; Young, William R.; Newell, Fiona N.; Craig, Cathy

2015-01-01

Abstract Background: Falls and fall-related injuries are symptomatic of an aging population. This study aimed to design, develop, and deliver a novel method of balance training, using an interactive game-based system to promote engagement, with the inclusion of older adults at both high and low risk of experiencing a fall. Study Design: Eighty-two older adults (65 years of age and older) were recruited from sheltered accommodation and local activity groups. Forty volunteers were randomly selected and received 5 weeks of balance game training (5 males, 35 females; mean, 77.18 ± 6.59 years), whereas the remaining control participants recorded levels of physical activity (20 males, 22 females; mean, 76.62 ± 7.28 years). The effect of balance game training was measured on levels of functional balance and balance confidence in individuals with and without quantifiable balance impairments. Results: Balance game training had a significant effect on levels of functional balance and balance confidence (P < 0.05). This was further demonstrated in participants who were deemed at high risk of falls. The overall pattern of results suggests the training program is effective and suitable for individuals at all levels of ability and may therefore play a role in reducing the risk of falls. Conclusions: Commercial hardware can be modified to deliver engaging methods of effective balance assessment and training for the older population. PMID:26469308

Cardiovascular risk factors and retinal microvascular signs in an adult Japanese population: the Funagata Study.

PubMed

Kawasaki, Ryo; Wang, Jie Jin; Rochtchina, Elena; Taylor, Bronwen; Wong, Tien Yin; Tominaga, Makoto; Kato, Takeo; Daimon, Makoto; Oizumi, Toshihide; Kawata, Sumio; Kayama, Takamasa; Yamashita, Hidetoshi; Mitchell, Paul

2006-08-01

To describe the prevalence of retinal vascular signs and their association with cardiovascular risk factors in a Japanese population. Population-based cross-sectional study. Adult persons aged 35 years or older from Funagata, Yamagata Prefecture, Japan (n = 1481). The Funagata Study is a Japanese population-based study of persons aged 35 years or older, and included 1961 nondiabetic participants (53.3% of 3676 eligible subjects). A nonmydriatic retinal photograph was taken of 1 eye to assess retinal microvascular signs. Retinal arteriolar wall signs (focal arteriolar narrowing, arteriovenous nicking, enhanced arteriolar wall reflex) and retinopathy were assessed in 1481 participants without diabetes (40.3% of eligible persons) using a standardized protocol. Using a computer-assisted method, retinal vessel diameters were measured in 921 participants with gradable retinal image (25.1% of eligible persons). Prevalence of retinal microvascular signs and their association with cardiovascular risk factors. Moderate or severe focal arteriolar narrowing, arteriovenous nicking, enhanced arteriolar wall reflex, and retinopathy were found in 8.3%, 15.2%, 18.7%, and 9.0%, respectively, of the study population. Mean (+/-standard error) values for retinal arteriolar diameter were 178.6+/-21.0 mum, and mean values (+/-standard error) for venular diameter were 214.9+/-20.6 mum. Older persons were more likely to have retinal arteriolar wall signs, retinopathy, and narrower retinal vessel diameters. After adjusting for multiple factors, each 10-mmHg increase in mean arterial blood pressure was associated with a 20% to 40% increased likelihood of retinal arteriolar signs and a 2.8-mum reduction in arteriolar diameter. Retinopathy was associated with higher body mass index and both impaired glucose tolerance and impaired fasting glucose. In nondiabetic Japanese adults, retinal arteriolar wall signs were associated with older age and increased blood pressure, whereas retinopathy was associated with older age, higher body mass index, impaired glucose tolerance, and impaired fasting glucose. These findings are comparable with data from white populations.

Factors Associated with Variations in Population HIV Prevalence across West Africa: Findings from an Ecological Analysis

PubMed Central

Prudden, Holly J.; Beattie, Tara S.; Bobrova, Natalia; Panovska-Griffiths, Jasmina; Mukandavire, Zindoga; Gorgens, Marelize; Wilson, David; Watts, Charlotte H.

2015-01-01

Background Population HIV prevalence across West Africa varies substantially. We assess the national epidemiological and behavioural factors associated with this. Methods National, urban and rural data on HIV prevalence, the percentage of younger (15–24) and older (25–49) women and men reporting multiple (2+) partners in the past year, HIV prevalence among female sex workers (FSWs), men who have bought sex in the past year (clients), and ART coverage, were compiled for 13 countries. An Ecological analysis using linear regression assessed which factors are associated with national variations in population female and male HIV prevalence, and with each other. Findings National population HIV prevalence varies between 0 4–2 9% for men and 0 4–5.6% for women. ART coverage ranges from 6–23%. National variations in HIV prevalence are not shown to be associated with variations in HIV prevalence among FSWs or clients. Instead they are associated with variations in the percentage of younger and older males and females reporting multiple partners. HIV prevalence is weakly negatively associated with ART coverage, implying it is not increased survival that is the cause of variations in HIV prevalence. FSWs and younger female HIV prevalence are associated with client population sizes, especially older men. Younger female HIV prevalence is strongly associated with older male and female HIV prevalence. Interpretation In West Africa, population HIV prevalence is not significantly higher in countries with high FSW HIV prevalence. Our analysis suggests, higher prevalence occurs where more men buy sex, and where a higher percentage of younger women, and older men and women have multiple partnerships. If a sexual network between clients and young females exists, clients may potentially bridge infection to younger females. HIV prevention should focus both on commercial sex and transmission between clients and younger females with multiple partners. PMID:26698854

The Cascading Effects of Marginalization and Pathways of Resilience in Attaining Good Health Among LGBT Older Adults

PubMed Central

Fredriksen-Goldsen, Karen I.; Kim, Hyun-Jun; Bryan, Amanda E. B.; Shiu, Chengshi; Emlet, Charles A.

2017-01-01

Purpose of the Study: Lesbian, gay, bisexual, and transgender (LGBT) older adults comprise a diverse and growing health disparate population. In the present study, using the Health Equity Promotion Model, we investigated pathways by which LGBT older adults experience resilience, risk, and marginalization and their relationship to attaining positive health outcomes. Design and Methods: Aging with Pride: National Health, Aging, and Sexuality/Gender Study (NHAS) is the first longitudinal research project designed to examine the health, aging, and well-being of LGBT adults aged 50 and older. Using data from 2014 (N = 2,415), we tested a structural equation model linking lifetime marginalization, identity affirmation and management, social and psychological resources, and health behaviors to positive health outcomes. Results: Identity affirmation positively predicted social resources and mental health, and social resources positively predicted mental health. Marginalization was associated with fewer social resources for LGBT older adults with an open identity management style, lower identity affirmation for LGBT older adults who strategically concealed their sexual identity, and poorer mental health. Mental health was associated with better health behaviors, which in turn predicted positive physical health outcomes. Implications: Although a health disparate population, good health among LGBT older adults appears to be attained via multiple resilience and risk pathways. Providers must remain aware of the historical contexts in which LGBT older adults lived and the strengths they developed in order to understand their health and to develop tailored and targeted prevention and intervention services. PMID:28087797

Utilization of the emergency department by older residents in Kuala Lumpur, Malaysia.

PubMed

Mohd Mokhtar, Mohd Amin; Pin, Tan Maw; Zakaria, Mohd Idzwan; Hairi, Noran Naqiah; Kamaruzzaman, Shahrul Bahiyah; Vyrn, Chin Ai; Hua, Philip Poi Jun

2015-08-01

To determine the pattern of utilization of emergency department (ED) services by older patients in Kuala Lumpur, Malaysia, compared with younger patients in the same setting. The sociodemographics, clinical characteristics and resource utilization of consecutive patients attending the adult ED at the University Malaya Medical Center were recorded during a typical week. A total of 1649 patients were included in the study; 422/1649 (25.6%) were aged ≥60 years and 1077 (74.4%) were aged <60 years. Older adult patients were more likely to be diagnosed with ischemic heart disease (12.6% vs 2.5%, P < 0.001), and more likely to require investigations such as electrocardiogram (68.1% vs 16.6%, P < 0.001) or chest X-rays (67.6% vs 24.0%, P < 0.001) than their younger counterparts. Logistic regression methods showed that older adults remained an independent predictor of hospital admission (OR 2.75, 95% CI 2.11-3.57). The ratio of older adult patients attending our ED over the proportion of older people in the general population was 26:6, which is far higher than reported in previous published studies carried out in other countries. Older ED attenders are also more likely to require investigations, procedures and hospital admissions. With the rapidly aging population in Malaysia, reconfiguration of resources will need to occur at a compatible rate in order to ensure that the healthcare needs of our older adults are met. © 2014 Japan Geriatrics Society.

Traffic safety facts 1998 : older population

DOT National Transportation Integrated Search

1999-01-01

There are nearly 25 million people age 70 years and older in the United : States. In 1998, this age group made up 9 percent of the total U.S. : resident population, compared with 8 percent in 1988. From 1988 to : 1998, this older segment of the popul...

The Perceptions, Social Determinants, and Negative Health Outcomes Associated With Depressive Symptoms Among U.S. Chinese Older Adults

PubMed Central

Dong, XinQi; Chang, E-Shien; Wong, Esther; Simon, Melissa

2012-01-01

Purpose of the Study: Recent demographic growth of the U.S. Chinese aging population calls for comprehensive understanding of their unique health needs. The objective of this study is to examine the perceptions, social determinants of depressive symptoms as well as their impact on health and well-being in a community-dwelling U.S. Chinese aging population in Chicago. Design and Methods: A community-based participatory research approach was implemented to partner with the Chicago Chinatown population in a geographically defined community. Data were collected from questionnaires and semistructured focus group interviews with 78 community-dwelling Chinese older adults. Results: Our findings suggest that the depressive symptoms were common among older adults. It was frequently identified through feelings of helplessness, feelings of dissatisfaction with life, feelings of getting bored, loss of interests in activities, suicidal ideation, and feelings of worthlessness. Societal conflicts, family conflicts, financial constraints, personality, and worsening physical health may be associated with greater depressive symptoms. In addition, depressive symptoms may be detrimental to the overall health and well-being of Chinese older adults. Implications: This study has wide implications for health care professionals, social services agencies, and policy makers. Our results call for improved public health education and awareness programs to highlight the health impact of depressive symptoms on Chinese older adults. Future prospective studies are needed to investigate the prevalence of depressive symptoms among U.S. Chinese older adults. Longitudinal research is needed to quantify the risk and protective factors of depressive symptoms. PMID:22156734

Trends in nurse practitioners' prescribing to older adults in Ontario, 2000-2010: a retrospective cohort study

PubMed Central

Tranmer, Joan E.; Colley, Lindsey; Edge, Dana S.; Sears, Kim; VanDenKerkhof, Elizabeth; Levesque, Linda

2015-01-01

Background: Nurse prescribing is a practice that has evolved and will continue to evolve in response to emerging trends, particularly in primary care. The goal of this study was to describe the trends and patterns in medication prescription to adults 65 years of age or older in Ontario by nurse practitioners over a 10-year period. Methods: We conducted a population-based descriptive retrospective cohort study. All nurse practitioners registered in the Corporate Provider Database between Jan. 1, 2000, and Dec. 31, 2010, were identified. We identified actively prescribing nurse practitioners through linkage of dispensed medications to people aged 65 years or older from the Ontario Drug Benefit database. For comparison, all prescription medications dispensed by family physicians to a similar group were identified. Geographic location was determined based on site of nurse practitioner practice. Results: The number and proportion of actively prescribing nurse practitioners prescribing to older adults increased during the study period, from 44/340 (12.9%) to 888/1423 (62.4%). The number and proportion of medications dispensed for chronic conditions by nurse practitioners increased: in 2010, 9 of the 10 top medications dispensed were for chronic conditions. There was substantial variation in the proportion of nurse practitioners dispensing medication to older adults across provincial Local Health Integration Networks. Interpretation: Prescribing by nurse practitioners to older adults, particularly of medications related to chronic conditions, increased between 2000 and 2010. The integration of nurse practitioners into primary care has not been consistent across the province and has not occurred in relation to population changes and perhaps population needs. PMID:26457291

Systematic review of systematic reviews for the management of urinary incontinence and promotion of continence using conservative behavioural approaches in older people in care homes.

PubMed

Roe, Brenda; Flanagan, Lisa; Maden, Michelle

2015-07-01

To synthesize evidence from systematic reviews on the management of urinary incontinence and promotion of continence using conservative/behavioural approaches in older people in care homes to inform clinical practice, guidelines and research. Incontinence is highly prevalent in older people in care home populations. Systematic review of systematic reviews with narrative synthesis. Electronic searches of published systematic reviews in English using MEDLINE and CINAHL with no date restrictions up to September 2013. Searches supplemented by hand searching and electronic searching of Cochrane Library and PROSPERO. PRISMA statement was followed, as were established methods for systematic review of systematic reviews. Five systematic reviews of high quality were included, three specific to intervention studies and two reviewed descriptive studies. Urinary incontinence was the primary outcome in three reviews with factors associated with the management of urinary incontinence the primary outcome for the other reviews. Toileting programmes, in particular prompted voiding, with use of incontinence pads are the main conservative behavioural approach for the management of incontinence and promotion of continence in this population with evidence of effectiveness in the short term. Evidence from associated factors; exercise, mobility, comorbidities, hydration, skin care, staff perspectives, policies and older people's experiences and preference are limited. The majority of evidence of effectiveness are from studies from one country which may or may not be transferable to other care home populations. Future international studies are warranted of complex combined interventions using mixed methods to provide evidence of effectiveness, context of implementation and economic evaluation. © 2015 John Wiley & Sons Ltd.

Medicare Part D Enrollment in a Biracial Community-Based Population of Older Adults

ERIC Educational Resources Information Center

Skarupski, Kimberly A.; Mendes de Leon, Carlos F.; Barnes, Lisa L.; Evans, Denis A.

2009-01-01

Purpose: The Medicare Prescription Drug Benefit (Part D) program debuted in January 2006. We ascertained the sociodemographic and health characteristics of Blacks and Whites who enrolled in the early stages of the program. Design and Methods: Data were collected between April 2006 and October 2007 from an ongoing population-based biracial study of…

Stability and Change in Health Insurance Among Older Mexican Americans: Longitudinal Evidence From the Hispanic Established Populations for Epidemiologic Study of the Elderly

PubMed Central

Angel, Ronald J.; Angel, Jacqueline L.; Markides, Kyriakos S.

2002-01-01

Objectives. This study examined the association between health insurance coverage, medical care use, limitations in activities of daily living, and mortality among older Mexican-origin individuals. Methods. We analyzed longitudinal data from the Hispanic Established Populations for Epidemiologic Study of the Elderly (H-EPESE). Results. The uninsured tend to be younger, female, poor, and foreign born. They report fewer health care visits, are less likely to have a usual source of care, and more often receive care in Mexico. Conversely, those with private health insurance are economically better off and use more health care services. Over time, the data reveal substantial changes in type of insurance coverage. Conclusions. The data reveal serious vulnerabilities among older Mexican Americans that result from a lack of private Medigap supplemental coverage. (Am J Public Health. 2002;92:1264–1271) PMID:12144982

Levels of Health Literacy in a Community-Dwelling Population of Chinese Older Adults

PubMed Central

Li, Yu; Dong, XinQi

2014-01-01

Background. Lower levels of health literacy have been associated with adverse health outcomes, especially for older adults. However, limited research has been conducted to understand health literacy levels among Chinese American older adults. Methods. The PINE study is an epidemiological cohort of 3,159 community-dwelling Chinese older adults, 95% of whom do not speak or read English. Chinese older adults’ health literacy levels were examined using the Chinese version of the Rapid Estimate of Adult Literacy in Medicine, Revised (REALM-R) test. Kruskal–Wallis test and chi-square statistics were used to identify significant differences by sociodemographic and self-reported health characteristics. Pearson and Spearman correlation coefficients were used to examine correlations between personal characteristics and health literacy level. Results. The mean age among this sample of Chinese older adults was 72.8 years (SD = 8.3, range = 60–105) and the mean REALM-R test score was 6.9 [SD = 2.3, range (0–8)]. Health literacy was positively associated with education, marriage status, and number of people living with. Older age, being female, greater number of children, years in the United States, and preference for speaking Cantonese or Taishanese were negatively associated with health literacy. Health literary was not associated with self-reported health status or quality of life. Conclusions. In this Chicago Chinese population, older adults had reasonable levels of health literacy in Chinese. Future longitudinal research is needed to understand risk/protective factors associated with health literacy level in Chinese older adults. PMID:25378449

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

PubMed Central

Slack, Tim; Jensen, Leif

2008-01-01

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

Aging, Nutritional Status and Health.

PubMed

Leslie, Wilma; Hankey, Catherine

2015-07-30

The older population is increasing worldwide and in many countries older people will outnumber younger people in the near future. This projected growth in the older population has the potential to place significant burdens on healthcare and support services. Meeting the diet and nutrition needs of older people is therefore crucial for the maintenance of health, functional independence and quality of life. While many older adults remain healthy and eat well those in poorer health may experience difficulties in meeting their nutritional needs. Malnutrition, encompassing both under and over nutrition increases health risks in the older population. More recently the increase in obesity, and in turn the incidence of chronic disease in older adults, now justifies weight management interventions in obese older adults. This growing population group is becoming increasingly diverse in their nutritional requirements. Micro-nutrient status may fluctuate and shortfalls in vitamin D, iron and a number of other nutrients are relatively common and can impact on well-being and quality of life. Aging presents a number of challenges for the maintenance of good nutritional health in older adults.

Dental Usage Under Changing Economic Conditions

PubMed Central

Manski, Richard J.; Moeller, John F.; Chen, Haiyan; Schimmel, Jody; St Clair, Patricia A.; Pepper, John V.

2012-01-01

Objective The purpose of this article is to examine the relationship between changes in household finances (wealth and income) and changes in dental utilization at the onset of the recent recession in a population of older Americans. Methods Data from the Health and Retirement Study (HRS) were analyzed for U.S. individuals aged 51 years and older during the 2006 and 2008 waves of the HRS. We estimated logistic models of (1) starting and (2) stopping dental use between 2006 and 2008 survey periods as a function of changes in household wealth and income, controlling for other potentially confounding covariates. Results We found that only when household wealth falls by 50 percent or more were older adults less likely to seek dental care. Changes in household income and other changes in household wealth were not associated with changes in dental utilization among this population. Conclusions Older Americans’ dental care utilization appeared to be fairly resilient to changes in household finances; only when wealth fell by 50 percent or more did individuals decrease dental use. This finding might extend to other health care services that are preventive, routine, and relatively inexpensive. PMID:22994647

Reliability, minimal detectable change and responsiveness to change: Indicators to select the best method to measure sedentary behaviour in older adults in different study designs.

PubMed

Dontje, Manon L; Dall, Philippa M; Skelton, Dawn A; Gill, Jason M R; Chastin, Sebastien F M

2018-01-01

Prolonged sedentary behaviour (SB) is associated with poor health. It is unclear which SB measure is most appropriate for interventions and population surveillance to measure and interpret change in behaviour in older adults. The aims of this study: to examine the relative and absolute reliability, Minimal Detectable Change (MDC) and responsiveness to change of subjective and objective methods of measuring SB in older adults and give recommendations of use for different study designs. SB of 18 older adults (aged 71 (IQR 7) years) was assessed using a systematic set of six subjective tools, derived from the TAxonomy of Self report Sedentary behaviour Tools (TASST), and one objective tool (activPAL3c), over 14 days. Relative reliability (Intra Class Correlation coefficients-ICC), absolute reliability (SEM), MDC, and the relative responsiveness (Cohen's d effect size (ES) and Guyatt's Responsiveness coefficient (GR)) were calculated for each of the different tools and ranked for different study designs. ICC ranged from 0.414 to 0.946, SEM from 36.03 to 137.01 min, MDC from 1.66 to 8.42 hours, ES from 0.017 to 0.259 and GR from 0.024 to 0.485. Objective average day per week measurement ranked as most responsive in a clinical practice setting, whereas a one day measurement ranked highest in quasi-experimental, longitudinal and controlled trial study designs. TV viewing-Previous Week Recall (PWR) ranked as most responsive subjective measure in all study designs. The reliability, Minimal Detectable Change and responsiveness to change of subjective and objective methods of measuring SB is context dependent. Although TV viewing-PWR is the more reliable and responsive subjective method in most situations, it may have limitations as a reliable measure of total SB. Results of this study can be used to guide choice of tools for detecting change in sedentary behaviour in older adults in the contexts of population surveillance, intervention evaluation and individual care.

A Healthy Aging Program for Older Adults: Effects on Self-Efficacy and Morale

PubMed Central

Scult, Matthew; Haime, Vivian; Jacquart, Jolene; Takahashi, Jonathan; Moscowitz, Barbara; Webster, Ann; Denninger, John W.; Mehta, Darshan H.

2015-01-01

Context As of 2012, 810 million people were over the age of 60 worldwide, accounting for 11 percent of the population. That number is expected to rise to 2 billion by 2050 or to 22 percent of the overall population. As a result, a growing need exists to understand the factors that promote mental and physical health in older populations. Objectives The purpose of this study was to develop a healthy aging program for older adults and to measure the changes from baseline to the end of the program in participants’ relevant psychosocial outcomes; ie, self-efficacy and morale. Design The study’s Healthy Aging Mind Body Intervention (MBI) was adapted from the Relaxation Response Resiliency Program (3RP) at the Benson-Henry Institute for Mind Body Medicine (BHI), which incorporates elements from the fields of stress management, cognitive-behavioral therapy, and positive psychology. That program was modified with examples and exercises targeted to an older population, and evaluated in the current, single-arm, pilot study. Setting The program took place at the Massachusetts General Hospital (MGH). Participants The 9-week Healthy Aging MBI was developed for participants aged 65 and over. Fifty-one older adults from the surrounding community participated in the study’s groups. Intervention A new intervention group began the program every 3 months, with a maximum of 12 individuals per group. For each group, the MBI consisted of weekly, 90-minute sessions for 9 consecutive weeks, directed by a psychologist. The program included sessions that taught participants: (1) a variety of methods to elicit the relaxation response (RR), (2) the practice of adaptive coping and cognitions, (3) behaviors necessary to create a healthy lifestyle, and (4) methods of building social support. Outcome Measures The research team chose to focus on 2 psychological variables of interest for aging populations: morale and self-efficacy. The study used 2 questionnaires to measure those outcomes, the Philadelphia Geriatric Center Morale Scale (PGCMS), a multidimensional measure of the psychological state of older people, and the Coping Self-Efficacy Scale (CSES), a measure that addresses the multiple dimensions of self-efficacy. Results Data from 5 intervention groups were combined for the current analysis. Forty-six participants enrolled and completed questionnaires. Of those participants, 41 attended at least 7 out of the 9 sessions. Significant increases in self-efficacy and morale were observed for program completers. After a highly conservative sensitivity analysis, the change for the measure of self-efficacy remained significant, and the change for the measure of morale trended toward significance. Conclusions The study’s healthy aging program appears to be a feasible intervention for older adults, with the potential to increase levels of self-efficacy and morale in participants. Further research is warranted to determine its effects on other psychosocial outcomes and healthcare utilization in aging populations. PMID:25607120

Training of Older Workers in the Federal Republic of Germany. Training Discussion Paper No. 24.

ERIC Educational Resources Information Center

Sutter, Hannelore

Following tremendous growth in the population of West Germany until the early 1970s, the population stabilized with a slower birth rate but higher foreign immigration. The population is becoming increasingly older. About 28 percent of the German population is aged 55 or older; by the year 2030, this figure will be about 44 percent. In 1985, the…

National stereotypes of older people's competence are related to older adults' participation in paid and volunteer work.

PubMed

Bowen, Catherine E; Skirbekk, Vegard

2013-11-01

Why are older people perceived as more competent in some countries relative to others? In the current study, we investigate the extent to which national variation in perceptions of older people's competence is systematically related to national variation in the extent to which older people participate in paid and volunteer work. We used multilevel regression to analyze data from the European Social Survey and test the relationship between perceptions of older people's competence and older people's participation in paid and volunteer work across 28 countries. We controlled for a number of potentially confounding variables, including life expectancy as well as the gender ratio and average education of the older population in each country. We controlled for the average objective cognitive abilities of the older population in a subsample of 11 countries. Older people were perceived as more competent in countries in which more older people participated in paid or volunteer work, independent of life expectancy and the average education, gender makeup, and average cognitive abilities of the older population. The results suggest that older people's participation in paid and volunteer work is related to perceptions of older people's competence independent of older people's actual competence.

Multiple Chronic Conditions and Limitations in Activities of Daily Living in a Community-Based Sample of Older Adults in New York City, 2009

PubMed Central

Mielenz, Thelma J.; Parton, Hilary; Flatley, Anne-Marie; Thorpe, Lorna E.

2013-01-01

Introduction Nationally, 60% to 75% of older adults have multiple (2 or more) chronic conditions (MCCs), and the burden is even higher among low-income, racial/ethnic minority populations. MCCs limit activities of daily living (ADLs), yet this association is not well characterized outside of clinical populations. We examined the association of MCCs with ADLs in a racially/ethnically diverse population of low-income older adults living in New York City public housing. Methods A representative sample of 1,036 New York City Housing Authority residents aged 65 or older completed a telephone survey in June 2009. We examined the association of up to 5 chronic conditions with basic ADL (BADL) limitations, adjusting for potential confounders by using logistic regression. Results Of respondents, 28.7% had at least 1 BADL limitation; 92.9% had at least 1 chronic condition, and 79.0% had MCCs. We observed a graded association between at least 1 BADL limitation and number of chronic conditions (using 0 or 1 condition as the reference group): adjusted odds ratio (AOR) for 3 conditions was 2.2 (95% confidence interval [CI], 1.3–3.9); AOR for 4 conditions, 4.3 (95% CI, 2.5–7.6); and AOR for 5 conditions, 9.2 (95% CI, 4.3–19.5). Conclusion Prevalence of BADL limitations is high among low-income older adults and increases with number of chronic conditions. Initiating prevention of additional conditions and treating disease constellations earlier to decrease BADL limitations may improve aging outcomes in this population. PMID:24286273

Highway safety issues of older drivers in Kansas : final report.

DOT National Transportation Integrated Search

2009-08-01

The older population (>65 years) numbered 36.8 million in the United States in 2005. By 2030, the number is estimated to be 71.5 million, almost twice as many. An increase in the older population means an increase in older drivers as well. As a resul...

Primary care physicians' perceived barriers and facilitators to conservative care for older adults with chronic kidney disease: design of a mixed methods study.

PubMed

Tam-Tham, Helen; Hemmelgarn, Brenda; Campbell, David; Thomas, Chandra; Quinn, Robert; Fruetel, Karen; King-Shier, Kathryn

2016-01-01

Guideline committees have identified the need for research to inform the provision of conservative care for older adults with stage 5 chronic kidney disease (CKD) who have a high burden of comorbidity or functional impairment. We will use both qualitative and quantitative methodologies to provide a comprehensive understanding of barriers and facilitators to care for these patients in primary care. Our objectives are to (1) interview primary care physicians to determine their perspectives of conservative care for older adults with stage 5 CKD and (2) survey primary care physicians to determine the prevalence of key barriers and facilitators to provision of conservative care for older adults with stage 5 CKD. A sequential exploratory mixed methods design was adopted for this study. The first phase of the study will involve fundamental qualitative description and the second phase will be a cross-sectional population-based survey. The research is conducted in Alberta, Canada. The participants are primary care physicians with experience in providing care for older adults with stage 5 CKD not planning on initiating dialysis. The first objective will be achieved by undertaking interviews with primary care physicians from southern Alberta. Participants will be selected purposively to include physicians with a range of characteristics (e.g., age, gender, and location of clinical practice). Interviews will be recorded, transcribed verbatim, and analyzed using conventional content analysis to generate themes. The second objective will be achieved by undertaking a population-based survey of primary care physicians in Alberta. The questionnaire will be developed based on the findings from the qualitative interviews and pilot tested for face and content validity. Physicians will be provided multiple options to complete the questionnaire including mail, fax, and online methods. Descriptive statistics and associations between demographic factors and barriers and facilitators to care will be analyzed using regression models. A potential limitation of this mixed methods study is its cross-sectional nature. This work will inform development of clinical resources and tools for care of older adults with stage 5 CKD, to address barriers and enable facilitators to community-based conservative care.

Methodological Challenges in Physical Activity Research with Older Adults

PubMed Central

Chase, Jo-Ana D.

2015-01-01

The aging adult population is growing, as well as the incidence of chronic illness among older adults. Physical activity has been demonstrated in the literature to be a beneficial component of self-management for chronic illnesses commonly found in the older adult population. Health sciences research seeks to develop new knowledge, practices, and policies that may benefit older adults’ management of chronic illness and quality of life. However, research with the older adult population, though beneficial, includes potential methodological challenges specific to this age group. This article discusses common methodological issues in research among older adults, with a focus on physical activity intervention studies. Awareness and understanding of these issues may facilitate future development of research studies devoted to the aging adult population, through appropriate modification and tailoring of sampling techniques, intervention development, and data measures and collection. PMID:21821726

Age as a Determinant to Select an Anesthesia Method for Tympanostomy Tube Insertion in a Pediatric Population

PubMed Central

Jung, Kihwan; Kim, Hojong

2015-01-01

Background and Objectives To evaluate the relationship between age and anesthesia method used for tympanostomy tube insertion (TTI) and to provide evidence to guide the selection of an appropriate anesthesia method in children. Subjects and Methods We performed a retrospective review of children under 15 years of age who underwent tympanostomy tube insertion (n=159) or myringotomy alone (n=175) under local or general anesthesia by a single surgeon at a university-based, secondary care referral hospital. Epidermiologic data between local and general anesthesia groups as well as between TTI and myringotomy were analyzed. Medical costs were compared between local and general anesthesia groups. Results Children who received local anesthesia were significantly older than those who received general anesthesia. Unilateral tympanostomy tube insertion was performed more frequently under local anesthesia than bilateral. Logistic regression modeling showed that local anesthesia was more frequently applied in older children (odds ratio=1.041) and for unilateral tympanostomy tube insertion (odds ratio=8.990). The cut-off value of age for local anesthesia was roughly 5 years. Conclusions In a pediatric population at a single medical center, age and whether unilateral or bilateral procedures were required were important factors in selecting an anesthesia method for tympanostomy tube insertion. Our findings suggest that local anesthesia can be preferentially considered for children 5 years of age or older, especially in those with unilateral otitis media with effusion. PMID:26185791

Cohort Differences in the Availability of Informal Caregivers: Are the Boomers at Risk?

ERIC Educational Resources Information Center

Ryan, Lindsay H.; Smith, Jacqui; Antonucci, Toni C.; Jackson, James S.

2012-01-01

Purpose of the Study: We compare the close family resources of Baby Boomers (BBs) to previous cohorts of older adults at population level and then examine individual-level cohort comparisons of age-related trajectories of informal care availability from midlife into old age. Design and Methods: Population data from the U.S. Census and from the…

Acceptance and Commitment Therapy with Older Adults: Rationale and Considerations

PubMed Central

Petkus, Andrew J; M.A; Wetherell, Julie Loebach

2015-01-01

Older adults are the fastest growing segment of the population. With these changing demographics, mental health professionals will be seeing more older clients. Additionally, older adults are an underserved population in that most older adults in need of mental health services do not receive treatment. Thus, it is essential that treatments for mental and behavioral health problems are empirically supported with older adults and that mental health professionals are aware of the special needs of older adult populations. Acceptance and Commitment Therapy (ACT) is an emerging approach to the treatment of distress. The purpose of this article is to provide a rationale for using ACT with older adults based on gerontological theory and research. We also review research on ACT-related processes in later life. We present a case example of an older man with depression and anxiety whom we treated with ACT. Finally, we describe treatment recommendations and important adaptations that need to be considered when using ACT with older adults and discuss important areas for future research. PMID:26997859

Understanding the Effect of Workload on Automation Use for Younger and Older Adults

PubMed Central

McBride, Sara E.; Rogers, Wendy A.; Fisk, Arthur D.

2018-01-01

Objective This study examined how individuals, younger and older, interacted with an imperfect automated system. The impact of workload on performance and automation use was also investigated. Background Automation is used in situations characterized by varying levels of workload. As automated systems spread to domains such as transportation and the home, a diverse population of users will interact with automation. Research is needed to understand how different segments of the population use automation. Method Workload was systematically manipulated to create three levels (low, moderate, high) in a dual-task scenario in which participants interacted with a 70% reliable automated aid. Two experiments were conducted to assess automation use for younger and older adults. Results Both younger and older adults relied on the automation more than they complied with it. Among younger adults, high workload led to poorer performance and higher compliance, even when that compliance was detrimental. Older adults’ performance was negatively affected by workload, but their compliance and reliance were unaffected. Conclusion Younger and older adults were both able to use and double-check an imperfect automated system. Workload affected how younger adults complied with automation, particularly with regard to detecting automation false alarms. Older adults tended to comply and rely at fairly high rates overall, and this did not change with increased workload. Application Training programs for imperfect automated systems should vary workload and provide feedback about error types, and strategies for identifying errors. The ability to identify automation errors varies across individuals, thereby necessitating training. PMID:22235529

How Design of Places Promotes or Inhibits Mobility of Older Adults: Realist Synthesis of 20 Years of Research

PubMed Central

Yen, Irene H.; Flood, Johnna Fandel; Thompson, Hannah; Anderson, Lynda A.; Wong, Geoff

2015-01-01

Objective The objective of this study was to determine the environmental features that best support aging in place. Method We conducted a realist synthesis, a theory-driven interpretive method of evidence synthesis, of 120+ articles (published 1991–2011) that attempts to explain how place may influence older adults’ decisions about mobility (e.g., physical activity). We developed an initial program theory, reviewed the literature, identified outcomes, analyzed and synthesized patterns, and created a final program theory. Results Safety was a central mechanism, serving as one of the bridges between environmental components (e.g., connectivity, aesthetics, retail and services) and decisions about mobility. Population density, sidewalk presence, and park proximity did not emerge as key factors. Discussion Safety considerations are one of the most prominent influences of older adults’ decisions about mobility. Street connectivity, pedestrian access and transit, and retail and services were also important. These factors are amenable to change and can help promote mobility for older adults. PMID:24788714

Training for older adults.

PubMed

Hautier, C; Bonnefoy, M

2007-07-01

Aging is associated with a reduction in physical fitness, with loss of muscular force and endurance. Physical activity has been demonstrated to provide substantial health benefits and to maintain functional independence and improve quality of life in older adults. Resistance training has a significant effect on muscle mass and force whereas endurance training increases oxygen transport and consumption capacities. This article presents training methods used in the literature and their associated effects in order to adapt training protocols to older populations. To maximise benefits from adoption of a program to which the patient can adhere for long time, it is important to tailor the exercise prescription to the individual.

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…

The Impact of the Financial Crisis on Lifestyle Health Determinants Among Older Adults Living in the Mediterranean Region: The Multinational MEDIS Study (2005-2015)

PubMed Central

Soulis, George; Mariolis, Anargiros; Piscopo, Suzanne; Anastasiou, Foteini; Zeimbekis, Akis; Tur, Josep-Antoni; Tyrovola, Dimitra; Gotsis, Efthimios; Metallinos, George; Matalas, Antonia-Leda

2017-01-01

Objectives By the end of the 2000s, the economic situation in many European countries started to deteriorate, generating financial uncertainty, social insecurity and worse health status. The aim of the present study was to investigate how the recent financial crisis has affected the lifestyle health determinants and behaviours of older adults living in the Mediterranean islands. Methods From 2005 to 2015, a population-based, multi-stage convenience sampling method was used to voluntarily enrol 2749 older adults (50% men) from 20 Mediterranean islands and the rural area of the Mani peninsula. Lifestyle status was evaluated as the cumulative score of four components (range, 0 to 6), that is, smoking habits, diet quality (MedDietScore), depression status (Geriatric Depression Scale) and physical activity. Results Older Mediterranean people enrolled in the study from 2009 onwards showed social isolation and increased smoking, were more prone to depressive symptoms, and adopted less healthy dietary habits, as compared to their counterparts participating earlier in the study (p<0.05), irrespective of age, gender, several clinical characteristics, or socioeconomic status of the participants (an almost 50% adjusted increase in the lifestyle score from before 2009 to after 2009, p<0.001). Conclusions A shift towards less healthy behaviours was noticeable after the economic crisis had commenced. Public health interventions should focus on older adults, particularly of lower socioeconomic levels, in order to effectively reduce the burden of cardiometabolic disease at the population level. PMID:28173690

A mixed methods exploration of family involvement in medical care for older adults with serious mental illness.

PubMed

Aschbrenner, Kelly A; Pepin, Renee; Mueser, Kim T; Naslund, John A; Rolin, Stephanie A; Faber, Marjan J; Bartels, Stephen J

2014-01-01

Many older persons with serious mental illness (SMI) suffer from high rates of comorbid medical conditions. Although families play a critical role in psychiatric illness management among adults with SMI, their contributions to improving health outcomes in this population has received little attention. This study explored family involvement in medical care for older adults with SMI. This mixed methods study involved analysis of quantitative data collected from older adults with SMI and cardiovascular risk (n = 28) participating in a pilot study of an intervention designed to improve patient-centered primary care augmented by qualitative interviews with their relatives (n = 13) to explore family involvement in medical care. Approximately 89% of older adults with SMI reported family involvement in at least one aspect of their medical care (e.g., medication reminders, medical decision making). However, many family members reported that they were rarely involved in their relative's medical visits, and most did not perceive a need to be involved during routine care. Family members identified obesity as their relative's primary health concern and many wanted guidance from providers on effective strategies for supporting weight loss. Although many family members did not perceive a need to be involved in their relative's routine medical visits, they expressed interest in talking with providers about how to help their relative change unhealthy behaviors. Educating patients, families, and providers about the potential benefits of family involvement in medical care, including routine medical visits for persons with SMI and cardiovascular health risk may promote patient- and family-centered collaboration in this high-risk population.

An intensely sympathetic awareness: experiential similarity and cultural norms as means for gaining older African Americans' trust of scientific research.

PubMed

Sabir, Myra G; Pillemer, Karl A

2014-04-01

Well-known trust-building methods are routinely used to recruit and retain older African Americans into scientific research studies, yet the quandary over how to overcome this group's hesitance to participate in research remains. We present two innovative and testable methods for resolving the dilemma around increasing older African Americans' participation in scientific research studies. Certain specific and meaningful experiential similarities between the primary researcher and the participants, as well as clear recognition of the elders' worth and dignity, improved older African Americans' willingness to adhere to a rigorous research design. Steps taken in an intervention study produced a potentially replicable strategy for achieving strong results in recruitment, retention and engagement of this population over three waves of assessment. Sixty-two (n=62) older African Americans were randomized to treatment and control conditions of a reminiscence intervention. Sensitivity to an African American cultural form of respect for elders (recognition of worth and dignity), and intersections between the lived experience of the researcher and participants helped dispel this population's well-documented distrust of scientific research. Results suggest that intentional efforts to honor the worth and dignity of elders through high level hospitality and highlighting meaningful experiential similarities between the researcher and the participants can improve recruitment and retention results. Experiential similarities, in particular, may prove more useful to recruitment and retention than structural similarities such as age, race, or gender, which may not in themselves result in the trust experiential similarities elicit. Copyright © 2014 Elsevier Inc. All rights reserved.

[Analysis of cancer incidence and mortality in elderly population in China, 2013].

PubMed

Chen, W Q; Zheng, R S; Zhang, S W; Zeng, H M; Zou, X N; He, J

2017-01-23

Objective: To estimate the cancer incidence and mortality in elderly Chinese population in 2013 based on the data from local cancer registries submitted to National Central Cancer Registry (NCCR). Methods: Data from 255 cancer registries submitted to NCCR with qualified data after checked and evaluated, were selected for this estimation. Cancer incidence and mortality were stratified by areas, sex, age groups and cancer site, combined with population data of the year 2013 to estimate cancer epidemiology in older people in China. Chinese population census in 2000 and Segi's population were used for the estimation of age-standardized incidence/mortality rates. Results: All the 255 cancer registries (88 in urban and 167 in rural areas) were selected for this estimation, covered 37 407 728 elderly subjects, accounting for 17.73% of the entire national elderly population. It was estimated about 2 171.0 thousand new cancer cases in older people in China, accounting for 58.96% of all cancer incidence, with the crude incidence rate of 1 029.16/100 000 (1 297.96 per 100 000 in male, 777.18 per 100 000 in female), and the age-standardized incidence rate by Chinese standard population (ASIRC, 2000) was 1 019.25 per 100 000. It was estimated about 1 600.5 thousand deaths in older people in China, accounting for 67.70% of all cancer deaths, with the crude mortality of 758.72/100 000 (988.37 per 100 000 in males, 543.44 per 100 000 in females), and the age-standardized incidence rate by Chinese standard population (ASIRC, 2000) was 730.78 per 100 000. Lung cancer, stomach cancer, colorectal cancer, liver cancer and esophageal cancer were the most common cancers, accounting for about 67.70% of all cancer cases in China. Those cancers are also the most common cancers in China, accounting for about 73.45% of all cancer deaths. Conclusions: The cancer burden of elderly population in China is very serious. The major cancer incidence and mortality in urban and rural areas are similar, but the cancer patterns are very different in urban and rural areas. As cancer burdens for older people are different between urban and rural areas in China, more attention should be paid to the need of older people according to the actual situation.

Health Equity and Aging of Bisexual Older Adults: Pathways of Risk and Resilience

PubMed Central

Shiu, Chengshi; Bryan, Amanda E. B.; Goldsen, Jayn; Kim, Hyun-Jun

2017-01-01

Abstract Objectives: Bisexual older adults are a growing yet largely invisible, underserved, and understudied population. Utilizing the Health Equity Promotion Model, we examined hypothesized mechanisms accounting for health disparities between bisexual older adults and lesbian and gay older adults. Method: Based on data from Caring and Aging with Pride, the largest national survey of LGBT older adults, this study (N = 2,463) utilized structural equation modeling to investigate direct and indirect associations between sexual identity (bisexual vs. lesbian and gay) and health via sexual identity factors (identity disclosure and internalized stigma), social resources, and socioeconomic status (SES). Results: Bisexual older adults reported significantly poorer health compared with lesbian and gay older adults. Indirect effects involving sexual identity factors, social resources, and SES explained the association between bisexual identity and poorer health. A potentially protective pathway was also identified wherein bisexuals had larger social networks after adjusting for other factors. Discussion: Bisexual older adults face distinct challenges and health risks relative to other older adults, likely because of the accumulation of socioeconomic and psychosocial disadvantages across the life course. Interventions taking into account older bisexuals’ unique risk and protective factors may be helpful in reducing health inequities. PMID:27815302

Assessment of Visual Status of the Aeta, a Hunter-Gatherer Population of the Philippines (An AOS Thesis)

PubMed Central

Allingham, R. Rand

2008-01-01

Purpose A screening study was performed to assess levels of visual impairment and blindness among a representative sample of older members of the Aeta, an indigenous hunter-gatherer population living on the island of Luzon in the Philippines. Methods Unrelated older Aeta couples were randomly invited to participate in a visual screening study. All consented individuals had ocular history, medical history, complete ophthalmic examination, height, weight, and blood pressure taken. Results A total of 225 individuals were screened from 4 villages. Visual acuity, both uncorrected and pinhole corrected, was significantly worse among older vs younger age-groups for women, men, and when combined (P < .001). Visual impairment was present in 48% of uncorrected and 43% of pinhole corrected eyes in the oldest age-group. Six percent of the screened population was bilaterally blind. The major causes of blindness were readily treatable. The most common etiologies as a proportion of blind eyes were cataract (66%), refractive error (20%), and trauma (7%). No cases of primary open-angle, primary angle-closure, or exfoliation glaucoma were observed in this population. Discussion Visual impairment and blindness were common in the Aeta population. Primary forms of glaucoma, a major cause of blindness found in most population-based studies, were not observed. The absence of primary glaucoma in this population may reflect random sampling error. However, based on similar findings in the Australian Aborigine, this raises the possibility that these two similar populations may share genetic and/or environmental factors that are protective for glaucoma.. PMID:19277240

Social, Economic, and Health Disparities Among LGBT Older Adults.

PubMed

Emlet, Charles A

2016-01-01

LGBT older adults are a heterogeneous population with collective and unique strengths and challenges. Health, personal, and economic disparities exist in this group when compared to the general population of older adults, yet subgroups such as transgender and bisexual older adults and individuals living with HIV are at greater risk for disparities and poorer health outcomes. As this population grows, further research is needed on factors that contribute to promoting health equity, while decreasing discrimination and improving competent service delivery.

An eHealth Intervention to Promote Physical Activity and Social Network of Single, Chronically Impaired Older Adults: Adaptation of an Existing Intervention Using Intervention Mapping.

PubMed

Boekhout, Janet M; Peels, Denise A; Berendsen, Brenda Aj; Bolman, Catherine Aw; Lechner, Lilian

2017-11-23

Especially for single older adults with chronic diseases, physical inactivity and a poor social network are regarded as serious threats to their health and independence. The Active Plus intervention is an automated computer-tailored eHealth intervention that has been proven effective to promote physical activity (PA) in the general population of adults older than 50 years. The aim of this study was to report on the methods and results of the systematic adaptation of Active Plus to the wishes and needs of the subgroup of single people older than 65 years who have one or more chronic diseases, as this specific target population may encounter specific challenges regarding PA and social network. The Intervention Mapping (IM) protocol was used to systematically adapt the existing intervention to optimally suit this specific target population. A literature study was performed, and quantitative as well as qualitative data were derived from health care professionals (by questionnaires, n=10) and the target population (by focus group interviews, n=14), which were then systematically integrated into the adapted intervention. As the health problems and the targeted behavior are largely the same in the original and adapted intervention, the outcome of the needs assessment was that the performance objectives remained the same. As found in the literature study and in data derived from health professionals and focus groups, the relative importance and operationalization of the relevant psychosocial determinants related to these objectives are different from the original intervention, resulting in a refinement of the change objectives to optimally fit the specific target population. This refinement also resulted in changes in the practical applications, program components, intervention materials, and the evaluation and implementation strategy for the subgroup of single, chronically impaired older adults. This study demonstrates that the adaptation of an existing intervention is an intensive process in which adopting the IM protocol is an invaluable tool. The study provides a broad insight in adapting interventions aimed at single older adults with a chronic disease. It is concluded that even when the new target population is a sizable segment of the original target population, the adapted intervention still needs considerable changes to optimally fit the needs and situational differences of the narrower target population. ©Janet M Boekhout, Denise A Peels, Brenda AJ Berendsen, Catherine AW Bolman, Lilian Lechner. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 23.11.2017.

Aging baby boomers--a blessing or challenge for driver licensing authorities.

PubMed

Dobbs, Bonnie M

2008-08-01

In less than 5 years, the first wave of baby boomers will begin turning 65, with the last wave of boomers entering their senior years in January 2029. Currently, boomers make up a significant percentage of the population in Canada, the United States, and other developed countries. The baby boom generation has had a profound impact on our society over the last six decades, and this large cohort will continue to exert its influence for several decades to come. Central to this article is the rapid growth in the number of persons 65 years of age and older, beginning in 2011, with a corresponding increase in the number of older drivers. The demographic shift has important implications for licensing authorities, the regulatory bodies charged with licensing and 'fitness to drive' decisions. The objectives of this paper are to summarize the published scientific literature on licensing policies and procedures currently in use for older drivers, discuss their limitations, and provide recommendations for meeting the upcoming challenges of an aging baby boomer population of drivers. Online searches were conducted using the following databases: PsycINFO, MEDLINE, Scopus, and TRIS. Google and Google Scholar also were searched for scientific articles. References identified from database and online searches were examined for relevant articles. A number of studies have investigated the utility of different licensing policies and procedures for identifying older drivers who may be at risk for impaired driving performance. Overall, results suggest that current policies and procedures are ineffective in identifying high-risk older drivers. The results also emphasize the need for a different approach for the identification of high risk older drivers by licensing agencies. Recommendations to assist with that goal are provided. The aging of the baby boomer population, combined with the projected high crash rates for this cohort of drivers as it moves through the senior years, underscores the need for cost-effective, accurate, and efficient methods for identifying and assessing the subgroup of older drivers whose driving has declined to an unsafe level. That subgroup consists of individuals with medical conditions (and treatments) affecting driving performance. The demographic shift has been a blessing for licensing authorities in that it has created awareness of the need for a reexamination of licensing policies and procedures designed to identify those older drivers who may no longer be safe to drive. If that awareness becomes translated into effective policies and procedures that appropriately target the medically at-risk/impaired older driver rather than the older driver per se, the result will be an increase in the safety and mobility of the older driving population and increased public safety overall. However, a continued focus on older drivers rather than medically at-risk drivers will result in a costly, ineffective, and overburdened system.

Housing and respiratory health at older ages.

PubMed

Webb, E; Blane, D; de Vries, Robert

2013-03-01

A large proportion of the population of England live in substandard housing. Previous research has suggested that poor-quality housing, particularly in terms of cold temperatures, mould, and damp, poses a health risk, particularly for older people. The present study aimed to examine the association between housing conditions and objectively measured respiratory health in a large general population sample of older people in England. Data on housing conditions, respiratory health and relevant covariates were obtained from the second wave of the English Longitudinal Study of Ageing. Multivariate regression methods were used to test the association between contemporary housing conditions and respiratory health while accounting for the potential effect of other factors; including social class, previous life-course housing conditions and childhood respiratory health. Older people who were in fuel poverty or who did not live in a home they owned had significantly worse respiratory health as measured by peak expiratory flow rates. After accounting for covariates, these factors had no effect on any other measures of respiratory health. Self-reported housing problems were not consistently associated with respiratory health. The housing conditions of older people in England, particularly those associated with fuel poverty and living in rented accommodation, may be harmful to some aspects of respiratory health. This has implications for upcoming UK government housing and energy policy decisions.

Do socio-economic factors, elderly population size and service development factors influence the development of specialist mental health programs for older people?

PubMed

Shah, Ajit

2008-12-01

Despite the increase in the proportion of older people in the population, little is known about factors that facilitate the development of specialist mental health services for older people. The relationship between the presence of specialist mental health programs for older people and elderly population size, proportion of older people in the population, gross national domestic product (GDP), and various parameters of health funding, mental health funding and mental health service provision was examined in an ecological study using data from the World Health Organization. The presence of specialist mental health programs for older people was significantly associated with higher GDP, higher expenditure on healthcare and mental healthcare, the presence of a national mental health policy and a national mental health program, the availability of mental health care in primary care and the community, and higher density of psychiatric beds, psychiatrists, psychiatric nurses, psychologists and social workers. The challenge will be to persuade policy-makers in low and medium income countries, where the increase in the elderly population is most rapid, to develop specialist mental health services for older people.

Motivational interviewing for older adults in primary care: a systematic review.

PubMed

Purath, Janet; Keck, Annmarie; Fitzgerald, Cynthia E

2014-01-01

Chronic disease is now the leading cause of death and disability in United States. Many chronic illnesses experienced by older adults can be prevented or managed through behavior change, making patient counseling an essential component of disease prevention and management. Motivational Interviewing (MI), a type of conversational method, has been effective in eliciting health behavior changes in people in a variety of settings and may also be a useful tool to help older adults change. This review of the literature analyzes current research and describes potential biases of MI interventions that have been conducted in primary care settings with older adults. MI shows promise as a technique to elicit health behavior change among older adults. However, further study with this population is needed to evaluate efficacy of MI interventions in primary care settings. Copyright © 2014 Mosby, Inc. All rights reserved.

Patient Portal Use and Experience Among Older Adults: Systematic Review

PubMed Central

2017-01-01

Background The older adult population (65 years or older) in the United States is growing, and it is important for communities to consider ways to support the aging population. Patient portals and electronic personal health records (ePHRs) are technologies that could better serve populations with the highest health care needs, such as older adults. Objective The aim of this study was to assess the existing research landscape related to patient portal and ePHR use and experience among older adults and to understand the benefits and barriers to older adults’ use and adoption of patient portals and ePHRs. Methods We searched six pertinent bibliographic databases for papers, published from 2006 to 2016 and written in English, that focused on adults 60 years or older and their use of or experience with patient portals or ePHRs. We adapted preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines to review papers based on exclusion and inclusion criteria. We then applied thematic analysis to identify key themes around use, experience, and adoption. Results We retrieved 199 papers after an initial screening and removal of duplicate papers. Then we applied an inclusion and exclusion criteria, resulting in a final set of 17 papers that focused on 15 separate projects. The majority of papers described studies involving qualitative research, including interviews and focus groups. They looked at the experience and use of ePHRs and patient portals. Overall, we found 2 main barriers to use: (1) privacy and security and (2) access to and ability to use technology and the Internet. We found 2 facilitators: (1) technical assistance and (2) family and provider advice. We also reported on older adults’ experience, including satisfaction with the system and improvement of the quality of their health care. Several studies captured features that older adults wanted from these systems such as further assistance managing health-related tasks and contextual health advice and tips. Conclusions More research is needed to better understand the patient portal experience among older adults from initial use to adoption. There are also opportunities to explore the role of design in addressing barriers and supporting facilitators to patient portal and ePHR use. Finally, the future use of these systems by older adults should be anticipated and considered in the design process. PMID:29038093

Disparities in Health and Disability Among Older Adults in Same-Sex Cohabiting Relationships

PubMed Central

Gonzales, Gilbert; Henning-Smith, Carrie

2014-01-01

Objectives The present study compared indicators of impaired health and disability between older adults in same-sex cohabiting relationships and their peers in opposite-sex cohabiting relationships. Methods Data were obtained on men (n=698) and women (n=630) aged 50 years and older and in self-reported same-sex relationships from the National Health Interview Survey. Multiple regression analyses were conducted to estimate differences in physical health, mental health and disability status. Results Compared to their peers in married opposite-sex relationships, older men in same-sex relationships exhibited greater odds of psychological distress, and older women in same-sex relationships experienced elevated odds of poor/fair health, needing help with ADLs and IADLs, functional limitations, and psychological distress. Discussion This study adds to the limited information on health and disability among older lesbian, gay and bisexual adults. As this population grows, gerontologists must develop a better understanding of the unique issues and challenges facing them and their families. PMID:25253727

Core data elements tracking elder sexual abuse.

PubMed

Hanrahan, Nancy P; Burgess, Ann W; Gerolamo, Angela M

2005-05-01

Sexual abuse in the older adult population is an understudied vector of violent crimes with significant physical and psychological consequences for victims and families. Research requires a theoretical framework that delineates core elements using a standardized instrument. To develop a conceptual framework and identify core data elements specific to the older adult population, clinical, administrative, and criminal experts were consulted using a nominal group method to revise an existing sexual assault instrument. The revised instrument could be used to establish a national database of elder sexual abuse. The database could become a standard reference to guide the detection, assessment, and prosecution of elder sexual abuse crimes as well as build a base from which policy makers could plan and evaluate interventions that targeted risk factors.

Fatigue in a Representative Population of Older Persons and Its Association With Functional Impairment, Functional Limitation, and Disability

PubMed Central

Nayfield, Susan G.; Patel, Kushang V.; Eldadah, Basil; Cesari, Matteo; Ferrucci, Luigi; Ceresini, Graziano; Guralnik, Jack M.

2009-01-01

Background Older persons often complain of fatigue, but the functional consequences of this symptom are unclear. The aim of the present study was to evaluate fatigue and its association with measures of physical function and disability in a representative sample of the older population. Methods Cross-sectional data from a population-based sample of 1,055 Italian men and women aged 65 and older were analyzed. Fatigue was defined according to two questions evaluating whether participants felt that “everything was an effort” and/or they “could not get going” on three or more days in the past week. Objective measures of physical function were handgrip strength, the Short Physical Performance Battery (SPPB), and 400-m walking speed. Disability was defined as the inability to complete the 400-m walk test and self-reported difficulty in activities of daily living (ADL) and instrumental activities of daily living (IADL). Results The prevalence of fatigue was higher in women (29%) than in men (15%). In age-adjusted analyses, fatigued men and women had weaker handgrip strength, lower SPPB score, slower walking speed, and higher mobility, ADL, and IADL disability than nonfatigued persons. Further adjustment for health behaviors, diseases, inflammatory markers, and thyroid function generally reduced the relationship between fatigue and functional outcomes, but fatigue remained significantly associated with SPPB score, walking speed, and mobility and IADL disability. Conclusions Older persons who report fatigue had significantly poorer functional status than those who did not report this symptom. The causal link between fatigue and these outcomes should be further investigated. PMID:19176328

Using scenarios and personas to enhance the effectiveness of heuristic usability evaluations for older adults and their care team.

PubMed

Kneale, Laura; Mikles, Sean; Choi, Yong K; Thompson, Hilaire; Demiris, George

2017-09-01

Using heuristics to evaluate user experience is a common methodology for human-computer interaction studies. One challenge of this method is the inability to tailor results towards specific end-user needs. This manuscript reports on a method that uses validated scenarios and personas of older adults and care team members to enhance heuristics evaluations of the usability of commercially available personal health records for homebound older adults. Our work extends the Chisnell and Redish heuristic evaluation methodology by using a protocol that relies on multiple expert reviews of each system. It further standardizes the heuristic evaluation process through the incorporation of task-based scenarios. We were able to use the modified version of the Chisnell and Redish heuristic evaluation methodology to identify potential usability challenges of two commercially available personal health record systems. This allowed us to: (1) identify potential usability challenges for specific types of users, (2) describe improvements that would be valuable to all end-users of the system, and (3) better understand how the interactions of different users may vary within a single personal health record. The methodology described in this paper may help designers of consumer health information technology tools, such as personal health records, understand the needs of diverse end-user populations. Such methods may be particularly helpful when designing systems for populations that are difficult to recruit for end-user evaluations through traditional methods. Copyright © 2017 Elsevier Inc. All rights reserved.

Concordance of Motion Sensor and Clinician-Rated Fall Risk Scores in Older Adults.

PubMed

Elledge, Julie

2017-12-01

As the older adult population in the United States continues to grow, developing reliable, valid, and practical methods for identifying fall risk is a high priority. Falls are prevalent in older adults and contribute significantly to morbidity and mortality rates and rising health costs. Identifying at-risk older adults and intervening in a timely manner can reduce falls. Conventional fall risk assessment tools require a health professional trained in the use of each tool for administration and interpretation. Motion sensor technology, which uses three-dimensional cameras to measure patient movements, is promising for assessing older adults' fall risk because it could eliminate or reduce the need for provider oversight. The purpose of this study was to assess the concordance of fall risk scores as measured by a motion sensor device, the OmniVR Virtual Rehabilitation System, with clinician-rated fall risk scores in older adult outpatients undergoing physical rehabilitation. Three standardized fall risk assessments were administered by the OmniVR and by a clinician. Validity of the OmniVR was assessed by measuring the concordance between the two assessment methods. Stability of the OmniVR fall risk ratings was assessed by measuring test-retest reliability. The OmniVR scores showed high concordance with the clinician-rated scores and high stability over time, demonstrating comparability with provider measurements.

Mind over bladder: Women, aging, and bladder health.

PubMed

Long, Joanna E; Khairat, Saif; Chmelo, Elizabeth; Palmer, Mary H

The purpose of this study was to explore the efficacy and acceptability of an innovative, electronically delivered self-management intervention for urinary incontinence (UI) that included daily mindfulness practice, completion of sequential bladder diaries, and bladder health education to improve UI in older women living independently in a retirement community. A mixed methods pilot study was conducted over ten weeks using a custom website or CD. Ten women were recruited and 8 completed the study; 5 of those (71%) experienced fewer daily UI episodes post intervention (p = 0.055). The women also reported a statistically significant decrease in the impact UI had on their everyday life (p = 0.04). Seventy-one percent (N = 5) reported subjective improvement in UI, and high acceptability scores also were achieved. The intervention was both effective in helping older women self-manage UI and acceptable to the population group. Further research is needed with a larger and diverse population of older women. Copyright © 2017 Elsevier Inc. All rights reserved.

HIV after 40 in rural South Africa: A life course approach to HIV vulnerability among middle aged and older adults.

PubMed

Mojola, Sanyu A; Williams, Jill; Angotti, Nicole; Gómez-Olivé, F Xavier

2015-10-01

South Africa has the highest number of people living with HIV in the world (over 6 million) as well as a rapidly aging population, with 15% of the population aged 50 and over. High HIV prevalence in rural former apartheid homeland areas suggests substantial aging with HIV and acquisition of HIV at older ages. We develop a life course approach to HIV vulnerability, highlighting the rise and fall of risk and protection as people age, as well as the role of contextual density in shaping HIV vulnerability. Using this approach, we draw on an innovative multi-method data set collected within the Agincourt Health and Demographic Surveillance System in South Africa, combining survey data with 60 nested life history interviews and 9 community focus group interviews. We examine HIV risk and protective factors among adults aged 40-80, as well as how and why these factors vary among people at older ages. Copyright © 2015 Elsevier Ltd. All rights reserved.

HIV after 40 in Rural South Africa1: A Life Course Approach to HIV Vulnerability among Middle Aged and Older Adults

PubMed Central

Williams, Jill; Angotti, Nicole; Gómez-Olivé, Xavier

2015-01-01

South Africa has the highest number of people living with HIV in the world (over 6 million) as well as a rapidly aging population, with 15% of the population aged 50 and over. High HIV prevalence in rural former apartheid homeland areas suggests substantial aging with HIV and acquisition of HIV at older ages. We develop a life course approach to HIV vulnerability, highlighting the rise and fall of risk and protection as people age, as well as the role of contextual density in shaping HIV vulnerability. Using this approach, we draw on an innovative multi-method data set collected within the Agincourt Health and Demographic Surveillance System in South Africa, combining survey data with 60 nested life history interviews and 9 community focus group interviews. We examine HIV risk and protective factors among adults aged 40–80, as well as how and why these vary among people at older ages. PMID:26364007

There is no age limit for methadone: a retrospective cohort study

PubMed Central

2011-01-01

Background Data from the US indicates that methadone-maintained populations are aging, with an increase of patients aged 50 or older. Data from European methadone populations is sparse. This retrospective cohort study sought to evaluate the age trends and related developments in the methadone population of Basel-City, Switzerland. Methods The study included methadone patients between April 1, 1995 and March 31, 2003. Anonymized data was taken from the methadone register of Basel-City. For analysis of age distributions, patient samples were split into four age categories from '20-29 years' to '50 years and over'. Cross-sectional comparisons were performed using patient samples of 1996 and 2003. Results Analysis showed a significant increase in older patients between 1996 and 2003 (p < 0.001). During that period, the percentage of patients aged 50 and over rose almost tenfold, while the proportion of patients aged under 30 dropped significantly from 52.8% to 12.3%. The average methadone dose (p < 0.001) and the 1-year retention rate (p < 0.001) also increased significantly. Conclusions Findings point to clear trends in aging of methadone patients in Basel-City which are comparable, although less pronounced, to developments among US methadone populations. Many unanswered questions on medical, psychosocial and health economic consequences remain as the needs of older patients have not yet been evaluated extensively. However, older methadone patients, just as any other patients, should be accorded treatment appropriate to their medical condition and needs. Particular attention should be paid to adequate solutions for persons in need of care. PMID:21592331

Multidimensional Attitudes of Emergency Medicine Residents Toward Older Adults

PubMed Central

Hogan, Teresita M.; Chan, Shu B.; Hansoti, Bhakti

2014-01-01

Introduction The demands of our rapidly expanding older population strain many emergency departments (EDs), and older patients experience disproportionately high adverse health outcomes. Trainee attitude is key in improving care for older adults. There is negligible knowledge of baseline emergency medicine (EM) resident attitudes regarding elder patients. Awareness of baseline attitudes can serve to better structure training for improved care of older adults. The objective of the study is to identify baseline EM resident attitudes toward older adults using a validated attitude scale and multidimensional analysis. Methods Six EM residencies participated in a voluntary anonymous survey delivered in summer and fall 2009. We used factor analysis using the principal components method and Varimax rotation, to analyze attitude interdependence, translating the 21 survey questions into 6 independent dimensions. We adapted this survey from a validated instrument by the addition of 7 EM-specific questions to measures attitudes relevant to emergency care of elders and the training of EM residents in the geriatric competencies. Scoring was performed on a 5-point Likert scale. We compared factor scores using student t and ANOVA. Results 173 EM residents participated showing an overall positive attitude toward older adults, with a factor score of 3.79 (3.0 being a neutral score). Attitudes trended to more negative in successive post-graduate year (PGY) levels. Conclusion EM residents demonstrate an overall positive attitude towards the care of older adults. We noted a longitudinal hardening of attitude in social values, which are more negative in successive PGY-year levels. PMID:25035760

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

PubMed Central

Chen, Chih-Chen

2016-01-01

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

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

PubMed

Chen, Chih-Chen

2016-04-01

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

The Epidemiology of Social Isolation: National Health & Aging Trends Study.

PubMed

Cudjoe, Thomas K M; Roth, David L; Szanton, Sarah L; Wolff, Jennifer L; Boyd, Cynthia M; Thorpe, Roland J

2018-03-26

Social isolation among older adults is an important but under-recognized risk for poor health outcomes. Methods are needed to identify subgroups of older adults at risk for social isolation. We constructed a typology of social isolation using data from the National Health and Aging Trends Study (NHATS) and estimated the prevalence and correlates of social isolation among community-dwelling older adults. The typology was formed from four domains: living arrangement, core discussion network size, religious attendance, and social participation. In 2011, 24% of self-responding, community-dwelling older adults (65+ years), approximately 7.7 million people, were characterized as socially isolated, including 1.3 million (4%) who were characterized as severely socially isolated. Multinomial multivariable logistic regression indicated that being unmarried, male, having low education, and low income were all independently associated with social isolation. Black and Hispanic older adults had lower odds of social isolation compared to White older adults, after adjusting for covariates. Social isolation is an important and potentially modifiable risk that affects a significant proportion of the older adult population.

Examining mindfulness-based stress reduction: Perceptions from minority older adults residing in a low-income housing facility

PubMed Central

2011-01-01

Background Mindfulness-based stress reduction (MBSR) programs are becoming increasingly common, but have not been studied in low income minority older populations. We sought to understand which parts of MBSR were most important to practicing MBSR members of this population, and to understand whether they apply their training to daily challenges. Methods We conducted three focus groups with 13 current members of an MBSR program. Participants were African American women over the age of 60 in a low-income housing residence. We tape recorded each session and subsequently used inductive content analysis to identify primary themes. Results and discussion Analysis of the focus group responses revealed three primary themes stress management, applying mindfulness, and the social support of the group meditation. The stressors they cited using MBSR with included growing older with physical pain, medical tests, financial strain, and having grandchildren with significant mental, physical, financial or legal hardships. We found that participants particularly used their MBSR training for coping with medical procedures, and managing both depression and anger. Conclusion A reflective stationary intervention delivered in-residence could be an ideal mechanism to decrease stress in low-income older adult's lives and improve their health. PMID:21627807

Systematic review of descriptive studies that investigated associated factors with the management of incontinence in older people in care homes.

PubMed

Roe, Brenda; Flanagan, Lisa; Jack, Barbara; Shaw, Christine; Williams, Kate; Chung, Alan; Barrett, James

2013-03-01

Incontinence is prevalent among older populations and residents in care homes. This paper is a review of descriptive studies that investigated associated factors related to managing urinary incontinence in older people in care homes. A systematic literature review was undertaken. MEDLINE and CINHAL were searched from 1996-2010 using the Cochrane Incontinence Review Group search strings for urinary and faecal incontinence including all research designs. Sixteen studies were identified that reported on associated factors related to comorbidities, management preferences, policies, staff views and knowledge or methodological studies. Non-invasive methods involving toileting and use of pads were common management approaches. No studies aimed at maintaining continence were identified. Factors associated with incontinence need to also be considered when planning and managing care for individuals, and developing and designing systems of care within care homes. Further study in care home populations to change or inform practice and provide effective care is warranted. Preventive studies that maintain continence are required. Older people and their families should be involved with decisions regarding their preferred care, goals, management and outcomes for managing incontinence, promoting or maintaining continence. © 2011 Blackwell Publishing Ltd.

Engaging older adults in burn prevention education: results of a community-based urban initiative.

PubMed

Leahy, Nicole E; Sessler, Kelly A; Baggott, Kaitlin; Laverde, Louisa; Rabbitts, Angela; Yurt, Roger W

2012-01-01

The objective of the study is to educate New York City seniors aged 60 years and older about fire safety and burn prevention through the use of a community-based, culturally sensitive delivery platform. The ultimate goal is to reduce burn injury morbidity and mortality among this at-risk population. Programming was developed and provided to older adults attending community-based senior centers. Topics included etiology of injury, factors contributing to burn injuries, methods of prevention, emergency preparedness, and home safety. Attendees completed a postpresentation survey. Of the 234 senior centers invited to participate in the program, 64 (27%) centers requested presentations, and all received the educational programming, reaching 2196 seniors. An additional 2590 seniors received education during community-based health fairs. A majority reported learning new information, found the presentation helpful, and intended to apply this knowledge to daily routines. Data confirm that many opportunities exist to deliver culturally sensitive burn prevention programming to the older adult population of this large metropolitan area in settings that are part of their daily lives. A majority of respondents welcomed the information, perceived it as helpful, and reported that they were likely to integrate the information into their lives.

Usefulness of the group-comparison method to demonstrate sex differences in spatial orientation and spatial visualization in older men and women.

PubMed

Cohen, D

1976-10-01

This paper reports an analysis of sex differences in cognitive test scores covering the dimensions of spatial orientation and spatial visualization in groups of 6 older men and 6 women matched for speed of performance on a maze test and level of performance on a spatial relations task. Older men were more proficient solving spatial problems using the body as a referent, whereas there was no significant difference between the sexes in imagining spatial displacement. Matched comparisons appear a useful adjunct to population research to understand the type(s) of cognitive processes where differential performance by the sexes is observed.

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

Multitasking in older adults with type 2 diabetes: A cross-sectional analysis

PubMed Central

McDowd, Joan M.; Mahnken, Jonathan D.; Burns, Jeffrey M.; Sabus, Carla H.; Britton-Carpenter, Amanda J.; Utech, Nora B.; Kluding, Patricia M.

2017-01-01

Background and purpose Deficits in the ability to multitask contribute to gait abnormalities and falls in many at-risk populations. However, it is unclear whether older adults with type 2 diabetes mellitus (DM) also demonstrate impairments in multitasking. The purpose of this study was to compare multitasking performance in cognitively intact older adults with and without DM and explore its relationship to measures of gait and functional ability. Methods We performed a cross-sectional analysis of 40 individuals aged 60 and older with type 2 DM and a matched group of 40 cognitively intact older adults without DM. Multitasking was examined via the ambulatory Walking and Remembering Test (WART) and seated Pursuit Rotor Test (PRT). Self-selected normal and fast walking speed and stride length variability were quantitatively measured, and self-reported functional ability was assessed via the Late Life Function and Disability Index (LLFDI). Results Participants with DM walked slower and took more steps off path when multitasking during the WART. No between-group differences in multitasking performance were observed on the PRT. Multitasking performance demonstrated little correlation with gait and functional ability in either group. Discussion and conclusions Older adults with DM appear to perform poorly on an ambulatory measure of multitasking. However, we analyzed a relatively small, homogenous sample of older adults with and without type 2 DM and factors such as peripheral neuropathy and the use of multiple comparisons complicate interpretation of the data. Future research should explore the interactions between multitasking and safety, fall risk, and function in this vulnerable population. Clinicians should recognize that an array of factors may contribute to gait and physical dysfunction in older adults with type 2 diabetes, and be prepared to assess and intervene appropriately. PMID:29045492

Traffic safety facts 1996 : older population

DOT National Transportation Integrated Search

1997-01-01

There are approximately 24 million people age 70 years and older in the United States. In 1996, this age group made up 9 percent of the total U.S. resident population, compared with 8 percent in 1986. From 1986 to 1996, this older segment of the popu...

Demographic Trends of Adults in New York City Opioid Treatment Programs--An Aging Population.

PubMed

Han, Benjamin; Polydorou, Soteri; Ferris, Rosie; Blaum, Caroline S; Ross, Stephen; McNeely, Jennifer

2015-01-01

The population of adults accessing opioid treatment is growing older, but exact estimates vary widely, and little is known about the characteristics of the aging treatment population. Further, there has been little research regarding the epidemiology, healt h status, and functional impairments in this population. To determine the utilization of opioid treatment services by older adults in New York City. This study used administrative data from New York State licensed drug treatment programs to examine overall age trends and characteristics of older adults in opioid treatment programs in New York City from 1996 to 2012. We found significant increases in utilization of opioid treatment programs by older adults in New York City. By 2012, those aged 50-59 made up the largest age group in opioid treatment programs. Among older adults there were notable shifts in demographic background including gender and ethnicity, and an increase in self-reported impairments. More research is needed to fully understand the specific characteristics and needs of older adults with opioid dependence.

The Issue of Age Estimation in a Modern Skeletal Population: Are Even the More Modern Current Aging Methods Satisfactory for the Elderly?

PubMed

Cappella, Annalisa; Cummaudo, Marco; Arrigoni, Elena; Collini, Federica; Cattaneo, Cristina

2017-01-01

The main idea behind age assessment in adults is related to the analysis of the physiological degeneration of particular skeletal structures with age. The main issues with these procedures are due to the fact that they have not been tested on different modern populations and in different taphonomic contexts and that they tend to underestimate the age of older individuals. The purpose of this study was to test the applicability and the reliability of these methods on a contemporary population of skeletal remains of 145 elderly individuals of known sex and age. The results show that, due to taphonomic influences, some skeletal sites showed a lower survival. Therefore, the methods with the highest percentage of applicability were Lovejoy (89.6%) and Rougé-Maillart (81.3%), followed by Suchey-Brooks (59.3%), and those with the lowest percentage of applicability were Beauthier (26.2%) and Iscan (22.7%). In addition, this research has shown how for older adults the study of both acetabulum and auricular surface may be more reliable for aging. This is also in accordance with the fact that auricular surface and the acetabulum are the areas more frequently surviving taphonomic insult. © 2016 American Academy of Forensic Sciences.

An Evaluation of Wellness Assessment Visualizations for Older Adults

PubMed Central

Reeder, Blaine; Yoo, Daisy; Aziz, Rafae; Thompson, Hilaire J.; Demiris, George

2015-01-01

Abstract Background Smart home technologies provide a valuable resource to unobtrusively monitor health and wellness within an older adult population. However, the breadth and density of data available along with aging associated decreases in working memory, prospective memory, spatial cognition, and processing speed can make it challenging to comprehend for older adults. We developed visualizations of smart home health data integrated into a framework of wellness. We evaluated the visualizations through focus groups with older adults and identified recommendations to guide the future development of visualizations. Materials and Methods We conducted four focus groups with older adult participants (n=31) at an independent retirement community. Participants were presented with three different visualizations from a wellness pilot study. A qualitative descriptive analysis was conducted to identify thematic content. Results We identified three themes related to processing and application of visualizations: (1) values of visualizations for wellness assessment, (2) cognitive processing approaches to visualizations, and (3) integration of health data for visualization. In addition, the focus groups highlighted key design considerations of visualizations important towards supporting decision-making and evaluation assessments within integrated health displays. Conclusions Participants found inherent value in having visualizations available to proactively engage with their healthcare provider. Integrating the visualizations into a wellness framework helped reduce the complexity of raw smart home data. There has been limited work on health visualizations from a consumer perspective, in particular for an older adult population. Creating appropriately designed visualizations is valuable towards promoting consumer involvement within the shared decision-making process of care. PMID:25401414

Traffic safety facts 1995 : older population

DOT National Transportation Integrated Search

1996-01-01

There are approximately 23.6 million people age 70 years and older in the United States. In 1995, this age group made up 9 percent of the total U.S. resident population, compared with 8 percent in 1985. From 1985 to 1995, this older segment of the po...

Traffic safety facts 1993 : older population

DOT National Transportation Integrated Search

1994-01-01

There are almost 23 million people age 70 years and older in the United States. In 1993, this age group made up 8.8 percent of the total U.S. resident population, compared with 7.8 percent in 1983. From 1983 to 1993, this older segment of the populat...

Traffic safety facts 1999 : older population

DOT National Transportation Integrated Search

2000-01-01

There are more than 25 million people age 70 years and older in the United States. In 1999, this age group made up 9 percent of the total U.S. resident population, compared with 8 percent in 1989. From 1989 to 1999, this older segment of the populati...

A Study of the Impacts of Navigational Links, Task Complexity, and Experience with the Older User on Website Usability in a Community College Domain

ERIC Educational Resources Information Center

Garrett, Robin Eileen

2014-01-01

Community colleges serve a diverse population of learners including many older students counting on the community college for enhanced skills or personal enrichment. Many of these colleges target this population with programs designed specifically to meet the needs and goals of the older adult but may not consider this population when designing a…

The impact of breast cancer-specific birth cohort effects among younger and older Chinese populations.

PubMed

Sung, Hyuna; Rosenberg, Philip S; Chen, Wan-Qing; Hartman, Mikael; Lim, Wei-Yen; Chia, Kee Seng; Wai-Kong Mang, Oscar; Tse, Lapah; Anderson, William F; Yang, Xiaohong R

2016-08-01

Historically low breast cancer incidence rates among Asian women have risen worldwide; purportedly due to the adoption of a "Western" life style among younger generations (i.e., the more recent birth cohorts). However, no study has simultaneously compared birth cohort effects between both younger and older women in different Asian and Western populations. Using cancer registry data from rural and urban China, Singapore and the United States (1990-2008), we estimated age-standardized incidence rates (ASR), annual percentage change (EAPC) in the ASR, net drifts, birth cohort specific incidence rates and cohort rate ratios (CRR). Younger (30-49 years, 1943-1977 birth cohorts) and older women (50-79 years; 1913-1957 birth cohorts) were assessed separately. CRRs among Chinese populations were estimated using birth cohort specific rates with US non-Hispanic white women (NHW) serving as the reference population with an assigned CRR of 1.0. We observed higher EAPCs and net drifts among those Chinese populations with lower ASRs. Similarly, we observed the most rapidly increasing cohort-specific incidence rates among those Chinese populations with the lowest baseline CRRs. Both trends were more significant among older than younger women. Average CRRs were 0.06-0.44 among older and 0.18-0.81 among younger women. Rapidly rising cohort specific rates have narrowed the historic disparity between Chinese and US NHW breast cancer populations particularly in regions with the lowest baseline rates and among older women. Future analytic studies are needed to investigate risk factors accounting for the rapid increase of breast cancer among older and younger women separately in Asian populations. © 2016 UICC.

Horizontal inequity in outpatient care use and untreated morbidity: evidence from nationwide surveys in India between 1995 and 2014.

PubMed

Pandey, Anamika; Ploubidis, George B; Clarke, Lynda; Dandona, Lalit

2017-09-01

Equity in healthcare has been a long-term guiding principle of health policy in India. We estimate the change in horizontal inequities in healthcare use over two decades comparing the older population (60 years or more) with the younger population (under 60 years). We used data from the nationwide healthcare surveys conducted in India by the National Sample Survey Organization in 1995-96 and 2014 with sample sizes 633 405 and 335 499, respectively. Bivariate and multivariate logit regression analyses were used to study the socioeconomic differentials in self-reported morbidity (SRM), outpatient care and untreated morbidity. Deviations in the degree to which healthcare was distributed according to need were measured by horizontal inequity index (HI). In each consumption quintile the older population had four times higher SRM and outpatient care rate than the younger population in 2014. In 1995-96, the pro-rich inequity in outpatient care was higher for the older (HI: 0.085; 95% CI: 0.066, 0.103) than the younger population (0.039; 0.034, 0.043), but by 2014 this inequity became similar. Untreated morbidity was concentrated among the poor; more so for the older (-0.320; -0.391, -0.249) than the younger (-0.176; -0.211, -0.141) population in 2014. The use of public facilities increased most in the poorest and poor quintiles; the increase was higher for the older than the younger population in the poorest (1.19 times) and poor (1.71 times) quintiles. The use of public facilities was disproportionately higher for the poor in 2014 than in 1995-96 for the older (-0.189; -0.234, -0.145 vs - 0.065; -0.129, -0.001) and the younger (-0.145; -0.175, -0.115 vs - 0.056; -0.086, -0.026) population. The older population has much higher morbidity and is often more disadvantaged in obtaining treatment. Health policy in India should pay special attention to equity in access to healthcare for the older population. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

Psychometric properties and confirmatory factor analysis of the CASP-19, a measure of quality of life in early old age: the HAPIEE study

PubMed Central

Kim, Gyu Ri; Netuveli, Gopalakrishnan; Blane, David; Peasey, Anne; Malyutina, Sofia; Simonova, Galina; Kubinova, Ruzena; Pajak, Andrzej; Croezen, Simone; Bobak, Martin; Pikhart, Hynek

2015-01-01

Objectives: The aim was to assess the reliability and validity of the quality of life (QoL) instrument CASP-19, and three shorter versions of CASP-12 in large population sample of older adults from the HAPIEE (Health, Alcohol, and Psychosocial factors In Eastern Europe) study. Methods: From the Czech Republic, Russia, and Poland, 13,210 HAPIEE participants aged 50 or older completed the retirement questionnaire including CASP-19 at baseline. Three shorter 12-item versions were also derived from original 19-item instrument. Psychometric validation used confirmatory factor analysis, Cronbach's alpha, Pearson's correlation, and construct validity. Results: The second-order four-factor model of CASP-19 did not provide a good fit to the data. Two-factor CASP-12v.3 including residual covariances for negative items to account for the method effect of negative items had the best fit to the data in all countries (CFI = 0.98, TLI = 0.97, RMSEA = 0.05, and WRMR = 1.65 in the Czech Republic; 0.96, 0.94, 0.07, and 2.70 in Poland; and 0.93, 0.90, 0.08, and 3.04 in Russia). Goodness-of-fit indices for the two-factor structure were substantially better than second-order models. Conclusions: This large population-based study is the first validation study of CASP scale in Central and Eastern Europe (CEE), which includes a general population sample in Russia, Poland, and the Czech Republic. The results of this study have demonstrated that the CASP-12v.3 is a valid and reliable tool for assessing QoL among adults aged 50 years or older. This version of CASP is recommended for use in future studies investigating QoL in the CEE populations. PMID:25059754

The Sex, Age, and Me study: recruitment and sampling for a large mixed-methods study of sexual health and relationships in an older Australian population.

PubMed

Lyons, Anthony; Heywood, Wendy; Fileborn, Bianca; Minichiello, Victor; Barrett, Catherine; Brown, Graham; Hinchliff, Sharron; Malta, Sue; Crameri, Pauline

2017-09-01

Older people are often excluded from large studies of sexual health, as it is assumed that they are not having sex or are reluctant to talk about sensitive topics and are therefore difficult to recruit. We outline the sampling and recruitment strategies from a recent study on sexual health and relationships among older people. Sex, Age and Me was a nationwide Australian study that examined sexual health, relationship patterns, safer-sex practices and STI knowledge of Australians aged 60 years and over. The study used a mixed-methods approach to establish baseline levels of knowledge and to develop deeper insights into older adult's understandings and practices relating to sexual health. Data collection took place in 2015, with 2137 participants completing a quantitative survey and 53 participating in one-on-one semi-structured interviews. As the feasibility of this type of study has been largely untested until now, we provide detailed information on the study's recruitment strategies and methods. We also compare key characteristics of our sample with national estimates to assess its degree of representativeness. This study provides evidence to challenge the assumptions that older people will not take part in sexual health-related research and details a novel and successful way to recruit participants in this area.

Traffic safety facts 1994 : older population

DOT National Transportation Integrated Search

1995-01-01

There are more than 23.2 million people age 70 years and older in the United States. In 1994, this age group made up 8.9 percent of the total U.S. resident population, compared with 7.9 percent in 1984. From 1984 to 1994, this older segment of the po...

Dietary blueberry improves cognition among older adults in a randomized, double-blind, placebo-controlled trial

USDA-ARS?s Scientific Manuscript database

As populations shift to include a larger proportion of older adults, the necessity of research targeting older populations is becoming increasingly apparent. Changes in motor coordination during ‘normal’ aging, in animals and humans, include decrements in balance and locomotion. Parallel to alterati...

Traffic safety facts 2000 : older population

DOT National Transportation Integrated Search

2001-01-01

There are more than 25 million people age 70 years and older in the United States. In 2000, this age group made up 9.2 percent of the total U.S. resident population, compared with 8.5 percent in 1990. From 1990 to 2000, this older segment of the popu...

Bone material strength is associated with areal BMD but not with prevalent fractures in older women.

PubMed

Rudäng, R; Zoulakis, M; Sundh, D; Brisby, H; Diez-Perez, A; Johansson, L; Mellström, D; Darelid, A; Lorentzon, M

2016-04-01

Reference point indentation is a novel method to assess bone material strength index (BMSi) in vivo. We found that BMSi at the mid-tibia was weakly associated with spine and hip areal bone mineral density but not with prevalent fracture in a population-based cohort of 211 older women. Reference point indentation is a novel method to assess BMSi in vivo. Lower BMSi has been observed in patients with prior fracture than in controls, but no association between BMSi and areal bone mineral density (aBMD) has been found. Population-based association studies and prospective studies with BMSi and fractures are lacking. We hypothesized that BMSi would be associated with prevalent fractures in older Swedish women. The aim was to investigate the associations between BMSi, aBMD, and prevalent fracture in older women. Two hundred eleven women, mean age 78.3 ± 1.1 years, were included in this cross-sectional, population-based study. BMSi was assessed using the OsteoProbe device at the mid-tibia. Areal BMD of the hip, spine, and non-dominant radius was measured using dual-energy X-ray absorptiometry (DXA). Fracture history was retrieved using questionnaires, and vertebral fractures were identified using vertebral fracture assessment (VFA) by DXA. One hundred ninety-eight previous fractures in 109 subjects were reported. A total of 106 women had a vertebral fracture, of which 58 women had moderate or severe fractures. An inverse correlation between BMSi and weight (r = -0.14, p = 0.04) was seen, and BMSi differed according to operator (ANOVA p < 0.01). Adjusting for weight and operator in a linear regression model, we found that BMSi was positively associated with aBMD of the total hip (β = 0.14, p = 0.04), non-dominant radius (β = 0.17, p = 0.02), and lumbar spine (L1-L4) (β = 0.14, p < 0.05). Using logistic regression, we could not find any association in crude or adjusted BMSi (for age, weight, height, walking speed, calcium intake, smoking, bisphosphonate and glucocorticoid use, and operator) with prevalent fractures. We conclude that BMSi is associated with aBMD but not with prevalent fracture in a population-based cohort of 211 older women.

Comorbidity among older American Indians: the native elder care study.

PubMed

Goins, R Turner; Pilkerton, Courtney S

2010-12-01

Comorbidity is a growing challenge and the older adult population is most at risk of developing comorbid conditions. Comorbidity is associated with increased risk of mortality, increased hospitalizations, increased doctor visits, increased prescription medications, nursing home placement, poorer mental health, and physical disability. American Indians experience some of the highest rates of chronic conditions, but to date there have been only two published studies on the subject of comorbidity in this population. With a community-based sample of 505 American Indians aged 55 years or older, this study identified the most prevalent chronic conditions, described comorbidity, and identified socio-demographic, functional limitations, and psychosocial correlates of comorbidity. Results indicated that older American Indians experience higher rates of hypertension, diabetes, back pain, and vision loss compared to national statistics of older adults. Two-thirds of the sample experienced some degree of comorbidity according to the scale used. Older age, poorer physical functioning, more depressive symptomatology, and lower personal mastery were all correlates of higher comorbidity scores. Despite medical advances increasing life expectancy, morbidity and mortality statistics suggest that the health of older American Indians lags behind the majority population. These findings highlight the importance of supporting chronic care and management services for the older American Indian population.

Challenges in the Management of Hypertension in Older Populations.

PubMed

Pont, Lisa; Alhawassi, Tariq

2017-01-01

The prevalence of hypertension increases with age making it a significant health concern for older persons. Aging involves a range of physiological changes such as increases in arterial stiffness, widening pulse pressure, changes in renin and aldosterone levels, decreases in renal salt excretion, declining in renal function, changes in the autonomic nervous system sensitivity and function and changes to endothelial function all of which may not only affect blood pressure but may also affect individual response to pharmacotherapy used to manage hypertension and prevent end organ damage and other complications associated with poor blood pressure control.Unlike many chronic conditions where there is limited evidence for management in older populations, there is good evidence regarding the management of hypertension in the elderly. The findings from multiple large, robust trials have provided a solid evidence-base regarding the management of hypertension in older adults, showing that reduction of blood pressure in older hypertensive populations is associated with reduced mortality and morbidity. Diuretics, agents action on the renin angiotensin system, beta blockers and calcium channel blockers have all been well studied in older populations both in view of the benefits associated with blood pressure lowering and the risks associated with associated adverse events. While all antihypertensive agents will lower blood pressure, when managing hypertension in older persons the choice of agent is dependent not only on the ability to lower blood pressure but also on the potential for harm with older persons. Understanding such potential harms in older populations is essential with older persons experiencing increased sensitivity to many of the adverse effects such as dizziness associated with the use of antihypertensive agents.Despite the wealth of evidence regarding the benefits of managing hypertension in the old and very old, a significant proportion of older individuals with hypertension have suboptimal BP control. While there is good evidence supporting blood pressure lowering in older antihypertensive agents, these have not yet been optimally translated fully into clinical guidelines and clinical practice. There appear to be considerable differences between guidelines in terms of the guidance given to clinicians. Differences in interpretation of the evidence, as well as differences in study design and populations all contribute to differences in the guideline recommendations with respect to older populations, despite the strength of the underlying scientific evidence. Differences around who is considered "old" and what BP targets and management are considered appropriate may lead to confusion among clinicians and further contribute to the evidence-practice lag.

Outcomes of Older Adults with Burn Injury: University Clinical Center of Kosovo

PubMed Central

B. Duci, Shkelzen; M. Arifi, Hysni; R. Ahmeti, Hasan; K. Zatriqi, Violeta; A. Buja, Zejn; T. Hoxha, Enver; Y. Mekaj, Agon

2015-01-01

BACKGROUND Advances in burn care over the past 50 years have brought about remarkable improvement in mortality rates such that survival has become an expected outcome even in patients with extensive injuries. Although these improvements have occurred in all age groups, survival in older adults still lags far behind that in younger cohorts. This study determines the outcomes of older adults with burn injury in University Clinical Center of Kosovo. METHODS This is a retrospective study that includes 56 burn patients, older than 60 years who were admitted at the Department of Plastic Surgery, between 1 January 2004 and 31 December 2013. Data processing was done with the statistical package of Stat 3. From the statistical parameters the structural index, arithmetic median, and standard deviation were calculated. RESULTS Fifty six burned patient older than 60 years were included during a 10-year period. Of the 56 elderly patients 29 were women and 27 were men with a mean age of 66.7 years (range, 60-85 years). The differences were not statistically significant for both genders regarding the causes of burn injury. CONCLUSION Considering the gradual increase of the elderly population in our country based on the data of the Ministry of Public Services, an increase is expected to the incidence of burn injuries in the population of this category of our country. PMID:26284184

Dynapenia and Sarcopenia as a Risk Factor for Disability in a Falls and Fractures Clinic in Older Persons

PubMed Central

Benjumea, Angela-María; Curcio, Carmen-Lucía; Duque, Gustavo; Gómez, Fernando

2018-01-01

BACKGROUND: The role of sarcopenia and dynapenia in disability in older persons from falls and bone health clinics remain unknown. AIM: This study aims to compare the association of sarcopenia and dynapenia with physical and instrumental disability in a population of older persons attending a falls and fractures clinic. METHODS: This is a cross-sectional study in Manizales, Andes Mountains, Colombia. A cohort of 534 subjects (mean age = 74, 75% female) Sarcopenia was measured according to the European Working Group on Sarcopenia in Older People (EWGSOP) including an index of skeletal mass, muscle strength, and gait speed. Dynapenia was defined as a handgrip force ≤ 30 kg for men and ≤ 20 kg for women. RESULTS: Dynapenia and sarcopenia were present in 84.6% and 71.2% respectively. Both were more prevalent in older subjects and women than men. While sarcopenia was associated with body mass index and hypertension, dynapenia was associated with hypothyroidism and visual impairment. After controlling for all covariates, sarcopenia was associated with low IADL and mobility disability. CONCLUSIONS: Sarcopenia was associated with mobility, ADL and IADL disability. Dynapenia was not associated with disability in this high - risk population. Systematic assessment of sarcopenia should be implemented in falls and fractures clinics to identify sarcopenia and develop interventions to prevent functional decline among elderly individuals. PMID:29531601

Disparity in Dental Coverage Among Older Adult Populations: A Comparative Analysis Across Selected European Countries and the United States

PubMed Central

Manski, Richard; Moeller, John; Chen, Haiyan; Widström, Eeva; Lee, Jinkook; Listl, Stefan

2014-01-01

Background Insurance against the cost risks associated with prevention and treatment of oral diseases can reduce inequalities in dental care use and oral health. The purpose of this study was to examine the extent of variation in dental insurance coverage for older adult populations within and between the United States and various European countries. Method The analyses relied on 2006/2007 data from the Survey of Health, Ageing, and Retirement in Europe (SHARE) and 2004-2006 data from of the Health and Retirement Study (HRS) in the United States for respondents aged 51 years and older. A series of logistic regression models was estimated to identify disparities in dental coverage. Results The highest extent of significant insurance differences between various population subgroups was found for the United States. In comparison with countries belonging to the Eastern and Southern welfare state regimes, a lower number of significant coverage differences occurred for Scandinavian countries. Countries categorized as having comprehensive public insurance coverage showed a tendency towards less insurance variation within their populations than countries categorized as not having comprehensive public coverage, exceptions being Poland and Switzerland. Conclusions The findings of the present study suggest that significant variations in dental coverage exist within all elderly populations examined and the extent of inequalities also differs between countries. By and large, the observed variations corroborate the perception that population dental coverage is more equally distributed under public subsidy. This could be relevant information for decision makers who seek to improve policies towards more equitable dental coverage. PMID:25363376

Rapid and reliable high-throughput methods of DNA extraction for use in barcoding and molecular systematics of mushrooms.

PubMed

Dentinger, Bryn T M; Margaritescu, Simona; Moncalvo, Jean-Marc

2010-07-01

We present two methods for DNA extraction from fresh and dried mushrooms that are adaptable to high-throughput sequencing initiatives, such as DNA barcoding. Our results show that these protocols yield ∼85% sequencing success from recently collected materials. Tests with both recent (<2 year) and older (>100 years) specimens reveal that older collections have low success rates and may be an inefficient resource for populating a barcode database. However, our method of extracting DNA from herbarium samples using small amount of tissue is reliable and could be used for important historical specimens. The application of these protocols greatly reduces time, and therefore cost, of generating DNA sequences from mushrooms and other fungi vs. traditional extraction methods. The efficiency of these methods illustrates that standardization and streamlining of sample processing should be shifted from the laboratory to the field. © 2009 Blackwell Publishing Ltd.

Trends and predicted trends in presentations of older people to Australian emergency departments: effects of demand growth, population aging and climate change.

PubMed

Burkett, Ellen; Martin-Khan, Melinda G; Scott, Justin; Samanta, Mayukh; Gray, Leonard C

2017-07-01

Objectives The aim of the present study was to describe trends in and age and gender distributions of presentations of older people to Australian emergency departments (EDs) from July 2006 to June 2011, and to develop ED utilisation projections to 2050. Methods A retrospective analysis of data collected in the National Non-admitted Patient Emergency Department Care Database was undertaken to assess trends in ED presentations. Three standard Australian Bureau of Statistics population growth models, with and without adjustment for current trends in ED presentation growth and effects of climate change, were examined with projections of ED presentations across three age groups (0-64, 65-84 and ≥85 years) to 2050. Results From 2006-07 to 2010-11, ED presentations increased by 12.63%, whereas the Australian population over this time increased by only 7.26%. Rates of presentation per head of population were greatest among those aged ≥85 years. Projections of ED presentations to 2050 revealed that overall ED presentations are forecast to increase markedly, with the rate of increase being most marked for older people. Conclusion Growth in Australian ED presentations from 2006-07 to 2010-11 was greater than that expected from population growth alone. The predicted changes in demand for ED care will only be able to be optimally managed if Australian health policy, ED funding instruments and ED models of care are adjusted to take into account the specific care and resource needs of older people. What is known about the topic? Rapid population aging is anticipated over coming decades. International studies and specific local-level Australian studies have demonstrated significant growth in ED presentations. There have been no prior national-level Australian studies of ED presentation trends by age group. What does this paper add? The present study examined national ED presentation trends from July 2006 to June 2011, with specific emphasis on trends in presentation by age group. ED presentation growth was found to exceed population growth in all age groups. The rate of ED presentations per head of population was highest among those aged ≥85 years. ED utilisation projections to 2050, using standard Australian Bureau of Statistics population modelling, with and without adjustment for current ED growth, were developed. The projections demonstrated linear growth in ED presentation for those aged 0-84 years, with growth in ED presentations of the ≥85 year age group demonstrating marked acceleration after 2030. What are the implications for practitioners? Growth in ED presentations exceeding population growth suggests that current models of acute health care delivery require review to ensure that optimal care is delivered in the most fiscally efficient manner. Trends in presentation of older people emphasise the imperative for ED workforce planning and education in care of this complex patient cohort, and the requirement to review funding models to incentivise investment in ED avoidance and substitutive care models targeting older people.

Fruit and vegetable intake among older adults: a scoping review

PubMed Central

Kadell, Andria R.

2013-01-01

Older adults are the fastest growing segment of the world population. Older adults are also at heightened risk of chronic conditions (such as diabetes, heart disease, and cancer) and specific geriatric conditions (such as cognitive impairment, frailty, and falls). Research studies have examined the relationship between fruit and vegetable intake and subsequent health outcomes and the correlates of fruit and vegetable intake in the U.S. population. However, relatively few studies have specifically examined health impacts and correlates of fruit and vegetable intake among older adults, who have unique biophysical and socioeconomic circumstances. Evidence is reviewed to (1) describe findings related to consumption and chronic, geriatric, and other health outcomes among older adults and (2) describe patterns in fruit and vegetable consumption among older adults and how these patterns vary within and among populations. This review addresses specific barriers faced by older adults in obtaining and consuming fruits and vegetables in community settings. Recommendations for practice and policy are discussed. PMID:23769545

"Convivência" groups: building active and healthy communities of older adults in Brazil.

PubMed

Benedetti, Tânia R Bertoldo; d'Orsi, Eleonora; Schwingel, Andiara; Chodzko-Zajko, Wojtek J

2012-01-01

In old age, social groups can be a crucial component for health and well-being. In 2009-2010, a follow-up survey was carried out in Florianópolis, Brazil to understand the impact of a variety of programs established since 2002 that were designed to enhance social activities among the older adult population. This study employed two surveys within the population of older adults in Florianópolis. The first survey interviewed a total of 875 older adults in 2002, and the second survey involved 1,705 older adults between 2009 and 2010. By 2010, many new programs were offered in the community and the enrollment of older adults in social programs followed similar trends. "Convivência" groups stood out as extremely popular social groups among this population. This paper discusses some of the potential outcomes associated with participation in "convivência" groups.

“Convivência” Groups: Building Active and Healthy Communities of Older Adults in Brazil

PubMed Central

Benedetti, Tânia R. Bertoldo; d'Orsi, Eleonora; Schwingel, Andiara; Chodzko-Zajko, Wojtek J.

2012-01-01

In old age, social groups can be a crucial component for health and well-being. In 2009-2010, a follow-up survey was carried out in Florianópolis, Brazil to understand the impact of a variety of programs established since 2002 that were designed to enhance social activities among the older adult population. This study employed two surveys within the population of older adults in Florianópolis. The first survey interviewed a total of 875 older adults in 2002, and the second survey involved 1,705 older adults between 2009 and 2010. By 2010, many new programs were offered in the community and the enrollment of older adults in social programs followed similar trends. “Convivência” groups stood out as extremely popular social groups among this population. This paper discusses some of the potential outcomes associated with participation in “convivência” groups. PMID:22830022

The impact of forced migration on the mental health of the elderly: a scoping review.

PubMed

Virgincar, Ashwini; Doherty, Shannon; Siriwardhana, Chesmal

2016-06-01

The worldwide elderly population fraction is increasing, with the greatest rise in developing countries. Older adults affected by conflict and forced migration mainly taking place in developing countries may be particularly vulnerable to poor mental health due to other age-specific risk factors. This review aims to explore global evidence on the effect of conflict-induced forced migration on the mental health of older adults. Seven bibliographic databases were searched. The title and abstract of 797 results were reviewed for qualitative and quantitative studies meeting inclusion and exclusion criteria. Six studies were selected for the in-depth review. Five papers assessed mental health in older adult populations displaced as refugees. One paper assessed mental health of older adults with varying immigration status. This review highlights the dearth of evidence about the impact of forced migration on the mental health of older adults. Further research is needed to explore the risk factors and processes that contribute to adverse mental health outcomes among older adult populations. This is essential to the development of interventions for this vulnerable and at-risk population, particularly in resource-poor settings.

Osteoporosis in older persons: current pharmacotherapy and future directions.

PubMed

Duque, Gustavo

2013-10-01

Osteopororic fractures are highly prevalent in older persons having catastrophic consequences in their quality of life and increasing disability and mortality in this population. The mechanisms of osteoporosis in older persons are unique in terms of cellular changes and response to osteoporosis treatment. Therefore, specifically targeted treatments are required in this particular population. This paper provides an overview on the particular mechanisms of osteoporosis in older persons and the current and future therapeutic strategies to improve bone mass and prevent fractures in this population. Osteoporosis in older persons (especially in the old-old) has a unique pathophysiology that predisposes them to fractures thus having catastrophic consequences. Identification of patients at risk followed by therapies targeted to their cellular changes is pivotal to close the care gap observed in osteoporosis, predominantly in the older population. The treatment of osteoporosis has evolved from daily to yearly dosing thus facilitating compliance and effectiveness. It is expected that future biologically targeted treatments will have a similar separate dosing regime with better anti-fracture efficacy and lower incidence of side effects.

Social care networks and older LGBT adults: challenges for the future.

PubMed

Brennan-Ing, Mark; Seidel, Liz; Larson, Britta; Karpiak, Stephen E

2014-01-01

Research on service needs among older adults rarely addresses the special circumstances of lesbian, gay, bisexual, and transgender (LGBT) individuals, such as their reliance on friend-centered social networks or the experience of discrimination from service providers. Limited data suggests that older LGBT adults underutilize health and social services that are important in maintaining independence and quality of life. This study explored the social care networks of this population using a mixed-methods approach. Data were obtained from 210 LGBT older adults. The average age was 60 years, and 71% were men, 24% were women, and 5% were transgender or intersex. One-third was Black, and 62% were Caucasian. Quantitative assessments found high levels of morbidity and friend-centered support networks. Need for and use of services was frequently reported. Content analysis revealed unmet needs for basic supports, including housing, economic supports, and help with entitlements. Limited opportunities for socialization were strongly expressed, particularly among older lesbians. Implications for senior programs and policies are discussed.

Walking and Metabolic Syndrome in Older Adults

PubMed Central

Strath, Scott; Swartz, Ann; Parker, Sarah; Miller, Nora; Cieslik, Linda

2010-01-01

Background Little data exists describing the impact that walking has on metabolic syndrome (MetS) in a multicultural sample of older adults. Methods Walking was measured via pedometer in 150 older adults from 4 different ethnic categories. Steps per day were classified as low (<3100 steps/d) or high (≥3100 steps/d) for statistical analyses. Results Occurrence of MetS was lower in the white (33%) versus non-white population (50%). Low steps/d were related to an increase in MetS for both white (OR = 96.8, 95% CI 12.3–764.6) and non-white individuals (OR = 4.5, 95% CI 1.8–11.3). Low steps/d also increased the odds for selected components of MetS in both the white and non-white groups. Conclusion Low levels of walking increase the likelihood of having MetS in both white and non-white older adults. Efforts to increase walking in older adults may decrease the likelihood of developing this clustering of disease risk factors. PMID:18209231

Facilitating aerobic exercise training in older adults with Alzheimer's disease.

PubMed

Yu, Fang; Kolanowski, Ann

2009-01-01

Emerging science suggests that aerobic exercise might modify the pathophysiology of Alzheimer's disease (AD) and improve cognition. However, there are no clinical practice guidelines for aerobic exercise prescription and training in older adults with AD. A few existing studies showed that older adults with AD can participate in aerobic exercise and improve dementia symptoms, but lack adequate descriptions of their aerobic exercise training programs and their clinical applicability. In this paper, we summarize current knowledge about the potential benefits of aerobic exercise in older adults with AD. We then describe the development of a moderate-intensity aerobic exercise program for this population and report results from its initial testing in a feasibility trial completed by two persons with AD. Two older adults with AD completed the aerobic exercise program. Barriers to the program's implementation are described, and methods to improve more wide-spread adoption of such programs and the design of future studies that test them are suggested.

[Prevalence of cardiovascular diseases and cardiovascular risk factors in older than 65 years persons in an urban area: DERIVA study].

PubMed

Rodríguez-Sánchez, Emiliano; García-Ortiz, Luis; Gómez-Marcos, Manuel A; Recio-Rodríguez, José I; Mora-Simón, Sara; Pérez-Arechaederra, Diana; Agudo-Conde, Cristina; Escribano-Hernández, Alfonso; Patino-Alonso, María C

2013-01-01

To estimate the prevalence of cardiovascular diseases, cardiovascular risk factors, and the psychosocial characteristics associated with them in an urban population aged 65 years and older. Descriptive cross-sectional study of the population. City of Salamanca (Spain). A total of 480 participants aged 65 and older were selected using a stratified randomized sampling method. A health questionnaire was completed in the participants' homes. Weight, height, waist circumference, arterial pressure, blood glucose and cholesterol, were measured, and the standardized prevalence for a European population was estimated. A total of 327 participants were interviewed (68.10% of those selected), mean age of participants was 76 (SD: 7.33). Of the total, 64.5% were women and 20.2% (15.8-24.5) had some cardiovascular disease. In males, the most prevalent cardiovascular disease was ischemic heart disease (12.1% [6.1-18]), while in females it was heart failure (10.4% [6.3-14.6]). Hypertension was the most frequent cardiovascular risk factor for males (63.8% [53.2-70.9]) and females (69.7%.[63.5-75.9]), followed by diabetes in males (36.2% [27.5-45]), and sedentary lifestyle in females (36.0% [29.5-42.5]). Those with cardiovascular diseases were more dependent and had a worse prognosis (Charlson's Comorbility Index). Ischemic heart disease is the most prevalent heart disease in males, while heart failure is the most prevalent disease for females. Almost 80% of the population aged 65 and older did not suffer any of the three cardiovascular diseases that are the main causes of mortality in this group of age. Participants who had a CVD were more dependent for activities of daily living. Copyright © 2012 Elsevier España, S.L. All rights reserved.

A qualitative study of older first-time mothering in the first year.

PubMed

Nelson, Antonia M

2004-01-01

The number of older first-time mothers has increased significantly during the past 30 years. The purpose of this study was to create a phenomenologic text explicating the experience of older, first-time mothering during the first year. A phenomenologic/hermeneutic method was used to create a narrative text to address the following question: In what way does older age give a certain quality of meaning to first-time motherhood in women 35 years of age and older? This text incorporated data from interviews with seven first-time mothers ages 36 to 48 years, as well other data sources such as poetry, literary references, and findings from other qualitative studies. Among essential themes that emerged from analysis of study data were: "Being Ready," "Planned Intensity," and "How Far We've Come." Pediatric practitioners have unparalleled access to mothers during the first postpartum year. An increased understanding of the uniqueness of older primiparas as expressed in this narrative will enable nurses to more effectively address the needs and concerns of this growing population of women.

Attitudes Towards and Limitations to ICT Use in Assisted and Independent Living Communities: Findings from a Specially-Designed Technological Intervention

PubMed Central

Berkowsky, Ronald W.; Cotten, Shelia R.; Yost, Elizabeth A.; Winstead, Vicki P.

2012-01-01

While much literature has been devoted to theoretical explanations of the learning processes of older adults and to the methods of teaching best utilized in older populations, less has focused on the education of older adults who reside in assisted and independent living communities (AICs), especially with regards to information and communication technology (ICT) education. The purpose of this study is to determine whether participants’ attitudes and views towards computers and the Internet are affected as a result of participating in an eight-week training program designed to enhance computer and Internet use among older adults in such communities. Specifically, we examine if ICT education specially designed for AIC residents results in more positive attitudes towards ICTs and a perceived decrease in factors that may limit or prevent computer and Internet use. We discuss the implications of these results for enhancing the quality of life for older adults in AICs and make recommendations for those seeking to decrease digital inequality among older adults in these communities through their own ICT classes. PMID:24244065

An interactive ICT platform for early assessment and management of patient-reported concerns among older adults living in ordinary housing - development and feasibility.

PubMed

Algilani, Samal; Langius-Eklöf, Ann; Kihlgren, Annica; Blomberg, Karin

2017-06-01

To develop and test feasibility and acceptability of an interactive ICT platform integrated in a tablet for collecting and managing patient-reported concerns of older adults in home care. Using different ICT applications, for example interactive tablets for self-assessment of health and health issues based on health monitoring as well as other somatic and psychiatric monitoring systems may improve quality of life, staff and patient communication and feelings of being reassured. The European Commission hypothesises that introduction of ICT applications to the older population will enable improved health. However, evidence-based and user-based applications are scarce. The design is underpinned by the Medical Research Council's complex intervention evaluation framework. A mixed-method approach was used combining interviews with older adults and healthcare professionals, and logged quantitative data. In cooperation with a health management company, a platform operated by an interactive application for reporting and managing health-related problems in real time was developed. Eight older adults receiving home care were recruited to test feasibility. They were equipped with the application and reported three times weekly over four weeks, and afterwards interviewed about their experiences. Three nurses caring for them were interviewed. The logged data were extracted as a coded file. The older adults reported as instructed, in total 107 reports (Mean 13). The most frequent concerns were pain, fatigue and dizziness. The older adults experienced the application as meaningful with overall positive effects as well as potential benefits for the nurses involved. The overall findings in this study indicated high feasibility among older adults using the ICT platform. The study's results support further development of the platform, as well as tests in full-scale studies and in other populations. An ICT platform increased the older adults' perception of involvement and facilitated communication between the patient and nurses. © 2016 John Wiley & Sons Ltd.

Measuring moderate-intensity walking in older adults using the ActiGraph accelerometer.

PubMed

Barnett, Anthony; van den Hoek, Daniel; Barnett, David; Cerin, Ester

2016-12-08

Accelerometry is the method of choice for objectively assessing physical activity in older adults. Many studies have used an accelerometer count cut point corresponding to 3 metabolic equivalents (METs) derived in young adults during treadmill walking and running with a resting metabolic rate (RMR) assumed at 3.5 mL · kg -1  · min -1 (corresponding to 1 MET). RMR is lower in older adults; therefore, their 3 MET level occurs at a lower absolute energy expenditure making the cut point derived from young adults inappropriate for this population. The few studies determining older adult specific moderate-to-vigorous intensity physical activity (MVPA) cut points had methodological limitations, such as not measuring RMR and using treadmill walking. This study determined a MVPA hip-worn accelerometer cut point for older adults using measured RMR and overground walking. Following determination of RMR, 45 older adults (mean age 70.2 ± 7 years, range 60-87.6 years) undertook an outdoor, overground walking protocol with accelerometer count and energy expenditure determined at five walking speeds. Mean RMR was 2.8 ± 0.6 mL · kg -1  · min -1 . The MVPA cut points (95% CI) determined using linear mixed models were: vertical axis 1013 (734, 1292) counts · min -1 ; vector magnitude 1924 (1657, 2192) counts · min -1 ; and walking speed 2.5 (2.2, 2.8) km · hr -1 . High levels of inter-individual variability in cut points were found. These MVPA accelerometer and speed cut points for walking, the most popular physical activity in older adults, were lower than those for younger adults. Using cut points determined in younger adults for older adult population studies is likely to underestimate time spent engaged in MVPA. In addition, prescription of walking speed based on the adult cut point is likely to result in older adults working at a higher intensity than intended.

Racial and Ethnic Differences in Advance Directive Possession: Role of Demographic Factors, Religious Affiliation, and Personal Health Values in a National Survey of Older Adults

PubMed Central

Neuhaus, John M.; Chiong, Winston

2016-01-01

Abstract Background: Black and Hispanic older Americans are less likely than white older Americans to possess advance directives. Understanding the reasons for this racial and ethnic difference is necessary to identify targets for future interventions to improve advance care planning in these populations. Methods: The aim of the study was to evaluate whether racial and ethnic differences in advance directive possession are explained by other demographic factors, religious characteristics, and personal health values. A general population survey was conducted in a nationally representative sample using a web-enabled survey panel of American adults aged 50 and older (n = 2154). Results: In a sample of older Americans, white participants are significantly more likely to possess advance directives (44.0%) than black older Americans (24.0%, p < 0.001) and Hispanic older Americans (29.0%, p = 0.006). Gender, age, retired or disabled employment status, educational attainment, religious affiliation, Internet access, preferences for physician-centered decision making, and desiring longevity regardless of functional status were independent predictors of advance directive possession. In fully adjusted multivariable models with all predictors included, black older Americans remained significantly less likely than white older Americans to have an advance directive (odds ratio [OR] = 0.42, 95% confidence interval [CI] = 0.24–0.75), whereas the effect of Hispanic ethnicity was no longer statistically significant (OR = 0.65, 95% CI = 0.39–1.1). Conclusion: In a nationally representative sample, black race is an independent predictor for advance directive possession. This association remains even after adjustment for other demographic variables, religious characteristics, and personal health values. These findings support targeted efforts to mitigate racial disparities in access to advance care planning. PMID:26840850

Police on the Front Line of Community Geriatric Healthcare: Challenges and Opportunities

PubMed Central

Brown, Rebecca T.; Ahalt, Cyrus; Steinman, Michael A.; Kruger, Kelly; Williams, Brie A.

2015-01-01

As the population ages, police increasingly serve as first responders to incidents involving older adults in which aging-related health plays a critical role. The goals of this study were to assess police officers’ knowledge of aging-related health; to identify challenges police experience in their encounters with older adults; and to describe their recommendations for how to address those challenges. This was a mixed methods study of 141 San Francisco police officers recruited from mandatory police trainings between 2011 and 2013. Descriptive statistics were used to analyze 141 self-administered questionnaires and principles of grounded theory were used to analyze open-ended questionnaire responses and 11 additional qualitative interviews. Nearly all officers (89%) reported interacting with older adults at least monthly. Although 84% of police reported prior training in working with older adults, only 32% rated themselves knowledgeable about aging-related health. Participants described themselves as first-responders to medical and social emergencies involving older adults and identified several challenges including identifying and responding to aging-related conditions and ensuring appropriate medical and social service hand-offs. To address these challenges, officers recommended developing trainings focused on recognizing and responding to aging-related conditions and improving police knowledge of community resources for older adults. They also called for enhanced communication and collaboration between police and clinicians. These findings suggest that despite playing a front-line role in responding to older adults with complex medical and social needs, many police may benefit from additional knowledge about aging-related health and community resources. Collaboration between police and healthcare providers presents an important opportunity to develop geriatrics training and interprofessional systems of care to support police work with a rapidly aging population. PMID:25378267

Police on the front line of community geriatric health care: challenges and opportunities.

PubMed

Brown, Rebecca T; Ahalt, Cyrus; Steinman, Michael A; Kruger, Kelly; Williams, Brie A

2014-11-01

As the population ages, police increasingly serve as first responders to incidents involving older adults in which aging-related health plays a critical role. The goals of this study were to assess police officers' knowledge of aging-related health, to identify challenges police experience in their encounters with older adults, and to describe their recommendations for how to address those challenges. This was a mixed-methods study of 141 San Francisco police officers recruited from mandatory police trainings between 2011 and 2013. Descriptive statistics were used to analyze 141 self-administered questionnaires, and principles of grounded theory were used to analyze open-ended questionnaire responses and 11 additional qualitative interviews. Eighty-nine percent of officers reported interacting with older adults at least monthly. Although 84% of police reported prior training in working with older adults, only 32% rated themselves as knowledgeable about aging-related health. Participants described themselves as first responders to medical and social emergencies involving older adults and identified several challenges, including identifying and responding to aging-related conditions and ensuring appropriate medical and social service handoffs. To address these challenges, officers recommended developing trainings focused on recognizing and responding to aging-related conditions and improving police knowledge of community resources for older adults. They also called for enhanced communication and collaboration between police and clinicians. These findings suggest that, because they assume a front-line role in responding to older adults with complex medical and social needs, many police may benefit from additional knowledge about aging-related health and community resources. Collaboration between police and healthcare providers presents an important opportunity to develop geriatrics training and interprofessional systems of care to support police work with a rapidly aging population. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

Isolation with Migration Models for More Than Two Populations

PubMed Central

Hey, Jody

2010-01-01

A method for studying the divergence of multiple closely related populations is described and assessed. The approach of Hey and Nielsen (2007, Integration within the Felsenstein equation for improved Markov chain Monte Carlo methods in population genetics. Proc Natl Acad Sci USA. 104:2785–2790) for fitting an isolation-with-migration model was extended to the case of multiple populations with a known phylogeny. Analysis of simulated data sets reveals the kinds of history that are accessible with a multipopulation analysis. Necessarily, processes associated with older time periods in a phylogeny are more difficult to estimate; and histories with high levels of gene flow are particularly difficult with more than two populations. However, for histories with modest levels of gene flow, or for very large data sets, it is possible to study large complex divergence problems that involve multiple closely related populations or species. PMID:19955477

Isolation with migration models for more than two populations.

PubMed

Hey, Jody

2010-04-01

A method for studying the divergence of multiple closely related populations is described and assessed. The approach of Hey and Nielsen (2007, Integration within the Felsenstein equation for improved Markov chain Monte Carlo methods in population genetics. Proc Natl Acad Sci USA. 104:2785-2790) for fitting an isolation-with-migration model was extended to the case of multiple populations with a known phylogeny. Analysis of simulated data sets reveals the kinds of history that are accessible with a multipopulation analysis. Necessarily, processes associated with older time periods in a phylogeny are more difficult to estimate; and histories with high levels of gene flow are particularly difficult with more than two populations. However, for histories with modest levels of gene flow, or for very large data sets, it is possible to study large complex divergence problems that involve multiple closely related populations or species.

Expanding the Caring Lens: Nursing and Medical Students Reflecting on Images of Older People.

PubMed

Brand, Gabrielle; Miller, Karen; Saunders, Rosemary; Dugmore, Helen; Etherton-Beer, Christopher

2016-01-01

In changing higher education environments, health profession's educators have been increasingly challenged to prepare future health professionals to care for aging populations. This article reports on an exploratory, mixed-method research study that used an innovative photo-elicitation technique and interprofessional small-group work in the classroom to enhance the reflective learning experience of medical and nursing students. Data were collected from pre- and postquestionnaires and focus groups to explore shifts in perceptions toward older persons following the reflective learning session. The qualitative data revealed how using visual images of older persons provides a valuable learning space for reflection. Students found meaning in their own learning by creating shared storylines that challenged their perceptions of older people and themselves as future health professionals. These data support the use of visual methodologies to enhance engagement, reflection, and challenge students to explore and deepen their understanding in gerontology.

PAHA study: Psychological Active and Healthy Aging: psychological wellbeing, proactive attitude and happiness effects of whole-body vibration versus Multicomponent Training in aged women: study protocol for a randomized controlled trial

PubMed Central

2014-01-01

Background Evidence demonstrates that physical exercise and psychological wellbeing are closely interlinked, particularly in older-aged women. However, research investigating how different forms of exercise influence mental health in older-aged women is underdeveloped. Methods/Design A randomized controlled trial (N = 300) will assess the relative effectiveness of two different exercise programs (whole-body vibration and Multicomponent Training) for improving psychological wellbeing in older-aged women. The following outcomes will be assessed at three time points (that is, pre, post, and follow-up): psychological wellbeing, proactive attitude, quality of life, and happiness. Discussion Results will have important implications for preventing psychological and physiological disease in older-aged women and for managing health-related costs for this population group. Trial registration Number NCT01966562 on Clinical Gov database the 8 October 2013 PMID:24886107

Mindfulness-based stress reduction in middle-aged and older adults with memory complaints: a mixed-methods study.

PubMed

Berk, Lotte; Hotterbeekx, Rafke; van Os, Jim; van Boxtel, Martin

2017-07-19

In a rapidly aging world population, an increasingly large group faces age-related decline in cognitive functioning. Cognitive complaints of older adults are often related to worries and concerns associated with age-related functional decline. Mindfulness-Based Stress Reduction (MBSR) can successfully target stress, worry and ruminative thinking, but the applicability of this method in middle-aged and older adults with memory complaints is unclear. Patients of a university hospital memory clinic (n = 13), aged 45-85 years, with memory complaints but no diagnosis of cognitive disorder, participated in a standard 8-week MBSR program, consisting of weekly group meetings and a one-day silent retreat. After completion, semi-structured qualitative interviews were conducted. Questionnaires (administered before, one week after and five weeks after the intervention) assessed quality of life, psychological distress (stress, anxiety and depressive symptoms), mindfulness, self-compassion, and subjective memory functioning. Neurocognitive functioning was assessed online, before and after the intervention. The qualitative analysis showed positive effects of the training (e.g. increased serenity), many participants worrying less about memory complaints. The self-reported measures were in line with the results of the qualitative analysis. This exploratory mixed-methods study suggests that MBSR is feasible and well received among older individuals with cognitive complaints.

Dehydration of Older Patients in Institutional Care and the Home Environment.

PubMed

Lešnik, Amadeus; Piko, Nejc; Železnik, Danica; Bevc, Sebastjan

2017-11-01

Dehydration in older adults is an important clinical problem associated with more comorbidities, longer hospital stays, and higher mortality rates. However, in daily clinical practice, no single gold standard marker of hydration status in older adults is available. The aim of the current study was to define the fluid balance status in older adults residing in institutional care or the home. Four hundred ten patients (192 from institutional care and 218 from home care) 65 and older from the region of lower Styria (Slovenia) were included in the study. Serum osmolality, electrolytes, and blood urea nitrogen to creatinine (BUN:Cr) ratio were used to identify dehydration. Statistically significant differences were found between groups in serum osmolality and BUN:Cr ratio. Moreover, dehydration (defined as increased serum osmolality) was significantly more common in patients in institutional care than home care (51% versus 41.3%, respectively). The results confirm that dehydration is a common clinical problem in older adults, especially in those from institutional care. Although many methods of determining hydration status in older adults have been proposed, no gold standard exists, making hydration evaluation difficult in this population. [Res Gerontol Nurs. 2017; 10(6):260-266.]. Copyright 2017, SLACK Incorporated.

Evidence-based guidelines for fall prevention in Korea

PubMed Central

Kim, Kwang-Il; Jung, Hye-Kyung; Kim, Chang Oh; Kim, Soo-Kyung; Cho, Hyun-Ho; Kim, Dae Yul; Ha, Yong-Chan; Hwang, Sung-Hee; Won, Chang Won; Lim, Jae-Young; Kim, Hyun Jung; Kim, Jae Gyu

2017-01-01

Falls and fall-related injuries are common in older populations and have negative effects on quality of life and independence. Falling is also associated with increased morbidity, mortality, nursing home admission, and medical costs. Korea has experienced an extreme demographic shift with its population aging at the fastest pace among developed countries, so it is important to assess fall risks and develop interventions for high-risk populations. Guidelines for the prevention of falls were first developed by the Korean Association of Internal Medicine and the Korean Geriatrics Society. These guidelines were developed through an adaptation process as an evidence-based method; four guidelines were retrieved via systematic review and the Appraisal of Guidelines for Research and Evaluation II process, and seven recommendations were developed based on the Grades of Recommendation, Assessment, Development, and Evaluation framework. Because falls are the result of various factors, the guidelines include a multidimensional assessment and multimodal strategy. The guidelines were developed for primary physicians as well as patients and the general population. They provide detailed recommendations and concrete measures to assess risk and prevent falls among older people. PMID:28049285

Treatment-Related Toxicities in Older Adults with Head and Neck Cancer: A Population-Based Analysis

PubMed Central

O’Neill, Caitriona B.; Baxi, Shrujal S.; Atoria, Coral L.; O’Neill, James P.; Henman, Martin C.; Sherman, Eric J.; Lee, Nancy Y.; Pfister, David G.; Elkin, Elena B.

2016-01-01

Background Despite advantages in terms of cancer control and organ preservation, the benefits of chemoradiation (CTRT) may be offset by potentially severe, treatment-related toxicities particularly in older patients. Our objectives were to assess the type and frequency of toxicities in older adults with locally or regionally advanced, head and neck squamous cell carcinoma of the (HNSCC) receiving either primary CTRT or RT alone. Methods Using SEER cancer registry data linked with Medicare claims, we identified patients aged 66 years or older with locally advanced HNSCC, diagnosed 2001–2009, who received CTRT or RT alone. We examined differences in the frequency of toxicity-related hospital admissions and emergency room (ER) visits as well as feeding tube use and estimated the impact of chemotherapy on the likelihood of toxicity, controlling for demographic and disease characteristics. Results Of patients who received CTRT (N=1,502), 62% had a treatment-related toxicity, compared with 46% of patients who received RT alone (N=775). Controlling for demographic and disease characteristics, CTRT patients were twice as likely to experience an acute toxicity compared with their RT only peers. Fifty-five percent of CTRT patients had a feeding tube placed during or after treatment compared with 28% of the RT-only group. Conclusions In this population-based cohort of older adults with HNSCC, the rate of acute toxicities and feeding tube use in patients receiving CTRT was considerable. It is possible that for certain older patients, the potential benefit of adding CT to RT does not outweigh the harms of this combined modality therapy. PMID:25728057

An Empirical Comparison of Different Models of Active Aging in Canada: The International Mobility in Aging Study

PubMed Central

Ahmed, Tamer; Filiatrault, Johanne; Yu, Hsiu-Ting; Zunzunegui, Maria Victoria

2017-01-01

Abstract Purpose: Active aging is a concept that lacks consensus. The WHO defines it as a holistic concept that encompasses the overall health, participation, and security of older adults. Fernández-Ballesteros and colleagues propose a similar concept but omit security and include mood and cognitive function. To date, researchers attempting to validate conceptual models of active aging have obtained mixed results. The goal of this study was to examine the validity of existing models of active aging with epidemiological data from Canada. Methods: The WHO model of active aging and the psychological model of active aging developed by Fernández-Ballesteros and colleagues were tested with confirmatory factor analysis. The data used included 799 community-dwelling older adults between 65 and 74 years old, recruited from the patient lists of family physicians in Saint-Hyacinthe, Quebec and Kingston, Ontario. Results: Neither model could be validated in the sample of Canadian older adults. Although a concept of healthy aging can be modeled adequately, social participation and security did not fit a latent factor model. A simple binary index indicated that 27% of older adults in the sample did not meet the active aging criteria proposed by the WHO. Implications: Our results suggest that active aging might represent a human rights policy orientation rather than an empirical measurement tool to guide research among older adult populations. Binary indexes of active aging may serve to highlight what remains to be improved about the health, participation, and security of growing populations of older adults. PMID:26350153

Aging Perceptions in Older Gay and Bisexual Men in Portugal: A Qualitative Study.

PubMed

Pereira, Henrique; Serrano, Juan Pedro; de Vries, Brian; Esgalhado, Graça; Afonso, Rosa Marina; Monteiro, Samuel

2018-07-01

Aims and Objectives The purpose of this study was to explore the perceptions toward aging among Portuguese gay and bisexual men over 60 years old. Background Despite the growth of the older population, and the increased visibility and acceptance of lesbian, gay, and bisexual people in Western countries, the experience of aging in older gay and bisexual men is only beginning to be understood. Design We used a qualitative research methodology, based on critical gerontology, for establishing research questions and to identify the perspectives on the aging process in older gay and bisexual individuals. Methods We used a structured electronic inquiry with 25 gay and bisexual men over 60 years of age from Portugal. Data were analyzed using thematic analysis to help identify repeated patterns of meaning in the data set. Results The recurrent themes in the narratives of the aging experiences of the participants in the study were as follows: positive perceptions of aging, negative perceptions of aging, coping with being a gay/bisexual man and family ties, professional care, homophobia/discrimination, relationships and social support, intergenerational differences, mediating role of sexual orientation, sociopolitical changes, and personal characteristics. Conclusion Analysis of perceptions about the aging process in older gay and bisexual men emphasized the desire for normalization in the social awareness of sexual orientation. It is important to continue doing research on this topic and disseminate this information among professionals who work with older lesbian, gay, and bisexual people so that they may better understand how they can meet the specific needs of this population.

Why is tractable vision loss in older people being missed? Qualitative study.

PubMed

Kharicha, Kalpa; Iliffe, Steve; Myerson, Sybil

2013-07-16

There is compelling evidence that there is substantial undetected vision loss amongst older people. Early recognition of undetected vision loss and timely referral for treatment might be possible within general practice, but methods of identifying those with unrecognised vision loss and persuading them to take up services that will potentially improve their eyesight and quality of life are not well understood. Population screening does not lead to improved vision in the older population. The aim of this study is to understand why older people with vision loss respond (or not) to their deteriorating eyesight. Focus groups and interviews were carried out with 76 people aged 65 and over from one general practice in London who had taken part in an earlier study of health risk appraisal. An analytic induction approach was used to analyse the data. Three polarised themes emerged from the groups and interviews. 1) The capacity of individuals to take decisions and act on them effectively versus a collection of factors which acted as obstacles to older people taking care of their eyesight. 2) The belief that prevention is better than cure versus the view that deteriorating vision is an inevitable part of old age. 3) The incongruence between the professionalism and personalised approach of opticians and the commercialisation of their services. The reasons why older people may not seek help for deteriorating vision can be explained in a model in which psychological attributes, costs to the individual and judgments about normal ageing interact. Understanding this model may help clinical decision making and health promotion efforts.

A Population-Based Intervention for the Prevention of Falls and Fractures in Home Dwelling People 65 Years and Older in South Germany: Protocol

PubMed Central

Rapp, Kilian; Küpper, Michaela; Becker, Clemens; Fischer, Torben; Büchele, Gisela; Benzinger, Petra

2014-01-01

Background Falls and fall-related injuries pose a major threat to older peoples’ health, and are associated with increased morbidity and mortality. In the course of demographic changes, development and implementation of fall prevention strategies have been recognized as an urgent public health challenge. Various risk factors for falls and a number of effective interventions have been recognized. A substantial proportion of falls occur for people who are neither frail nor at high risk. Therefore, population-based approaches reaching the entire older population are needed. Objective The objective of the study presented is the development, implementation, and evaluation of a population-based intervention for the prevention of falls and fall-related injuries in a medium sized city in Germany. Methods The study is designed as a population-based approach. The intervention community is a mid sized city named Reutlingen in southern Germany with a population of 112,700 people. All community dwelling inhabitants 65 years and older are addressed. There are two main measures that are defined: (1) increase of overall physical activity, and (2) reduction of modifiable risk factors for falls such as deficits in strength and balance, home and environmental hazards, impaired vision, unsafe footwear, and improper use of assistive devices. The implementation strategies are developed in a participatory community planning process. These might include, for example, training of professionals and volunteers, improved availability of exercise classes, and education and raising awareness via newspaper, radio, or lectures. Results The study starts in September 2010 and ends in December 2013. It is evaluated primarily by process evaluation as well as by telephone survey. Conclusions Physical activity as a key message entails multiple positive effects with benefits on a range of geriatric symptoms. The strength of the design is the development of implementation strategies in a participatory community planning. The problems that we anticipate are the dependency on the stakeholders’ willingness to participate, and the difficulty of evaluating population-based programs by hard end points. PMID:24686959

The National Blueprint for Promoting Physical Activity in the Mid-Life and Older Adult Population

ERIC Educational Resources Information Center

Chodzko-Zajko, Wojtek; Sheppard, Lisa; Senior, Jane; Park, Chae-Hee; Mockenhaupt, Robin; Bazzarre, Terry

2005-01-01

The National Blueprint: Increasing Physical Activity Among Adults Age 50 and Older was designed to develop a national strategy for the promotion of physically active lifestyles among the mid-life and older adult population. The Blueprint identifies barriers to physical activity in the areas of research, home and community programs, medical…

Salivary sex hormone measurement in a national, population-based study of older adults.

PubMed

Gavrilova, Natalia; Lindau, Stacy Tessler

2009-11-01

To describe the methods used for, correlates of cooperation with, and validity of in-home salivary specimens collected from older adults. Salivary specimens were collected between 2005 and 2006 during in-home interviews with a probability sample of 3,005 U.S. men and women, ages 57-85 years. Sex hormone levels were assessed by enzyme-linked immunoassay conducted at Salimetrics, LLC (State College, PA). Mean salivary sex hormone concentrations were compared by gender and in relation to medication use and health conditions. Self-collected saliva specimens were provided by 2,722 (90.6%) individuals; 95.8% of these were adequate for analysis. Black participants were significantly less likely than individuals of other racial/ethnic groups to provide a salivary specimen; age, gender, education, and self-rated health were not associated with participation. Mean testosterone levels were higher in men compared with women, and estradiol levels were higher in women using estrogens. Salivary hormone measurements obtained in the National Social Life, Health, and Aging Project (NSHAP) and other studies are of similar magnitude. NSHAP is the first large, population-based study of older adults to measure salivary estradiol, progesterone, dehydroepiandrosterone (DHEA), and, in women, testosterone. These data demonstrate a high cooperation rate with in-home salivary specimen collection from older adults and good validity of sex hormone measurements.

Factors Associated with Falls in Community-Dwelling Older People with Focus on Participation in Sport Organizations: The Japan Gerontological Evaluation Study Project

PubMed Central

Hayashi, Takahiro; Kondo, Katsunori; Suzuki, Kayo; Yamada, Minoru; Matsumoto, Daisuke

2014-01-01

Objective. Promoting participation in sport organizations may be a population strategy for preventing falls in older people. In this study, we examined whether participation in sport organizations is associated with fewer falls in older people even after adjusting for multiple individual and environmental factors. Methods. We used the Japan Gerontological Evaluation Study data of 90,610 people (31 municipalities) who were not eligible for public long-term care. Logistic regression analysis was performed, with multiple falls over the past year as the dependent variable and participation in a sport organization as the independent variable, controlling for 13 factors. These included individual factors related to falls, such as age and sex, and environmental factors such as population density of the habitable area. Results. A total of 6,391 subjects (7.1%) had a history of multiple falls. Despite controlling for 13 variables, those who participated in a sport organization at least once a week were approximately ≥20% less likely to fall than those who did not participate at all (once a week; odds ratio = 0.82 and 95% confidence interval = 0.72–0.95). Conclusion. Participation in a sport organization at least once per week might help prevent falls in the community-dwelling older people. PMID:24955360

Geriatric Education in the Health Professions: Are We Making Progress?

PubMed Central

Bardach, Shoshana H.; Rowles, Graham D.

2012-01-01

Purpose: Relative to the overall population, older adults consume a disproportionally large percentage of health care resources. Despite advocacy and efforts initiated more than 30 years ago, the number of providers with specialized training in geriatrics is still not commensurate with the growing population of older adults. This contribution provides a contemporary update on the status of geriatric education and explores how geriatric coverage is valued, how geriatric competence is defined, and how students are evaluated for geriatric competencies. Design and Methods: Semi-structured interviews were conducted with curriculum representatives from 7 health profession disciplines in a case study of one academic medical center. Findings: Geriatric training varies across health professions’ disciplines. Although participants recognized the unique needs of older patients and valued geriatric coverage, they identified shortage of time in packed curricula, lack of geriatrics-trained educators, absence of financial incentive, and low student demand (resulting from limited exposure to older adults and gerontological stereotyping) as barriers to improving geriatric training. Implications: Progress in including geriatric training within curricula across the health professions continues to lag behind need as a result of the continuing presence of barriers identified several decades ago. There remains an urgent need for institutional commitment to enhance geriatric education as a component of health professions curricula. PMID:22394495

Polybrominated diphenyl ether serum concentrations in a Californian population of children, their parents, and older adults: an exposure assessment study

EPA Science Inventory

BackgroundPolybrominated diphenyl ethers (PBDEs) are used as flame retardants in many household items. Given concerns over their potential adverse health effects, we identified predictors and evaluated temporal changes of PBDE serum concentrations.MethodsPBDE serum concentrations...

Validity of questions about activities of daily living to screen for dependency in older adults

PubMed Central

Rebouças, Monica; Coelho-Filho, João Macedo; Veras, Renato Peixoto; Lima-Costa, Maria Fernanda; Ramos, Luiz Roberto

2017-01-01

ABSTRACT OBJECTIVE To determine the criterion validity of the activities of daily living present in functionality questionnaires in older adults for population surveys and to identify which activities are valid to quantify the real daily need for help of this population. METHODS This is a population sample of older adults stratified by levels of functionality, according to self-perception of dependency in the activities of daily living. Self-perception was compared with the gold standard – direct observation of these activities in the household of older adults by a trained professional, blinded to the answers in the questionnaire. At the visit, it was decided if the older adult needed help to perform any of the activities of daily living for the research. The sensitivity of each activity of daily living was greater when the self-assessment that there was no need for help coincided with the assessment of the professional. Specificity indicates coincidence regarding the need for help in the activities of daily living – coefficients of sensitivity and specificity above 70% were considered as indicative of good validity. RESULTS Self-assessments showed better sensitivity than specificity – older adults and observers agreed more on daily independency than on dependency. All activities showed sensitivity above 70%. Some activities had low (go shopping: 55%) or very low specificity (brush the hair: 33%). The best specificities were to take a shower and dress up (95.8% for both), among the personal ones, and to use transportation and perform banking transactions (78% for both), among the instrumental ones. CONCLUSIONS Activities of daily living can be valid indicators of functional dependence. The best coefficients of validity were generally obtained for personal activities. Some activities with good sensitivities and specificities – walk 100 meters, take a shower, and lie down in and get out of the bed – can be used to classify older adults into low, average, and high need for help depending on the affected activities and, therefore, can help in the planning of health services aimed at them. PMID:28876414

A factorial-design cluster randomised controlled trial investigating the cost-effectiveness of a nutrition supplement and an exercise programme on pneumonia incidence, walking capacity and body mass index in older people living in Santiago, Chile: the CENEX study protocol

PubMed Central

Dangour, Alan D; Albala, Cecilia; Aedo, Cristian; Elbourne, Diana; Grundy, Emily; Walker, Damian; Uauy, Ricardo

2007-01-01

Background Chile is currently undergoing a period of rapid demographic transition which has led to an increase in the proportion of older people in the population; the proportion aged 60 years and over, for example, increased from 8% of the population in 1980 to 12% in 2005. In an effort to promote healthy ageing and preserve function, the government of Chile has formulated a package of actions into the Programme of Complementary Feeding for the Older Population (PACAM) which has been providing a nutritional supplement to older people since 1998. PACAM distributes micronutrient fortified foods to individuals aged 70 years and over registered at Primary Health Centres and enrolled in the programme. The recommended serving size (50 g/day) of these supplements provides 50% of daily micronutrient requirements and 20% of daily energy requirements of older people. No information is currently available on the cost-effectiveness of the supplementation programme. Aim The aim of the CENEX cluster randomised controlled trial is to evaluate the cost-effectiveness of an ongoing nutrition supplementation programme, and a specially designed physical exercise intervention for older people of low to medium socio-economic status living in Santiago, Chile. Methods The study has been conceptualised as a public health programme effectiveness study and has been designed as a 24-month factorial cluster-randomised controlled trial conducted among 2800 individuals aged 65.0–67.9 years at baseline attending 28 health centres in Santiago. The main outcomes are incidence of pneumonia, walking capacity and change in body mass index over 24 months of intervention. Costing data (user and provider), collected at all levels, will enable the determination of the cost-effectiveness of the two interventions individually and in combination. The study is supported by the Ministry of Health in Chile, which is keen to expand and improve its national programme of nutrition for older people based on sound science-base and evidence for cost-effectiveness. Trial registration ISRCTN48153354 PMID:17615064

Estimating risks of heat strain by age and sex: a population-level simulation model.

PubMed

Glass, Kathryn; Tait, Peter W; Hanna, Elizabeth G; Dear, Keith

2015-05-18

Individuals living in hot climates face health risks from hyperthermia due to excessive heat. Heat strain is influenced by weather exposure and by individual characteristics such as age, sex, body size, and occupation. To explore the population-level drivers of heat strain, we developed a simulation model that scales up individual risks of heat storage (estimated using Myrup and Morgan's man model "MANMO") to a large population. Using Australian weather data, we identify high-risk weather conditions together with individual characteristics that increase the risk of heat stress under these conditions. The model identifies elevated risks in children and the elderly, with females aged 75 and older those most likely to experience heat strain. Risk of heat strain in males does not increase as rapidly with age, but is greatest on hot days with high solar radiation. Although cloudy days are less dangerous for the wider population, older women still have an elevated risk of heat strain on hot cloudy days or when indoors during high temperatures. Simulation models provide a valuable method for exploring population level risks of heat strain, and a tool for evaluating public health and other government policy interventions.

Exploring nursing expertise in residential care for older people: a mixed method study.

PubMed

Phelan, Amanda; McCormack, Brendan

2016-10-01

To explore the expertise of Registered Nurses in residential care for older people. As older people in residential care have many complex dependencies, nursing expertise is an essential component of care excellence. However, the work of these nurses can be invisible and, therefore, unrecognized. Thus, additional attention is required to illuminate such nursing expertise. A mixed method design was used in this study. The research took place in 2012 in the Republic of Ireland. Twenty-three case study nurses were recruited from nursing homes. Each case study nurse involved five data collection methods: shadowing, interview with a colleague, interview with a resident, a demographic profile and a director of nursing survey. The study was also informed by a modified focus group. Qualitative data were analysed using directed content analysis using a conceptual framework generated from the literature on nursing expertise. Quantitative data were analysed using SPSS and presented in descriptive statistics. The findings from the case studies and the modified focus group are presented in seven themes, which represent nursing expertise in residential care of older people: transitions, context of the nursing home, saliency, holistic practice knowledge, knowing the resident, moral agency and skilled know how. Nursing expertise in residential care of older people is a complex phenomenon which encompasses many aspects of care delivery in a person-centred framework. By rendering this expertise visible, the need for appropriate and adequate skill mix for a growing residential care population is presented. © 2016 John Wiley & Sons Ltd.

Typology of older female sex workers and sexual risks for HIV infection in China: a qualitative study

PubMed Central

Hao, Chun; Sherman, Susan G.; Jiang, Baofa; Li, Xiaojing; Xu, Yongfang; Jiang, Zhenxia; Zang, Chunpeng

2013-01-01

The HIV epidemic continues to develop among older adults in China, including older female sex workers. Yet, few studies have been conducted among this relatively hidden population. The objectives of this study were to investigate the reasons for women's entry into sex work during their thirties and to develop typology of older women sex workers. Semi-structured in-depth interviews with sixty-three older women sex workers and six focus groups interviews with stakeholders were conducted in three cities in China in 2012. Data were analysed inductively using constant comparative method. The mean age of participants was 43 years old and the mean age of entry into sex work was 39 years old. The primary reasons for entry into sex work include heavy economic burdens, limited employment opportunities, and the appealing nature of sex work. Street-based and venue-based older sex workers were identified based on where they solicited clients. Street-based older sex workers were more likely to engage in unsafe commercial sex due to financial incentives, whereas those in entertainment venues were unlikely to use condoms with regular clients. The development of effective HIV interventions needs to consider older women sex workers unique characteristics and target factors that impede safer sex practices. PMID:23998493

Household characteristics for older adults and study background from SAGE Ghana Wave 1

PubMed Central

Biritwum, Richard B.; Mensah, George; Minicuci, Nadia; Yawson, Alfred E.; Naidoo, Nirmala; Chatterji, Somnath; Kowal, Paul

2013-01-01

Background Globally, the population aged 60 years and older is projected to reach 22% by 2050. In sub-Saharan Africa, this figure is projected to exceed 8%, while in Ghana, the older adult population will reach 12% by 2050. The living arrangements and household characteristics are fundamental determinants of the health and well-being of this population, data sources about which are increasingly available. Methods The World Health Organization's Study on global AGEing and adult health (SAGE) Wave 1 was conducted in China, Ghana, India, Russian Federation, Mexico, and South Africa between 2007 and 2010. SAGE Ghana Wave 1 was implemented in 2007/08 using face-to-face interviews in a nationally representative sample of persons aged 50-plus, along with a smaller cohort aged 18–49 years for comparison purposes. Household information included a household roster including questions about health insurance coverage for all household members, household and sociodemographic characteristics, status of the dwelling, and economic situation. Re-interviews were done in a random 10% of the sample and proxy interviews done where necessary. Verbal autopsies were conducted for deaths occurring in older adult household members in the 24 months prior to interview. Results The total household population was 27,270 from 5,178 households. The overall household response rate was 86% and household cooperation rate was 98%. Thirty-four percent of household members were under 15 years of age while 8.3% were aged 65-plus years. Households with more than 11 members were more common in rural areas (57.2%) and in the highest income quintile (30.6%). Household members with no formal education formed 24.7% of the sample, with Northern and Upper East regions reaching more than 50%. Only 26.8% of the household members had insurance coverage. Households with hard floors ranged from 25.7% in Upper West to 97.7% in Ashanti region. Overall, 84.9% of the households had access to improved sources of drinking water, with the lowest at 29.6% in the Volta region. The overall rate of access to improved sanitation was just 14.9%. The findings show significant regional differences, with the three Northern Regions having worse education, income, and sanitation levels, compared to Southern and Central Regions of the country. Conclusion Household characteristics and intra-household dynamics have been shown to influence health and health-seeking behaviors across a number of contexts and countries, and play a fundamental role in the well-being of older Ghanaians. SAGE Ghana is part of a multi-country study using standardized questionnaires and tested methodologies to provide household level data required to inform policy on the growing population of older adults in Ghana. With the good response rates and measures instituted to assure quality of data, this article demonstrates the high quality data and research methods of SAGE. PMID:23759325

Insular Celtic population structure and genomic footprints of migration

PubMed Central

Hellenthal, Garrett

2018-01-01

Previous studies of the genetic landscape of Ireland have suggested homogeneity, with population substructure undetectable using single-marker methods. Here we have harnessed the haplotype-based method fineSTRUCTURE in an Irish genome-wide SNP dataset, identifying 23 discrete genetic clusters which segregate with geographical provenance. Cluster diversity is pronounced in the west of Ireland but reduced in the east where older structure has been eroded by historical migrations. Accordingly, when populations from the neighbouring island of Britain are included, a west-east cline of Celtic-British ancestry is revealed along with a particularly striking correlation between haplotypes and geography across both islands. A strong relationship is revealed between subsets of Northern Irish and Scottish populations, where discordant genetic and geographic affinities reflect major migrations in recent centuries. Additionally, Irish genetic proximity of all Scottish samples likely reflects older strata of communication across the narrowest inter-island crossing. Using GLOBETROTTER we detected Irish admixture signals from Britain and Europe and estimated dates for events consistent with the historical migrations of the Norse-Vikings, the Anglo-Normans and the British Plantations. The influence of the former is greater than previously estimated from Y chromosome haplotypes. In all, we paint a new picture of the genetic landscape of Ireland, revealing structure which should be considered in the design of studies examining rare genetic variation and its association with traits. PMID:29370172

Psychology Doctoral Students' Interest in Working with Older Adults: The Roles of Knowledge, Ageism, Aging Anxiety and Contact

ERIC Educational Resources Information Center

Dobbin, Carrie B.

2012-01-01

Given the growing population of older adults with more reported mental health needs, there are not sufficient psychologists interested in working with this population. This study looked at why interest is so low, looking particularly at the correlations between interest in working with older adults and knowledge about aging, ageism, aging anxiety…

Narratives of Self in Older Bilingual Adults Diagnosed with Alzheimer's Disease

ERIC Educational Resources Information Center

López de Victoria Rodríguez, Patria C.

2016-01-01

As the boom in the older adult population continues to grow, so too grows the number of persons suffering from cognitive diseases, such as dementia of the Alzheimer's type (DAT). Older Latinos diagnosed with the disease make up 4 percent (200,000) of the current population; however, little research on bilinguals with DAT has been carried out…

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…

Oral-Diadochokinetic Rates for Hebrew-Speaking Healthy Ageing Population: Non-Word versus Real-Word Repetition

ERIC Educational Resources Information Center

Ben-David, Boaz M.; Icht, Michal

2017-01-01

Background: Oral-diadochokinesis (oral-DDK) tasks are extensively used in the evaluation of motor speech abilities. Currently, validated normative data for older adults (aged 65 years and older) are missing in Hebrew. The effect of task stimuli (non-word versus real-word repetition) is also non-clear in the population of older adult Hebrew…

Confidant Network Types and Well-Being Among Older Europeans

PubMed Central

Litwin, Howard; Stoeckel, Kimberly J.

2014-01-01

Purpose of the Study: To derive a typology of confidant networks among older adults in Europe and to examine them in relation to country differences and well-being (CASP-12). Design and Methods: The study population was composed of persons aged 65 and older in 16 countries from the 4th wave of the Survey of Health, Ageing and Retirement in Europe (N = 28,697). K-means cluster analysis was applied to data from a newly implemented name-generating network inventory. CASP-12 scores were regressed on network type controlling for country and potential sociodemographic and health confounders. Results: Six prototypical confidant network types were discerned, including proximal and distal family-based networks of varying configurations, as well as friend-based and other-based network types. Regional country differences in network type constellations were observed. Better well-being was found to be associated with network types with greater social capital. Respondents with no named confidants had the lowest CASP-12 scores, and those embedded in “other” network types also exhibited a negative association with well-being. Implications: The study demonstrates the utility of name-generating network inventories in understanding the social capital of older persons. It also shows that accessible family ties are strong correlates of well-being in this population. Finally, it documents the importance of improving the means to detect the small but significant subgroup of isolated older people—those who have no confidants on whom they may rely. PMID:23749390

Older Adults Need Guidance to Meet Nutritional Recommendations

PubMed Central

Foote, Janet A.; Giuliano, Anna R.; Harris, Robin B.

2009-01-01

Objective The purpose of this study was to compare the diet of healthy, free-living senior volunteers to the dietary reference intakes (DRIs) and Food Guide Pyramid recommendations. Methods This study was a cross-sectional assessment of dietary habits, as measured using a standardized food frequency questionnaire, among 1740 healthy Southwestern U.S. adults, aged 51 to 85 years. Assessment of independently-living volunteers to chemoprevention trials provides an efficient mechanism to profile typical dietary habits among the older adult population. Results Daily estimated macronutrient intakes exceeded recommended proportions of protein and fat. In contrast, more than 60% of this senior population reported dietary vitamin D, vitamin E, folate and calcium intakes below estimated average requirements (EAR). Based on the Food Guide Pyramid recommendations, fewer than 10% of the older adults consumed the recommended daily dairy and grain servings. More females than males consumed recommended vegetable (49% versus 40%) and fruit (53% versus 48%) servings (p <, 0.05). More males consumed recommended grain (11% versus 7%) and protein (78% versus 73%) servings (p <, 0.05) than females. Conclusions Mean micronutrient intakes compared well with DRIs, although fewer than one-half of these older adults consumed recommended levels for vitamin D, vitamin E, folate, and calcium or daily food servings of dairy, grains, vegetables or fruits. Since the beneficial aspects of foods are not limited to essential nutrients, nutrition recommendations to older adults may be improved by emphasizing daily servings of nutrient-dense choices within the Food Pyramid. PMID:11022877

Trends in the crash involvement of older drivers in Australia.

PubMed

Thompson, James P; Baldock, Matthew R J; Dutschke, Jeffrey K

2018-05-03

Research from the USA and Great Britain indicates that the number of fatal crashes (as well as the rates of crashes of all levels of injury and property damage) involving older drivers declined between approximately 1997 and 2010 despite increases in the number of older drivers on the road and in their driving exposure. Differing results have been found in Australian research with the number of older driver fatalities having been steady and even slightly increasing between 2004 and 2013. The present study further examined trends in the crash involvement of older drivers in Australia to determine whether their involvement has been increasing or decreasing, and how this compares to trends for younger aged drivers. Crash, injury, population and licensure data were examined by age group for the years 2003-2012. There were increases in the population and licensure of drivers aged 65 years and older, while the total crashes, serious injuries, and fatalities remained steady for drivers aged 65-84 and increased for the oldest group (85+) between 2003 and 2012. Increasing trends were also found for drivers 85 and older for rates of serious or fatal injuries per head of population and per licensed driver. Population and licensure among younger age groups also increased but their crash numbers and crash rates remained steady or declined. The stable or slightly increasing fatal crash involvement of older drivers in Australia contrasts with the declining trends in the USA and Great Britain. Therefore, greater attention should be given to the road safety of older drivers in Australia. Copyright © 2018 Elsevier Ltd. All rights reserved.

The Impact of Cuban Economic Reform on Older Persons.

PubMed

Strug, David L

2017-03-01

This paper discusses the economic reforms initiated by Cuban President Raúl Castro in 2008 and its effect on the country's fast-growing, vulnerable population of older persons 60+ years of age. Cubans are living longer and the country has a very low birthrate. These two factors combined have reduced the proportion of the population in the work force. This adversely affects the economy. Population aging is a major reason why the government has introduced structural reforms and reduced social spending, which have weakened the welfare state on which older persons depend. Many older persons have become critical of the reforms over time. Policy makers need to address the impact the reforms are having on older Cubans and consider them as active participants in economic reform. Data for this paper come from qualitative, case study research carried out in Havana between the years 2008-15 and from a review of the literature on aging and economic reforms in Cuba. Two case studies illustrate the impact of the economic reforms on older persons.

A Population-based study of dementia in the oldest old: the Monzino 80-plus Study

PubMed Central

2011-01-01

Background Despite being the fastest growing and the most cognitively impaired age group, the oldest olds are under-represented in clinical research. The purpose of this study was to describe the design, methods, and baseline characteristics of the survey population and investigate possible differences in demographic, cognitive, functional, and behavioral characteristics between oldest old with and without any performance on cognitive tests and between oldest old alive and those deceased prior to the interview. Methods The Monzino 80-plus Study is a prospective door-to-door population-based survey among 80 years or older residents in the municipalities in the province of Varese, Italy. Dementia cases were identified with a one-phase design. Trained psychologists interviewed both the subject and a proxy informant. The interview included a comprehensive standardized questionnaire together with an array of rating scales and a multidomain cognitive battery to assess cognitive and functional ability, behavioral disturbances and mood. Results Information was available for 2,139 of the 2,428 registered individuals aged 80 years or older. Main baseline characteristics of the population are reported and discussed. In comparison with those living, elderly persons who had died before the first visit were older, had twice the rate of institutionalization, poorer cognitive performance and competence, and significantly greater instrumental and basic functional disability. The percentage of elderly persons, alive at baseline, without Mini-Mental State Examination rose rather evenly with age. Moreover, they had significantly worse cognitive competence and functional ability, and reported higher prevalences of depressive symptoms and problem behaviors than those with Mini-Mental State Examination. Conclusions Prospective investigation of a large population of oldest old can contribute significantly to understanding the relations between age, cognitive decline, and dementia occurrence. Use of informant-based instruments in surveys in the oldest old is crucial in assessing everyday functioning and changes, especially in participants with no cognitive test performance available. Failure to include information on deceased elderly would underestimate, increasingly with age, the prevalence of cognitive and functional disability in the elderly population. PMID:21612585

The use of Zostavax in Spain: the economic case for vaccination of individuals aged 50 years and older.

PubMed

Lopez-Belmonte, Juan Luis; Cisterna, Ramón; Gil de Miguel, Angel; Guilmet, Caroline; Bianic, Florence; Uhart, Mathieu

2016-06-01

Background Population aging brings up a number of health issues, one of which is an increased incidence of herpes zoster (HZ) and its complication, post-herpetic neuralgia (PHN). Zostavax vaccine has recently become available to prevent HZ and PHN. This study evaluates the cost-effectiveness of vaccination against HZ in Spain considering a vaccination of the population aged 50 years and older and comparing this to the current situation where no vaccination is being administered. Methods An existing, validated, and published economic model was adapted to Spain using relevant local input parameters and costs from 2013. Results Vaccinating 30% of the Spanish population aged 50 years and older resulted in €16,577/QALY gained, €2025/HZ case avoided, and €5594/PHN case avoided under the third-party payer perspective. From a societal perspective, the ICERs increased by 6%, due to the higher price of the vaccine. The number needed to vaccinate to prevent one case was 20 for HZ, and 63 for PHN3. Sensitivity analyses showed that the model was most sensitive to the HZ and PHN epidemiological data, the health state utilities values, and vaccine price used. Conclusion Considering an acceptable range of cost-effectiveness of €30,000-€50,000 per QALY gained, vaccination of the 50+ population in Spain against HZ with a new vaccine, Zostavax, is cost-effective and makes good use of the valuable healthcare budget.

Social vulnerability from a social ecology perspective: a cohort study of older adults from the National Population Health Survey of Canada

PubMed Central

2014-01-01

Background Numerous social factors, generally studied in isolation, have been associated with older adults’ health. Even so, older people’s social circumstances are complex and an approach which embraces this complexity is desirable. Here we investigate many social factors in relation to one another and to survival among older adults using a social ecology perspective to measure social vulnerability among older adults. Methods 2740 adults aged 65 and older were followed for ten years in the Canadian National Population Health Survey (NPHS). Twenty-three individual-level social variables were drawn from the 1994 NPHS and five Enumeration Area (EA)-level variables were abstracted from the 1996 Canadian Census using postal code linkage. Principal Component Analysis (PCA) was used to identify dimensions of social vulnerability. All social variables were summed to create a social vulnerability index which was studied in relation to ten-year mortality. Results The PCA was limited by low variance (47%) explained by emergent factors. Seven dimensions of social vulnerability emerged in the most robust, yet limited, model: social support, engagement, living situation, self-esteem, sense of control, relations with others and contextual socio-economic status. These dimensions showed complex inter-relationships and were situated within a social ecology framework, considering spheres of influence from the individual through to group, neighbourhood and broader societal levels. Adjusting for age, sex, and frailty, increasing social vulnerability measured using the cumulative social vulnerability index was associated with increased risk of mortality over ten years in a Cox regression model (HR 1.04, 95% CI:1.01-1.07, p = 0.01). Conclusions Social vulnerability has important independent influence on older adults’ health though relationships between contributing variables are complex and do not lend themselves well to fragmentation into a small number of discrete factors. A social ecology perspective provides a candidate framework for further study of social vulnerability among older adults. PMID:25129548

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

PubMed Central

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

2016-01-01

Introduction The use of functional assessments to evaluate patient change is complicated by a lack of consensus as to which assessment is most suitable for use with older adults. Objective: To identify and appraise the properties of assessments used to evaluate functional abilities in older adults. Methods A systematic review of randomised controlled trials of occupational therapy interventions was conducted up to 2012 to identify assessments used to measure function. Two authors screened and extracted data independently. A second search then identified papers investigating measurement properties of each assessment. Studies from the second search were included if: i) published in English, ii) the assessment was not modified from its original published form, iii) study aim was to evaluate the quality of the tool, iv) and was original research. Translated versions of assessments were excluded. Measurement quality was rated using the COSMIN checklist and Terwee criteria. Results Twenty-eight assessments were identified from the systematic search of occupational therapy interventions provided to older adults. Assessments were of varied measurement quality and many had been adapted (although still evaluated as though the original tool had been administered) potentially altering the conclusions drawn about measurement quality. Synthesis of best evidence established 15 functional assessments have not been tested in an older adult population. Conclusions The Functional Autonomy Measurement System (SMAF) appears to be a promising assessment for use with older adults. Only two tools (the SMAF and the Assessment of Motor and Process Skills (AMPS)) were deemed to be responsive to change when applied to older adults. Health professionals should use functional assessments that have been validated with their population and in their setting. There are reliable and valid assessments to capture the functional performance of older adults in community and hospital settings, although further refinement of these assessments may be necessary. PMID:26859678

Gender Differences: Examination of the 12-Item Bem Sex Role Inventory (BSRI-12) in an Older Brazilian Population

PubMed Central

Carver, Lisa F.; Vafaei, Afshin; Guerra, Ricardo; Freire, Aline; Phillips, Susan P.

2013-01-01

Objectives Although gender is often acknowledged as a determinant of health, measuring its components, other than biological sex, is uncommon. The Bem Sex Role Inventory (BSRI) quantifies self-attribution of traits, indicative of gender roles. The BSRI has been used with participants across cultures and countries, but rarely in an older population in Brazil, as we have done in this study. Our primary objective was to determine whether the BSRI-12 can be used to explore gender in an older Brazilian population. Methods The BSRI was completed by volunteer participants, all community dwelling adults aged 65+ living in Natal, Brazil. Exploratory factor analysis was performed, followed by a varimax rotation (orthogonal solution) for iteration to examine the underlying gender roles of feminine, masculine, androgynous and undifferentiated, and to validate the BSRI in older adults in Brazil. Results The 278 participants, (80 men, 198 women) were 65–99 years old (average 73.6 for men, 74.7 for women). Age difference between sexes was not significant (p = 0.22). A 12 item version of the BSRI (BSRI-12) previously validated among Spanish seniors was used and showed validity with 5 BSRI-12 items (Cronbach=0.66) loading as feminine, 6 items (Cronbach=0.51) loading onto masculine roles and neither overlapping with the category of biological sex of respondent. Conclusions Although the BSRI-12 appears to be a valid indicator of gender among elderly Brazilians, the gender role status identified with the BSRI-12 was not correlated with being male or female. PMID:24098482

Recruitment of Mobility Limited Older Adults Into a Facility-Led Exercise-Nutrition Study: The Effect of Social Involvement.

PubMed

Corcoran, Michael P; Nelson, Miriam E; Sacheck, Jennifer M; Reid, Kieran F; Kirn, Dylan; Fielding, Roger A; Folta, Sara C

2016-08-01

Older adults are among the most challenging population groups to enroll into health-related research. This article describes two methods used by investigators to recruit mobility limited older adults residing at assisted living or senior housing (SH) facilities into a facility-led exercise-nutrition research study. Sedentary older adults were recruited from 42 different assisted living facilities (ALFs) or SH communities. Two different recruitment approaches were used: At 22 sites, investigators conducted heavily advertised informational sessions to recruit participants (Info only). At 20 locations, these sessions were preceded by attendance of a study team member at various activities offered by the facility over the preceding 2 weeks (activity attendance). Population reach, enrollment, personnel cost, and time required to recruit at least five participants at each facility was measured. Reasons for declining participation and withdrawal rate were also measured. Sixty percent more residents elected to be screened for eligibility when study personnel attended an activity offered by the facility. Activity attendance resulted in significantly less time, costs, and participant withdrawals compared with facilities with no activity attendance. Study team member attendance at activities offered by senior living facilities reduces cost and duration of recruitment and improves study retention. Interventions targeting this demographic are likely to benefit from deliberately building trust and familiarity among the resident population at senior living communities as part of the recruitment process. © The Author 2015. 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.

Can standardized sleep questionnaires be used to identify excessive daytime sleeping in older post-acute rehabilitation patients?

PubMed

Skibitsky, Megan; Edelen, Maria Orlando; Martin, Jennifer L; Harker, Judith; Alessi, Cathy; Saliba, Debra

2012-02-01

Excessive daytime sleeping is associated with poorer functional outcomes in rehabilitation populations and may be improved with targeted interventions. The purpose of this study was to test simple methods of screening for excessive daytime sleeping among older adults admitted for postacute rehabilitation. Secondary analysis of data from 2 clinical samples. Two postacute rehabilitation (PAR) units in southern California. Two hundred twenty-six patients older than 65 years with Mini-Mental State Examination (MMSE) score higher than 11 undergoing rehabilitation. The primary outcome was excessive daytime sleeping, defined as greater than 15% (1.8 hours) of daytime hours (8 am to 8 pm) sleeping as measured by actigraphy. Participants spent, on average, 16.2% (SD 12.5%) of daytime hours sleeping as measured by actigraphy. Thirty-nine percent of participants had excessive daytime sleeping. The Pittsburgh Sleep Quality Index (PSQI) was significantly associated with actigraphically measured daytime sleeping (P = .0038), but the Epworth Sleepiness Scale (ESS) was not (P = .49). Neither the ESS nor the PSQI achieved sufficient sensitivity and specificity to be used as a screening tool for excessive daytime sleeping. Two additional models using items from these questionnaires were not significantly associated with the outcome. In an older PAR population, self-report items from existing sleep questionnaires do not identify excessive daytime sleeping. Therefore we recommend objective measures for the evaluation of excessive daytime sleeping as well as further research to identify new self-report items that may be more applicable in PAR populations. Copyright © 2012 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

Prevalence of psychotic symptoms among older adults in an Asian population.

PubMed

Subramaniam, Mythily; Abdin, Edimansyah; Vaingankar, Janhavi; Picco, Louisa; Shahwan, Shazana; Jeyagurunathan, Anitha; Zhang, Yunjue; Verma, Swapna; Chong, Siow Ann

2016-07-01

Psychotic symptoms are common among older adults and are seen in a wide range of conditions. Most studies examining the prevalence and correlates of psychotic symptoms among older adults have been conducted in Western populations. To address this gap the current study was undertaken to establish the prevalence and correlates of psychotic symptoms and paranoid ideation within a community sample of older adults without dementia in an Asian population. The Well-being of the Singapore Elderly (WiSE) study was a comprehensive single phase, cross-sectional survey. All respondents were assessed using the Geriatric Mental State examination (GMS). Specific questions of the GMS were then used to establish the prevalence of hallucinations and persecutory delusions. A total of 2,565 respondents completed the study giving a response rate of 65.6%. The prevalence of any psychotic symptoms in this population of older adults was 5.2%. The odds of hallucinations and any psychotic symptoms were significantly higher among those of Malay ethnicity, and those who had no formal education. Older adults aged 75-84 years were significantly associated with lower odds of having hallucinations (vs. older adult aged 60-74 years), while homemaker status was significantly associated with lower odds of having any psychotic symptoms. The prevalence of psychotic symptoms among older Asian adults without dementia was higher than that reported from Western countries. Psychotic symptoms were associated with Malay ethnicity, poor cognitive performance and fewer years of schooling, visual and hearing impairment as well as depression and irritability.

A comparison of methods for adjusting biomarkers of iron, zinc, and selenium status for the effect of inflammation in an older population: a case for interleukin 6.

PubMed

MacDonell, Sue O; Miller, Jody C; Harper, Michelle J; Reid, Malcolm R; Haszard, Jillian J; Gibson, Rosalind S; Houghton, Lisa A

2018-05-14

Older people are at risk of micronutrient deficiencies, which can be under- or overestimated in the presence of inflammation. Several methods have been proposed to adjust for the effect of inflammation; however, to our knowledge, none have been investigated in older adults in whom chronic inflammation is common. We investigated the influence of various inflammation-adjustment methods on micronutrient biomarkers associated with anemia in older people living in aged-care facilities in New Zealand. Blood samples were collected from 289 New Zealand aged-care residents aged >65 y. Serum ferritin, soluble transferrin receptor (sTfR), total body iron (TBI), plasma zinc, and selenium as well as the inflammatory markers high-sensitivity C-reactive protein (CRP), α1-acid glycoprotein (AGP), and interleukin 6 (IL-6) were measured. Four adjustment methods were applied to micronutrient concentrations: 1) internal correction factors based on stages of inflammation defined by CRP and AGP, 2) external correction factors derived from the literature, 3) a regression correction model in which reference CRP and AGP were set to the maximum of the lowest decile, and 4) a regression correction model in which reference IL-6 was set to the maximum of the lowest decile. Forty percent of participants had elevated concentrations of CRP, AGP, or both, and 37% of participants had higher than normal concentrations of IL-6. Adjusted geometric mean values for serum ferritin, sTfR, and TBI were significantly lower (P < 0.001), and plasma zinc and selenium were significantly higher (P < 0.001), than the unadjusted values regardless of the method applied. The greatest inflammation adjustment was observed with the regression correction that used IL-6. Subsequently, the prevalence of zinc and selenium deficiency decreased (-13% and -14%, respectively; P < 0.001), whereas iron deficiency remained unaffected. Adjustment for inflammation should be considered when evaluating micronutrient status in this aging population group; however, the approaches used require further investigation, particularly the influence of adjustment for IL-6.

Allocation of Rehabilitation Services for Older Adults in the Ontario Home Care System.

PubMed

Armstrong, Joshua J; Sims-Gould, Joanie; Stolee, Paul

Background: Physiotherapy and occupational therapy services can play a critical role in maintaining or improving the physical functioning, quality of life, and overall independence of older home care clients. Despite their importance, however, there is limited understanding of the factors that influence how rehabilitation services are allocated to older home care clients. The aim of this pilot study was to develop a preliminary understanding of the factors that influence decisions to allocate rehabilitation therapy services to older clients in the Ontario home care system, as perceived by three stakeholder groups. Methods: Semi-structured interviews were conducted with 10 key informants from three stakeholder groups: case managers, service providers, and health system policymakers. Results: Drivers of the allocation of occupational therapy and physiotherapy for older adults included functional needs and postoperative care. Participants identified challenges in providing home care rehabilitation to older adults, including impaired cognition and limited capacity in the home care system. Conclusions: Considering the changing demands for home care services, knowledge of current practices across the home care system can inform efforts to optimize rehabilitation services for the growing number of older adults. Further research is needed to advance the understanding of, and optimize rehabilitation service allocation to, older frail clients with multiple morbidities. Developing novel decision-support mechanisms and standardized clinical care pathways for older client populations may be beneficial.

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

PubMed

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

2016-01-01

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

Meeting the Housing and Care Needs of Older Homeless Adults: A Permanent Supportive Housing Program Targeting Homeless Elders.

PubMed

Brown, Rebecca T; Thomas, M Lori; Cutler, Deborah F; Hinderlie, Mark

2013-01-01

The homeless population is aging faster than the general population in the United States. As this vulnerable population continues to age, addressing complex care and housing needs will become increasingly important. This article reviews the often-overlooked issue of homelessness among older adults, including their poor health status and unique care needs, the factors that contribute to homelessness in this population, and the costs of homelessness to the U.S. health care system. Permanent supportive housing programs are presented as a potential solution to elder homelessness, and Hearth, an outreach and permanent supportive housing model in Boston, is described. Finally, specific policy changes are presented that could promote access to housing among the growing older homeless population.

Addressing the Aging Crisis in U.S. Criminal Justice Healthcare

PubMed Central

Williams, Brie A.; Goodwin, James S.; Baillargeon, Jacques; Ahalt, Cyrus; Walter, Louise C.

2012-01-01

The U.S. criminal justice population is aging at a significantly more rapid rate than the overall U.S. population: the population of older adults in prison has more than tripled since 1990. This increase is at the root of a prison healthcare crisis that is spilling into communities and public healthcare systems as nearly 95% of prisoners are eventually released. The graying prison population is also straining state and local budgets. In prison, older prisoners cost approximately three times as much as younger prisoners to incarcerate, largely due to healthcare costs. In the community, older former prisoners present the least risk of recidivism yet are vulnerable to serious and costly social and medical challenges such as housing instability, poor employability, multiple chronic health conditions, and health-related mortality. Older current and former prisoners, however, are largely ignored in the current geriatrics evidence base. Knowledge about the health, functional and cognitive status of older prisoners is limited, with even less known about risk factors for long term poor health outcomes during and after incarceration. This article provides an overview of aging in the criminal justice system. It then describes how geriatric models of care could be adapted to address the mounting older prisoner healthcare crisis and identifies areas where additional research is needed to explore prison-specific models of care for older adults. PMID:22642489

Multiple Trajectories of Successful Aging of Older and Younger Cohorts

ERIC Educational Resources Information Center

Hsu, Hui-Chuan; Jones, Bobby L.

2012-01-01

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

Older People's Views of Falls-Prevention Interventions in Six European Countries

ERIC Educational Resources Information Center

Yardley, Lucy; Bishop, Felicity L.; Beyer, Nina; Hauer, Klaus; Kempen, Gertrudis I. J. M.; Piot-Ziegler, Chantal; Todd, Chris J.; Cuttelod, Therese; Horne, Maria; Lanta, Kyriaki; Holt, Anne Rosell

2006-01-01

Purpose: Our study identified factors common to a variety of populations and settings that may promote or inhibit uptake and adherence to falls-related interventions. Design and Methods: Semistructured interviews to assess perceived advantages and barriers to taking part in falls-related interventions were carried out in six European countries…

Recruiting and Retaining an Ethnically Diverse Sample of Older Adults in a Longitudinal Intervention Study

ERIC Educational Resources Information Center

Austin-Wells, Vonnette; McDougall, Graham J.; Becker, Heather

2006-01-01

This paper describes strategies developed to recruit and retain an ethnically diverse sample in a longitudinal intervention of 246 participants in the SeniorWISE study. The ethnic and socioeconomic differences of these participants necessitated the use of different methods of effectively communicating with this population. Recruitment benefited…

Toward social system theory: implications for older people with developmental disabilities and service delivery.

PubMed

Dossa, P A

1990-01-01

The literature refers to older people with developmental disabilities as the "new service population." How and why this population emerged as a special category is discussed conceptually with reference to social systems theory. A brief review of social systems theory and some basic systemic tenets are presented. Systemic tenets are employed in examining the historical development of social gerontology and present trends in the service-delivery system. I show that the systemic variable of the economic model of human development has significantly impacted on the making of older people with developmental disabilities a dependent population. In the conclusion the systems perspective is explored in relation to recognizing the liminal, in-between parts between components. It is argued that such a perception minimizes the dichotomy between older people with developmental disabilities and the non-disabled population, paving the way for a genuine encounter.

[Demography and age-dependency in ophthalmic diseases].

PubMed

Wolfram, C

2015-01-01

This article explains key terms in demography and describes current and future changes in the composition of the German population. The ratio of older persons is greatly increasing as age groups from higher birth rates are growing older and as the life expectancy continues to rise particularly for older age groups. Ophthalmology is highly affected by these societal changes as eye diseases particularly affect the elderly. The prevalence of blindness and low vision is increasing in the older population even though this increase is being overlapped by a general reduction in the risk of blindness. Up to more than 30% more age-related eye diseases are expected in the population by the year 2030, which will lead to an additional roughly 7.7 million ophthalmic consultations in the population of more than 60 years of age. The healthcare units need to be adjusted to the rising demand for ophthalmic care.

Museums and Older Adults .

ERIC Educational Resources Information Center

Sharpe, Elizabeth M.; And Others

1984-01-01

This issue contains articles on characteristics of the older adult population and how one museum program addressed them; an analysis of sensory changes in older adulthood and their implications for museum facilities and programing; what older adults can contribute to the museum; older adults as museum volunteers; and case studies of museum…

Macroeconomic implications of population ageing and selected policy responses.

PubMed

Bloom, David E; Chatterji, Somnath; Kowal, Paul; Lloyd-Sherlock, Peter; McKee, Martin; Rechel, Bernd; Rosenberg, Larry; Smith, James P

2015-02-14

Between now and 2030, every country will experience population ageing-a trend that is both pronounced and historically unprecedented. Over the past six decades, countries of the world had experienced only a slight increase in the share of people aged 60 years and older, from 8% to 10%. But in the next four decades, this group is expected to rise to 22% of the total population-a jump from 800 million to 2 billion people. Evidence suggests that cohorts entering older age now are healthier than previous ones. However, progress has been very uneven, as indicated by the wide gaps in population health (measured by life expectancy) between the worst (Sierra Leone) and best (Japan) performing countries, now standing at a difference of 36 years for life expectancy at birth and 15 years for life expectancy at age 60 years. Population ageing poses challenges for countries' economies, and the health of older populations is of concern. Older people have greater health and long-term care needs than younger people, leading to increased expenditure. They are also less likely to work if they are unhealthy, and could impose an economic burden on families and society. Like everyone else, older people need both physical and economic security, but the burden of providing these securities will be falling on a smaller portion of the population. Pension systems will be stressed and will need reassessment along with retirement policies. Health systems, which have not in the past been oriented toward the myriad health problems and long-term care needs of older people and have not sufficiently emphasised disease prevention, can respond in different ways to the new demographic reality and the associated changes in population health. Along with behavioural adaptations by individuals and businesses, the nature of such policy responses will establish whether population ageing will lead to major macroeconomic difficulties. Copyright © 2015 World Health Organization. Published by Elsevier Ltd/Inc/BV. All rights reserved. Published by Elsevier Ltd. All rights reserved.

Identifying countermeasure strategies to increase safety of older pedestrians.

DOT National Transportation Integrated Search

2013-07-01

The increase in the older population as well as its increased frailty has led the National Highway Traffic Safety Administration (NHTSA) to conduct research initiatives examining the safety and mobility of older adults. Although older adults are stru...

Under-reporting of food intake and body fatness in independent older people: a doubly labelled water study.

PubMed

Pfrimer, Karina; Vilela, Mariana; Resende, Cristina Maria; Scagliusi, Fernanda Baeza; Marchini, Julio Sergio; Lima, Nereida K C; Moriguti, Julio Cesar; Ferriolli, Eduardo

2015-01-01

there are no accurate methods for the assessment of food intake in older populations, under-reporting of intake being highly prevalent. There is controversy about which dietary assessment method and what person's characteristics are associated with greater under-reporting rates. to assess the correlation between under-reporting of energy intake (EI) and different percentages of body fat in independent older people. cross-sectional study. area assisted by the Family Health Program of the Ribeirão Preto Medical School, University of São Paulo, Brazil. one hundred volunteers aged 60-70 years. all volunteers had their body composition assessed by dual-energy x-ray absorptiometry. In second phase, 41 volunteers were evaluated, representing the four quartiles of fat percentage. Total energy expenditure (TEE) was measured by the doubly labelled water method, and EI was assessed by 24-h recalls and a food frequency questionnaire (FFQ). TEE and EI values, EI-to-TEE ratios and EI-TEE values were compared. TEE was 2,220 ± 601 kcal, while the EI was 1,919 ± 602 kcal (24-h recall) and 2,119 ± 670 kcal (FFQ). The proportion of under-reporters was 31 and 40.5%, respectively. Under-reporting was more frequent in subjects with higher percentage of body fat and in females (P < 0.05). under-reporting was more frequent among older persons with higher percentage of body fat in both methods of assessment of food intake. Older persons follow the same profile of under-reporting as younger adults. © 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.

Family Support and Loneliness among Older Persons in Multiethnic Malaysia

PubMed Central

Teh, Jane Kimm Lii; Tey, Nai Peng; Ng, Sor Tho

2014-01-01

This study investigates factors affecting older persons' state of loneliness in multiethnic Malaysia using data from the 2004 Malaysian Population and Family Survey, the first nationally representative sample in Malaysia. The study sample was extracted to include Malays, Chinese, Indians and other Indigenous groups aged 60 and above, and who had children (n = 1791). Cross tabulations and ordinal logistic regression methods were used in the analysis. Among the ethnic groups, older Malays were more likely than their Chinese and Indian counterparts to experience loneliness. Loneliness was found to be associated with age, marital status, education level, sources of income, health status, and physical limitations. Among older people, feelings of loneliness were inversely related with coresidence with adult children and participation in religious activities. Sociodemographic changes have eroded the traditional family support system for the elderly, while social security remains inadequate. This study shows the important role of family in alleviating loneliness among older people. Hence the need to promote and facilitate coresidence, as well as participation in religious activities, and a healthy lifestyle as a priority strategy is in line with the objectives of the National Policy for the Older People. PMID:25383374

Clinical Research That Matters: Designing Outcome-Based Research for Older Adults to Qualify for Systematic Reviews and Meta-Analyses.

PubMed

Lee, Jeannie K; Fosnight, Susan M; Estus, Erica L; Evans, Paula J; Pho, Victoria B; Reidt, Shannon; Reist, Jeffrey C; Ruby, Christine M; Sibicky, Stephanie L; Wheeler, Janel B

2018-01-01

Though older adults are more sensitive to the effects of medications than their younger counterparts, they are often excluded from manufacturer-based clinical studies. Practice-based research is a practical method to identify medication-related effects in older patients. This research also highlights the role of a pharmacist in improving care in this population. A single study rarely has strong enough evidence to change geriatric practice, unless it is a large-scale, multisite, randomized controlled trial that specifically targets older adults. It is important to design studies that may be used in systematic reviews or meta-analyses that build a stronger evidence base. Recent literature has documented a gap in advanced pharmacist training pertaining to research skills. In this paper, we hope to fill some of the educational gaps related to research in older adults. We define best practices when deciding on the type of study, inclusion and exclusion criteria, design of the intervention, how outcomes are measured, and how results are reported. Well-designed studies increase the pool of available data to further document the important role that pharmacists have in optimizing care of older patients.

Characteristics of Emergency Department Visits by Older Versus Younger Homeless Adults in the United States

PubMed Central

Steinman, Michael A.

2013-01-01

Objectives. We compared the characteristics of emergency department (ED) visits of older versus younger homeless adults. Methods. We analyzed 2005–2009 data from the National Hospital Ambulatory Medical Care Survey, a nationally representative survey of visits to hospitals and EDs, and used sampling weights, strata, and clustering variables to obtain nationally representative estimates. Results. The ED visits of homeless adults aged 50 years and older accounted for 36% of annual visits by homeless patients. Although demographic characteristics of ED visits were similar in older and younger homeless adults, clinical and health services characteristics differed. Older homeless adults had fewer discharge diagnoses related to psychiatric conditions (10% vs 20%; P = .002) and drug abuse (7% vs 15%; P = .003) but more diagnoses related to alcohol abuse (31% vs 23%; P = .03) and were more likely to arrive by ambulance (48% vs 36%; P = .02) and to be admitted to the hospital (20% vs 11%; P = .003). Conclusions. Older homeless adults’ patterns of ED care differ from those of younger homeless adults. Health care systems need to account for these differences to meet the needs of the aging homeless population. PMID:23597348

Identification of Dynapenia in Older Adults Through the Use of Grip Strength T-Scores

PubMed Central

Bohannon, Richard W; Magasi, Susan

2014-01-01

Objective To generate reference values and t-scores (1.0 to 2.5 standard deviations below average) for grip strength for healthy young adults and to examine the utility of t-scores from this group for the identification of dynapenia in older adults. Design Secondary analysis of cross-sectional grip strength data from the NIH Toolbox norming sample. Setting Population-based general community sample. Participants Community dwelling adults, between the ages 20 and 40 years (n=558); and 60 to 85 years (n=390) Main Outcomes Measures Grip strength measured with a Jamar plus dynamometer. Results Maximum grip strengths were consistent over the 20–40 year age span. For men they were 108.0 lbs (S.D. 22.6). For women, they were 65.8 lbs (S.D. 14.6) Comparison of older participant grip strengths to those of the younger reference group revealed (depending on age strata) that 46.2–87.1% of older men and 50.0–82.4% of older women could be designated as dynapenic on the basis of t-scores. Conclusion The use of reference value t-scores from younger adults is a promising method for determining dynapenia in older adults. PMID:24729356

Identification of dynapenia in older adults through the use of grip strength t-scores.

PubMed

Bohannon, Richard W; Magasi, Susan

2015-01-01

The aim of this study was to generate reference values and t-scores (1.0-2.5 standard deviations below average) for grip strength for healthy young adults and to examine the utility of t-scores from this group for the identification of dynapenia in older adults. Our investigation was a population-based, general community secondary analysis of cross-sectional grip strength data utilizing the NIH Toolbox Assessment norming sample. Participants consisted of community-dwelling adults, with age ranges of 20-40 years (n = 558) and 60-85 years (n = 390). The main outcome measure was grip strength using a Jamar plus dynamometer. Maximum grip strengths were consistent over the 20-40-year age group [men 108.0 (SD 22.6) pounds, women 65.8 (SD 14.6) pounds]. Comparison of older group grip strengths to those of the younger reference group revealed (depending on age strata) that 46.2-87.1% of older men and 50.0-82.4% of older women could be designated as dynapenic on the basis of t-scores. The use of reference value t-scores from younger adults is a promising method for determining dynapenia in older adults. © 2014 Wiley Periodicals, Inc.

Mobility and Active Ageing in Suburban Environments: Findings from In-Depth Interviews and Person-Based GPS Tracking

PubMed Central

Zeitler, Elisabeth; Buys, Laurie; Aird, Rosemary; Miller, Evonne

2012-01-01

Background. Governments face a significant challenge to ensure that community environments meet the mobility needs of an ageing population. Therefore, it is critical to investigate the effect of suburban environments on the choice of transportation and its relation to participation and active ageing. Objective. This research explores if and how suburban environments impact older people's mobility and their use of different modes of transport. Methods. Data derived from GPS tracking, travel diaries, brief questionnaires, and semistructured interviews were gathered from thirteen people aged from 56 to 87 years, living in low-density suburban environments in Brisbane, Australia. Results. The suburban environment influenced the choice of transportation and out-of-home mobility. Both walkability and public transportation (access and usability) impact older people's transportation choices. Impracticality of active and public transportation within suburban environments creates car dependency in older age. Conclusion. Suburban environments often create barriers to mobility, which impedes older people's engagement in their wider community and ability to actively age in place. Further research is needed to develop approaches towards age-friendly suburban environments which will encourage older people to remain active and engaged in older age. PMID:23346108

Association among measures of mobility-related disability and self-perceived fatigue among older people: a population-based study

PubMed Central

Soares, Wuber J. S.; Lima, Camila A.; Bilton, Tereza L.; Ferrioli, Eduardo; Dias, Rosângela C.; Perracini, Monica R.

2015-01-01

Objective: To investigate the relationship between self-perceived fatigue with different physical functioning tests and functional performance scales used for evaluating mobility-related disability among community-dwelling older persons. Method: This is a cross-sectional, population-based study. The sample was composed of older persons with 65 years of age or more living in Cuiabá, MT, and Barueri, SP, Brazil. The data for this study is from the FIBRA Network Study. The presence of self-perceived fatigue was assessed using self-reports based on the Center for Epidemiologic Studies-Depression Scale. The Lawton instrumental activities of daily living scale (IADL) and the advanced activities of daily living scale (AADL) were used to assess performance and participation restriction. The following physical functioning tests were used: five-step test (FST), the Short Physical Performance Battery (SPPB), and usual gait speed (UGS). Three models of logistic regression analysis were conducted, and a significance level of α<0.05 was adopted. Results: The sample was composed of 776 older adults with a mean age (SD) of 71.9 (5.9) years, of whom the majority were women (74%). The prevalence of self-perceived fatigue within the participants was 20%. After adjusting for covariates, SPPB, UGS, IADL, and AADL remained associated with self-perceived fatigue in the final multivariate regression model. Conclusion: Our results suggest that there is an association between self-perceived fatigue and lower extremity function, usual gait speed and activity limitation and participation restriction in older adults. Further cohort studies are needed to investigate which physical performance measure may be able to predict the negative impact of fatigue in older adults. PMID:26039035

Sexual Behaviors and HIV Status: A Population-Based Study Among Older Adults in Rural South Africa

PubMed Central

Gómez-Olivé, Francesc X.; Rohr, Julia K.; Houle, Brian C.; Kabudula, Chodziwadziwa W.; Wagner, Ryan G.; Salomon, Joshua A.; Kahn, Kathleen; Berkman, Lisa F.; Tollman, Stephen M.; Bärnighausen, Till

2017-01-01

Objective: To identify the unmet needs for HIV prevention among older adults in rural South Africa. Methods: We analyzed data from a population-based sample of 5059 men and women aged 40 years and older from the study Health and Aging in Africa: Longitudinal Studies of INDEPTH Communities (HAALSI), which was carried out in the Agincourt health and sociodemographic surveillance system in the Mpumalanga province of South Africa. We estimated the prevalence of HIV (laboratory-confirmed and self-reported) and key sexual behaviors by age and sex. We compared sexual behavior profiles across HIV status categories with and without age–sex standardization. Results: HIV prevalence was very high among HAALSI participants (23%, 95% confidence interval [CI]: 21 to 24), with no sex differences. Recent sexual activity was common (56%, 95% CI: 55 to 58) across all HIV status categories. Condom use was low among HIV-negative adults (15%, 95% CI: 14 to 17), higher among HIV-positive adults who were unaware of their HIV status (27%, 95% CI: 22 to 33), and dramatically higher among HIV-positive adults who were aware of their status (75%, 95% CI: 70 to 80). Casual sex and multiple partnerships were reported at moderate levels, with slightly higher estimates among HIV-positive compared to HIV-negative adults. Differences by HIV status remained after age–sex standardization. Conclusions: Older HIV-positive adults in an HIV hyperendemic community of rural South Africa report sexual behaviors consistent with high HIV transmission risk. Older HIV-negative adults report sexual behaviors consistent with high HIV acquisition risk. Prevention initiatives tailored to the particular prevention needs of older adults are urgently needed to reduce HIV risk in this and similar communities in sub-Saharan Africa. PMID:27926667

Filling the Gaps in a Fragmented Health Care System: Development of the Health and Welfare Information Portal (ZWIP).

PubMed

Robben, Sarah Hm; Huisjes, Mirjam; van Achterberg, Theo; Zuidema, Sytse U; Olde Rikkert, Marcel Gm; Schers, Henk J; Heinen, Maud M; Melis, René Jf

2012-09-19

Current health care systems are not optimally designed to meet the needs of our aging populations. First, the fragmentation of care often results in discontinuity of care that can undermine the quality of care provided. Second, patient involvement in care decisions is not sufficiently facilitated. To describe the development and the content of a program aimed at: (1) facilitating self-management and shared decision making by frail older people and informal caregivers, and (2) reducing fragmentation of care by improving collaboration among professionals involved in the care of frail older people through a combined multidisciplinary electronic health record (EHR) and personal health record (PHR). We used intervention mapping to systematically develop our program in six consecutive steps. Throughout this development, the target populations (ie, professionals, frail older people, and informal caregivers) were involved extensively through their participation in semi-structured interviews and working groups. We developed the Health and Welfare Information Portal (ZWIP), a personal, Internet-based conference table for multidisciplinary communication and information exchange for frail older people, their informal caregivers, and professionals. Further, we selected and developed methods for implementation of the program, which included an interdisciplinary educational course for professionals involved in the care of frail older people, and planned the evaluation of the program. This paper describes the successful development and the content of the ZWIP as well as the strategies developed for its implementation. Throughout the development, representatives of future users were involved extensively. Future studies will establish the effects of the ZWIP on self-management and shared decision making by frail older people as well as on collaboration among the professionals involved.

Estimating and modelling cure in population-based cancer studies within the framework of flexible parametric survival models

PubMed Central

2011-01-01

Background When the mortality among a cancer patient group returns to the same level as in the general population, that is, the patients no longer experience excess mortality, the patients still alive are considered "statistically cured". Cure models can be used to estimate the cure proportion as well as the survival function of the "uncured". One limitation of parametric cure models is that the functional form of the survival of the "uncured" has to be specified. It can sometimes be hard to find a survival function flexible enough to fit the observed data, for example, when there is high excess hazard within a few months from diagnosis, which is common among older age groups. This has led to the exclusion of older age groups in population-based cancer studies using cure models. Methods Here we have extended the flexible parametric survival model to incorporate cure as a special case to estimate the cure proportion and the survival of the "uncured". Flexible parametric survival models use splines to model the underlying hazard function, and therefore no parametric distribution has to be specified. Results We have compared the fit from standard cure models to our flexible cure model, using data on colon cancer patients in Finland. This new method gives similar results to a standard cure model, when it is reliable, and better fit when the standard cure model gives biased estimates. Conclusions Cure models within the framework of flexible parametric models enables cure modelling when standard models give biased estimates. These flexible cure models enable inclusion of older age groups and can give stage-specific estimates, which is not always possible from parametric cure models. PMID:21696598

Patterns of residential crowding among Hispanics in later life: immigration, assimilation, and housing market factors.

PubMed

Burr, Jeffrey A; Mutchler, Jan E; Gerst, Kerstin

2010-11-01

We describe patterns of residential crowding among older Hispanics and non-Hispanic Whites. We also examine hypotheses about the relationship of residential crowding with assimilation (language and duration of residence) and housing market characteristics. We employ a multilevel research design, using data from the 2000 U.S. Census of Population. Hierarchical linear models are utilized to estimate the association between residential crowding and both individual and housing market factors. Approximately one third of older Hispanics in metropolitan areas live in crowded housing compared with only one tenth of older non-Hispanic Whites. Foreign-born older persons report higher levels of crowding than U.S.-born older persons. Residential crowding differences between older Hispanics and non-Hispanics are not eliminated after controls are included. Older Hispanics who report better English language skills and a longer duration of residence in the United States live in less crowded housing. We do not find evidence for a relationship between crowding and residential segregation, but we find consistent evidence for an association between residential crowding and relative size of the Hispanic population. The forces that shape household composition and access to housing among older Hispanics appear to result in higher levels of residential crowding for this population.

Socio-cultural reflections on heat in Australia with implications for health and climate change adaptation

PubMed Central

Banwell, Cathy; Dixon, Jane; Bambrick, Hilary; Edwards, Ferne; Kjellström, Tord

2012-01-01

Background Australia has a hot climate with maximum summer temperatures in its major cities frequently exceeding 35°C. Although ‘heat waves’ are an annual occurrence, the associated heat-related deaths among vulnerable groups, such as older people, suggest that Australians could be better prepared to deal with extreme heat. Objective To understand ways in which a vulnerable sub-population adapt their personal behaviour to cope with heat within the context of Australians’ relationship with heat. Design We draw upon scientific, historical and literary sources and on a set of repeat interviews in the suburbs of Western Sydney with eight older participants and two focus group discussions. We discuss ways in which this group of older people modifies their behaviour to adapt to heat, and reflect on manifestations of Australians’ ambivalence towards heat. Results Participants reported a number of methods for coping with extreme heat, including a number of methods of personal cooling, changing patterns of daily activity and altering dietary habits. The use of air-conditioning was near universal, but with recognition that increasing energy costs may become more prohibitive over time. Conclusions While a number of methods are employed by older people to stay cool, these may become limited in the future. Australians’ attitudes may contribute to the ill-health and mortality associated with excessive heat. PMID:23078748

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 use of aspirin by older Americans with elevated risk of cardiovascular disease could generate substantial population health benefits over the next twenty years and do so very cost-effectively. PMID:27902693

Newly arrived elderly immigrants: a concept analysis of "aging out of place".

PubMed

Sadarangani, Tina R; Jun, Jin

2015-03-01

Newcomer elderly immigrants, defined as adults older than the age of 65 who have arrived in the United States in the last 10 years, represent a growing sector of the American population. Newcomers who experience limited English proficiency, financial strain, and acculturative stress are at considerable risk of developing poor health outcomes. Nursing's focus on healthy aging and aging in place has largely ignored the experiences of these older adults, who are said to be "aging out of place." This concept analysis uses Rodgers's evolutionary method to define "aging out of place" and illustrates why existing theories of elderly migration do not necessarily apply to this population. The challenge for nurses is incorporating the family, with whom conflict may arise, into the care of these elders. Community-based strategies that enable social integration and create a greater division of labor in the care of newcomer elders are called for. © The Author(s) 2014.

Incidence and Short-term Mortality From Perforated Peptic Ulcer in Korea: A Population-Based Study

PubMed Central

Bae, SeungJin; Shim, Ki-Nam; Kim, Nayoung; Kang, Jung Mook; Kim, Dong-Sook; Kim, Kyoung-Min; Cho, Yu Kyung; Jung, Sung Woo

2012-01-01

Background Perforated peptic ulcer (PPU) is associated with serious health and economic outcomes. However, few studies have estimated the incidence and health outcomes of PPU using a nationally representative sample in Asia. We estimated age- and sex-specific incidence and short-term mortality from PPU among Koreans and investigated the risk factors for mortality associated with PPU development. Methods A retrospective population-based study was conducted from 2006 through 2007 using the Korean National Health Insurance claims database. A diagnostic algorithm was derived and validated to identify PPU patients, and PPU incidence rates and 30-day mortality rates were determined. Results From 2006 through 2007, the PPU incidence rate per 100 000 population was 4.4; incidence among men (7.53) was approximately 6 times that among women (1.24). Incidence significantly increased with advanced age, especially among women older than 50 years. Among 4258 PPU patients, 135 (3.15%) died within 30 days of the PPU event. The 30-day mortality rate increased with advanced age and reached almost 20% for patients older than 80 years. The 30-day mortality rate was 10% for women and 2% for men. Older age, being female, and higher comorbidity were independently associated with 30-day mortality rate among PPU patients in Korea. Conclusions Special attention should be paid to elderly women with high comorbidity who develop PPU. PMID:22955110

Relative survival: a useful tool to assess generalisability in longitudinal studies of health in older persons

PubMed Central

2011-01-01

Background Generalisability of longitudinal studies is threatened by issues such as choice of sampling frame, representativeness of the initial sample, and attrition. To determine representativeness, cohorts are often compared with the population of interest at baseline on demographic and health characteristics. This study illustrates the use of relative survival as a tool for assessing generalisability of results from a cohort of older people among whom death is a potential threat to generalisability. Methods The authors used data from the 1921-26 cohort (n = 12,416, aged 70-75 in 1996) of the Australian Longitudinal Study on Women's Health (ALSWH). Vital status was determined by linkage to the National Death Index, and expected deaths were derived using Australian life tables. Relative survival was estimated using observed survival in the cohort divided by expected survival among women of the same age and State or Territory. Results Overall, the ALSWH women showed relative survival 9.5% above the general population. Within States and Territories, the relative survival advantage varied from 6% to 23%. The interval-specific relative survival remained relatively constant over the 12 years (1996-2008) under review, indicating that the survival advantage of the cohort has not diminished over time. Conclusion This study demonstrates that relative survival can be a useful measure of generalisability in a longitudinal study of the health of the general population, particularly when participants are older. PMID:21294918

Meeting the Housing and Care Needs of Older Homeless Adults: A Permanent Supportive Housing Program Targeting Homeless Elders

PubMed Central

Brown, Rebecca T.; Thomas, M. Lori; Cutler, Deborah F.; Hinderlie, Mark

2014-01-01

The homeless population is aging faster than the general population in the United States. As this vulnerable population continues to age, addressing complex care and housing needs will become increasingly important. This article reviews the often-overlooked issue of homelessness among older adults, including their poor health status and unique care needs, the factors that contribute to homelessness in this population, and the costs of homelessness to the U.S. health care system. Permanent supportive housing programs are presented as a potential solution to elder homelessness, and Hearth, an outreach and permanent supportive housing model in Boston, is described. Finally, specific policy changes are presented that could promote access to housing among the growing older homeless population. PMID:24729832

Researching older lesbians: problems and partial solutions.

PubMed

Westwood, Sue

2013-01-01

There is a lack of research about older lesbians, who can be considered not only a "hidden population" but also a population in hiding. Yet older lesbians hold vital historical and cultural narratives that are, in turn, the heritage of younger lesbians. They also have much to contribute to understandings about gender, sexuality and aging, and to their currently unmet needs in terms of age-related housing, health, and social care provision. This article reflects on some of the issues that make it difficult to access older lesbians for research purposes. It identifies four problematic areas in researching older lesbians: definitions, access, representative sampling, and ethical issues. It suggests that participative action research might offer a means of widening access and engaging with older lesbians in a more collaborative way.

Supervision of care networks for frail community dwelling adults aged 75 years and older: protocol of a mixed methods study

PubMed Central

Verver, Didi; Merten, Hanneke; Robben, Paul; Wagner, Cordula

2015-01-01

Introduction The Dutch healthcare inspectorate (IGZ) supervises the quality and safety of healthcare in the Netherlands. Owing to the growing population of (community dwelling) older adults and changes in the Dutch healthcare system, the IGZ is exploring new methods to effectively supervise care networks that exist around frail older adults. The composition of these networks, where formal and informal care takes place, and the lack of guidelines and quality and risk indicators make supervision complicated in the current situation. Methods and analysis This study consists of four phases. The first phase identifies risks for community dwelling frail older adults in the existing literature. In the second phase, a qualitative pilot study will be conducted to assess the needs and wishes of the frail older adults concerning care and well-being, perception of risks, and the composition of their networks, collaboration and coordination between care providers involved in the network. In the third phase, questionnaires based on the results of phase II will be sent to a larger group of frail older adults (n=200) and their care providers. The results will describe the composition of their care networks and prioritise risks concerning community dwelling older adults. Also, it will provide input for the development of a new supervision framework by the IGZ. During phase IV, a second questionnaire will be sent to the participants of phase III to establish changes of perception in risks and possible changes in the care networks. The framework will be tested by the IGZ in pilots, and the researchers will evaluate these pilots and provide feedback to the IGZ. Ethics and dissemination The study protocol was approved by the Scientific Committee of the EMGO+institute and the Medical Ethical review committee of the VU University Medical Centre. Results will be presented in scientific articles and reports and at meetings. PMID:26307619

Illness Conceptualizations among Older Rural Mexican-Americans with Anxiety and Depression

PubMed Central

Letamendi, Andrea M.; Ayers, Catherine R.; Ruberg, Joshua L.; Singley, Daniel B.; Wilson, Jacqueline; Chavira, Denise; Palinkas, Lawrence; Wetherell, Julie Loebach

2014-01-01

Background Research on barriers and utilization of mental health services in older ethnic minorities has been productive. However, little is known about the characterization and beliefs about anxiety and depression symptoms among older Mexican-Americans. Exploration of these conceptualizations will lead to better detection and provision of care to this large, yet underserved group. Method The present study used a mixed methods approach to explore conceptualizations of anxiety and depression in a group of rural older Mexican-Americans. Twenty-five Spanish-speaking participants (mean age 71.2) responded to flyers that solicited individuals who felt “tense or depressed.” Participants completed a structured diagnostic interview as well as self-report questionnaires about medical health, anxiety and depressive symptoms, and cognitive functioning. Qualitative interviews included questions about how participants describe, conceptualize, and cope with anxiety and depression symptoms. Results Sixty-eight percent of the sample met criteria for at least one anxiety or mood disorder with high comorbidity rates. Self-reported symptoms of depression, anxiety, and somatization were below clinical ranges for all participants. Medical illness, cognitive impairment, age, education, and acculturation were not associated with distress. Qualitative analyses revealed that nearly half of the terms used by the sample to describe distress phenomena deviated from Western labels traditionally used to indicate anxious and depressive symptomatology. Discussion Multiple methods of symptom endorsement demonstrated that older Mexican-Americans may report distress differently than detected by traditional self-report measures or common Western terminology. Understanding these additional illness conceptualizations may have implications for improving the detection of mental illness and increasing service use among this growing population. PMID:24077906

Older adults in jail: high rates and early onset of geriatric conditions.

PubMed

Greene, Meredith; Ahalt, Cyrus; Stijacic-Cenzer, Irena; Metzger, Lia; Williams, Brie

2018-02-17

The number of older adults in the criminal justice system is rapidly increasing. While this population is thought to experience an early onset of aging-related health conditions ("accelerated aging"), studies have not directly compared rates of geriatric conditions in this population to those found in the general population. The aims of this study were to compare the burden of geriatric conditions among older adults in jail to rates found in an age-matched nationally representative sample of community dwelling older adults. This cross sectional study compared 238 older jail inmates age 55 or older to 6871 older adults in the national Health and Retirement Study (HRS). We used an age-adjusted analysis, accounting for the difference in age distributions between the two groups, to compare sociodemographics, chronic conditions, and geriatric conditions (functional, sensory, and mobility impairment). A second age-adjusted analysis compared those in jail to HRS participants in the lowest quintile of wealth. All geriatric conditions were significantly more common in jail-based participants than in HRS participants overall and HRS participants in the lowest quintile of net worth. Jail-based participants (average age of 59) experienced four out of six geriatric conditions at rates similar to those found in HRS participants age 75 or older. Geriatric conditions are prevalent in older adults in jail at significantly younger ages than non-incarcerated older adults suggesting that geriatric assessment and geriatric-focused care are needed for older adults cycling through jail in their 50s and that correctional clinicians require knowledge about geriatric assessment and care.

Population prevalence and distribution of ankle pain and symptomatic radiographic ankle osteoarthritis in community dwelling older adults: A systematic review and cross-sectional study

PubMed Central

Murray, Charlotte; Rathod, Trishna; Bowen, Catherine J.; Menz, Hylton B.; Roddy, Edward

2018-01-01

Objectives To identify by systematic review published prevalence estimates of radiographic ankle osteoarthritis (OA) and to subsequently estimate the prevalence of ankle pain and symptomatic, radiographic ankle OA within community-dwelling older adults from North Staffordshire, UK. Methods Electronic databases were searched using terms for ankle, osteoarthritis and radiography. Data regarding population, radiographic methods, definitions and prevalence estimates of ankle OA were extracted from papers meeting predetermined selection criteria. Adults aged ≥50 years and registered with four general practices in North Staffordshire were mailed a health questionnaire. Ankle pain in the previous month was determined using a foot and ankle pain manikin. Respondents reporting pain in or around the foot in the last 12 months were invited to attend a research clinic where weight-bearing, antero-posterior and lateral ankle radiographs were obtained and scored for OA using a standardised atlas. Prevalence estimates for ankle pain and symptomatic, radiographic ankle OA were calculated using multiple imputation and weighted logistic regression, and stratified by age, gender and socioeconomic status. Results Eighteen studies were included in the systematic review. The methods of radiographic classification of ankle OA were poorly reported and showed heterogeneity. No true general population prevalence estimates of radiographic ankle OA were found, estimates in select sporting and medical community-dwelling populations ranged from 0.0–97.1%. 5109 participants responded to the health survey questionnaire (adjusted response 56%). Radiographs were obtained in 557 participants. The prevalence of ankle pain was 11.7% (10.8,12.6) and symptomatic, radiographic ankle OA grade≥2 was 3.4% (2.3, 4.5) (grade≥1: 8.8% (7.9,9.8); grade = 3: 1.9% (1.0,2.7). Prevalence was higher in females, younger adults (50–64 years) and those with routine/manual occupations. Conclusion No general population prevalence estimates of radiographic ankle OA were identified in the published literature. Our prevalence study found that ankle pain was common in community-dwelling older adults, whereas moderate to severe symptomatic, radiographic ankle OA occurred less frequently. Further investigations of the prevalence of ankle OA using more sensitive imaging modalities are warranted. PMID:29708977

Coping and health in older adults.

PubMed

Yancura, Loriena A; Aldwin, Carolyn M

2008-02-01

Although coping has been shown to influence physical health in younger populations, whether coping affects health in older adults appears to depend upon how coping and health are conceptualized. This article reviews recent literature on coping and health in older adults in three areas. First, we discuss coping's distinct relevance to health in older adults. Second, we describe ways in which coping may differ between older and younger populations. Third, we detail recent and notable findings of coping's specific effects on biomedical health and health in general. The recent literature suggests that coping may be a developmental and multifaceted process. Positive coping strategies may have positive and even protective effects on health, whereas negative strategies may have negative effects.

Is Geriatric Medicine Possible in a Middle-Income Country? The Case of Costa Rica.

PubMed

Morales-Martínez, Fernando

2017-08-01

This article outlines the current and future-projected demographic data, organization, networks for the care of older people, and perspectives in Costa Rica in relation to the challenges resulting from exponential growth of the older adult population, most notably those aged 80 and older. It includes consideration of the Norms of Integrated Care of the Older Adult of Costa Rica's national social security system and contributions from other public and private institutions. It also makes note of commentaries on the need for ever-increasing efforts to manage the care of Costa Rica's burgeoning older adult population. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

Are older people more vulnerable to long-term impacts of disasters?

PubMed Central

Rafiey, Hassan; Momtaz, Yadollah Abolfathi; Alipour, Fardin; Khankeh, Hamidreza; Ahmadi, Shokoufeh; Sabzi Khoshnami, Mohammad; Haron, Sharifah Azizah

2016-01-01

Background Despite the growing interest in the study of disasters, there is limited research addressing the elderly population that lead to prejudiced beliefs that older adults are more vulnerable to disasters than younger adults. This study aimed to compare positive mental health between elderly and young earthquake survivors. Method Data for this study, consisting of 324 earthquake survivors, were obtained from a population-based cross-sectional survey conducted in Iran, 2015. The long-term effect of earthquake was assessed using the Mental Health Continuum-Short Form questionnaire. A one-way multivariate analysis of covariance (MANCOVA) using SPSS (version 22) was used in data analysis. Results Older adults scored significantly a higher level of overall positive mental health (mean [M]=34.31, standard deviation [SD]=10.52) than younger age group (M=27.48, SD=10.56, t=−4.41; P<0.001). Results of MANCOVA revealed a statistically significant difference between older and young adults on the combined positive mental health subscales (F(3,317)=6.95; P<0.001), after controlling for marital status, sex, and employment status. Conclusion The present findings showing a higher level of positive mental health among elderly earthquake survivors compared with their younger counterparts in the wake of natural disasters suggest that advancing age per se does not contribute to increasing vulnerability. PMID:27994445

Do photographs, older adults' narratives and collaborative dialogue foster anticipatory reflection ("preflection") in medical students?

PubMed

Brand, Gabrielle; Osborne, Ashlee; Carroll, Mark; Carr, Sandra E; Etherton-Beer, Christopher

2016-11-11

In changing higher education environments, medical educators are increasingly challenged to prepare new doctors to care for ageing populations. The Depth of Field: Exploring Ageing resource (DOF) uses photographs, reflective questioning prompts, older adults' narratives and collaborative dialogue to foster anticipatory reflection or 'preflection' in medical students prior to their first geriatric medicine clinical placement. The aim of this research is to explore whether photographs, narratives and small group collaborative dialogue fosters reflective learning, enhances reflective capacity and has the potential to shift medical students' attitudes towards caring for older adults. This study used a mixed method evaluation design, measuring attitudes using pre and post questionnaire responses and individual written reflections drawn from 128 second year medical students, exploring their perceptions toward older adults. Quantitative and qualitative data indicated that the DOF session generated reflective learning that resulted in positive shifts in medical students' perceptions towards older adults. The qualitative reflections were captured in four main themes: the opportunity provided to Envision working with older adults; the Tension created to challenge learners' misinformed assumptions, and the work of Dismantling those assumptions, leading to Seeing older people as individuals. These findings highlight how visual and narrative methodologies can be used as an effective reflective learning tool to challenge medical students' assumptions around ageing and how these may influence their care of older adults.

Perception and negative effect of loneliness in a Chicago Chinese population of older adults.

PubMed

Dong, Xinqi; Chang, E-Shien; Wong, Esther; Simon, Melissa

2012-01-01

This qualitative study aims to investigate the cultural understandings of loneliness, identify the contexts of loneliness, and to examine its effect on the health and well-being of U.S. Chinese older adults. Despite loneliness is one of the main indicators of well-being, little attention has been paid to understanding loneliness among immigrant older adults. This study utilizes both survey questionnaires and semi-structured focus group methods to investigate the feelings of loneliness among U.S. Chinese older adults. Based on interviews with 78 community-dwelling Chinese older adults in Chicago Chinatown, this community-based participatory research study (CBPR) shows loneliness is common among U.S. Chinese older adults. It was frequently identified through emotional isolation and social isolation. Social, psychological and physical health factors could contribute to the experience of loneliness. In addition, the health of older adults with loneliness may be associated with worsening overall health, elder mistreatment, health behavior changes and increased healthcare utilizations. This study has implications for healthcare professionals, social services agencies and policy makers. Our findings point to the needs for healthcare professionals to be more alert of the association of loneliness and adverse health outcomes. Communities and social services agencies should collectively take a lead in reducing social isolation, improving intergenerational relationships, and increasing social networks and companionship for this group of vulnerable older adults. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Perception and Negative Effect of Loneliness in a Chicago Chinese Population of Older Adults

PubMed Central

Dong, XinQi; Chang, E-Shien; Wong, Esther; Simon, Melissa

2011-01-01

This qualitative study aims to investigate the cultural understandings of loneliness, identify the contexts of loneliness, and to examine its effect on the health and well-being of U.S. Chinese older adults. Despite loneliness is one of the main indicators of well-being, little attention has been paid to understanding loneliness among immigrant older adults. This study utilizes both survey questionnaires and semi-structured focus group methods to investigate the feelings of loneliness among U.S. Chinese older adults. Based on interviews with 78 community-dwelling Chinese older adults in Chicago Chinatown, this community-based participatory research study (CBPR) shows loneliness is common among U.S. Chinese older adults. It was frequently identified through emotional isolation and social isolation. Social, psychological and physical health factors could contribute to the experience of loneliness. In addition, the health of older adults with loneliness may be associated with worsening overall health, elder mistreatment, health behavior changes and increased health care utilizations. This study has implications for healthcare professionals, social services agencies and policy makers. Our findings point to the needs for healthcare professionals to be more alert of the association of loneliness and adverse health outcomes. Communities and social services agencies should collectively take a lead in reducing social isolation, improving intergenerational relationships, and increasing social networks and companionship for this group of vulnerable older adults. PMID:21621865

Towards a new conceptualization of depression in older adult cancer patients: a review of the literature

PubMed Central

Saracino, Rebecca M.; Rosenfeld, Barry; Nelson, Christian J.

2016-01-01

Objectives Identifying depression in older adults with cancer presents a set of unique challenges, as it combines the confounding influences of cancer and its treatment with the developmental changes associated with aging. This paper reviews the phenomenology of depression in older adults, and individuals diagnosed with cancer. Method PsychInfo, PubMed, Web of Science, and Google Scholar databases were searched for English-language studies addressing the phenomenology, symptoms, or assessment of depression in older adults and those with cancer. Results The Diagnostic and Statistical Manual for Mental Disorders (DSM) criteria that appear to be relevant to both older adults and cancer patients are anhedonia, concentration difficulties, sleep disturbances, psychomotor retardation/agitation, and loss of energy. Possible alternative criteria that may be important considerations included constructs such as loss of purpose, loneliness, and irritability in older adults. Among cancer patients, tearfulness, social withdrawal, and not participating in treatment despite ability to do so were identified as potentially important symptoms. Conclusions Current DSM criteria may not adequately assess depression in older cancer patients and alternative criteria may be important to inform the understanding and identification of depression in this population. Enhancing diagnostic accuracy of depression is important as both the over-diagnosis and under-diagnosis is accompanied with significant costs. Thus, continued research exploring the phenomenology and identifying effective indicators of depression in older cancer patients is needed. PMID:26312455

"We definitely are role models": Exploring how clinical instructors' influence nursing students' attitudes towards older adults.

PubMed

Gibbs, Sheena Simpkins; Kulig, Judith C

2017-09-01

The world's population is getting older, which will inevitably cause increased demands for nurses to provide high quality care to this demographic. Attitudes have been shown to influence the quality of care that older adults receive. It is therefore important to gain a better understanding of what influences nursing students' attitudes towards older adults. This article reports on one of three inter-connected research questions of a mixed methods study that explored the relationship between clinical instructors' attitudes and nursing students' attitudes towards older adults. Semi-structured interviews were conducted with 6 clinical instructors and 13 nursing students. Interview data was analyzed using thematic analysis. A conceptual model was developed from the research findings, which revealed that nursing instructors are seen as strong role models for their students, and as role models, they influence students through demonstrations, expectations and support. As a result, nursing students mirror the attitudes of their instructors towards older adults. Findings from this study highlight the strong connection between nursing instructors' and students' attitudes. This has important implications for nursing education including strategies that instructors can employ to enhance students' attitudes towards older adults. Insights from this study also have the potential to improve the quality of care that future nurses provide to older adults. Copyright © 2017 Elsevier Ltd. All rights reserved.

Geriatric Patient Safety Indicators Based on Linked Administrative Health Data to Assess Anticoagulant-Related Thromboembolic and Hemorrhagic Adverse Events in Older Inpatients: A Study Proposal

PubMed Central

Quantin, Catherine; Reich, Oliver; Tuppin, Philippe; Fagot-Campagna, Anne; Paccaud, Fred; Peytremann-Bridevaux, Isabelle; Burnand, Bernard

2017-01-01

Background Frail older people with multiple interacting conditions, polypharmacy, and complex care needs are particularly exposed to health care-related adverse events. Among these, anticoagulant-related thromboembolic and hemorrhagic events are particularly frequent and serious in older inpatients. The growing use of anticoagulants in this population and their substantial risk of toxicity and inefficacy have therefore become an important patient safety and public health concern worldwide. Anticoagulant-related adverse events and the quality of anticoagulation management should thus be routinely assessed to improve patient safety in vulnerable older inpatients. Objective This project aims to develop and validate a set of outcome and process indicators based on linked administrative health data (ie, insurance claims data linked to hospital discharge data) assessing older inpatient safety related to anticoagulation in both Switzerland and France, and enabling comparisons across time and among hospitals, health territories, and countries. Geriatric patient safety indicators (GPSIs) will assess anticoagulant-related adverse events. Geriatric quality indicators (GQIs) will evaluate the management of anticoagulants for the prevention and treatment of arterial or venous thromboembolism in older inpatients. Methods GPSIs will measure cumulative incidences of thromboembolic and bleeding adverse events based on hospital discharge data linked to insurance claims data. Using linked administrative health data will improve GPSI risk adjustment on patients’ conditions that are present at admission and will capture in-hospital and postdischarge adverse events. GQIs will estimate the proportion of index hospital stays resulting in recommended anticoagulation at discharge and up to various time frames based on the same electronic health data. The GPSI and GQI development and validation process will comprise 6 stages: (1) selection and specification of candidate indicators, (2) definition of administrative data-based algorithms, (3) empirical measurement of indicators using linked administrative health data, (4) validation of indicators, (5) analyses of geographic and temporal variations for reliable and valid indicators, and (6) data visualization. Results Study populations will consist of 166,670 Swiss and 5,902,037 French residents aged 65 years and older admitted to an acute care hospital at least once during the 2012-2014 period and insured for at least 1 year before admission and 1 year after discharge. We will extract Swiss data from the Helsana Group data warehouse and French data from the national health insurance information system (SNIIR-AM). The study has been approved by Swiss and French ethics committees and regulatory organizations for data protection. Conclusions Validated GPSIs and GQIs should help support and drive quality and safety improvement in older inpatients, inform health care stakeholders, and enable international comparisons. We discuss several limitations relating to the representativeness of study populations, accuracy of administrative health data, methods used for GPSI criterion validity assessment, and potential confounding bias in comparisons based on GQIs, and we address these limitations to strengthen study feasibility and validity. PMID:28495660

A Systematic Literature Review of Studies Analyzing Inequalities in Health Expectancy among the Older Population

PubMed Central

Pongiglione, Benedetta; De Stavola, Bianca L.; Ploubidis, George B.

2015-01-01

Aim To collect, organize and appraise evidence of socioeconomic and demographic inequalities in health and mortality among the older population using a summary measure of population health: Health Expectancy. Methods A systematic literature review was conducted. Literature published in English before November 2014 was searched via two possible sources: three electronic databases (Web of Science, Medline and Embase), and references in selected articles. The search was developed combining terms referring to outcome, exposure and participants, consisting in health expectancy, socioeconomic and demographic groups, and older population, respectively. Results Of 256 references identified, 90 met the inclusion criteria. Six references were added after searching reference lists of included articles. Thirty-three studies were focused only on gender-based inequalities; the remaining sixty-three considered gender along with other exposures. Findings were organized according to two leading perspectives: the type of inequalities considered and the health indicators chosen to measure health expectancy. Evidence of gender-based differentials and a socioeconomic gradient were found in all studies. A remarkable heterogeneity in the choice of health indicators used to compute health expectancy emerged as well as a non-uniform way of defining same health conditions. Conclusions Health expectancy is a useful and convenient measure to monitor and assess the quality of ageing and compare different groups and populations. This review showed a general agreement of results obtained in different studies with regard to the existence of inequalities associated with several factors, such as gender, education, behaviors, and race. However, the lack of a standardized definition of health expectancy limits its comparability across studies. The need of conceiving health expectancy as a comparable and repeatable measure was highlighted as fundamental to make it an informative instrument for policy makers. PMID:26115099

Familial Aggregation of Hyperopia in an Elderly Population of Siblings in Salisbury, Maryland

PubMed Central

Wojciechowski, Robert; Congdon, Nathan; Bowie, Heidi; Munoz, Beatriz; Gilbert, Donna; West, Sheila

2011-01-01

Purpose To determine whether hyperopia aggregates in families in an older mixed-race population. Design Cross-sectional familial aggregation study using sibships. Methods We recruited 759 subjects (mean age, 73.4 years) in 241 families through the population-based Salisbury Eye Evaluation study. Subjects underwent noncycloplegic refraction if best-corrected visual acuity (BCVA) was ≤20/40, had lensometry to measure their currently worn spectacles if BCVA was >20/40 with spectacles, or were considered to be plano (refraction of zero) if the BCVA was >20/40 without spectacles. Preoperative refraction from medical records was used for bilaterally pseudophakic subjects. Results Utilizing hyperopia cutoffs from 1.00 to 2.50 diopters, age-, race-, and gender-adjusted odds ratios for hyperopia with an affected sibling ranged from 2.72 (95% confidence interval [CI], 1.84–4.01) to 4.87 (95% CI, 2.54–9.30). The odds of hyperopia increased with age until 75 years, after which they remained relatively constant. Black men were significantly less likely to be hyperopic than white men, white women, or black women. Conclusions Hyperopia appears to be under strong genetic control in this older population. PMID:15629824

Metacognitive Monitoring and Dementia: How Intrinsic and Extrinsic Cues Influence Judgments of Learning in People with Alzheimer’s disease

PubMed Central

Thomas, Ayanna K.; Lee, Meeyeon; Balota, David A.

2014-01-01

Objective The present research compared metamemorial monitoring processes among younger adults, non-demented older adults, and older adults diagnosed with early stage Dementia of the Alzheimer’s Type (DAT). Method In three experiments we examined the influence of intrinsic and extrinsic cues on Judgment of Learning (JOL) accuracy. Changes in association strength between cue-target word pairs served as our intrinsic manipulation in Experiments 1 and 2. Changes in encoding orientation served as our extrinsic manipulation in Experiment 3. Results Across all experiments we found that young adults, non-demented older adults, and individuals in the early stages of DAT effectively used intrinsic and extrinsic factors to guide JOL predictions. Conclusions We conclude that while certain aspects of metacognition may be impaired in both the normal and demented older populations, these groups remain able to use theory-based processing, or general knowledge about how memory works, to make metamemory monitoring predictions. PMID:23876118

Macroeconomic implications of population ageing and selected policy responses

PubMed Central

Bloom, David E; Chatterji, Somnath; Kowal, Paul; Lloyd-Sherlock, Peter; McKee, Martin; Rechel, Bernd; Rosenberg, Larry; Smith, James P

2015-01-01

Between now and 2030, every country will experience population ageing—a trend that is both pronounced and historically unprecedented. Over the past six decades, countries of the world had experienced only a slight increase in the share of people aged 60 years and older, from 8% to 10%. But in the next four decades, this group is expected to rise to 22% of the total population—a jump from 800 million to 2 billion people. Evidence suggests that cohorts entering older age now are healthier than previous ones. However, progress has been very uneven, as indicated by the wide gaps in population health (measured by life expectancy) between the worst (Sierra Leone) and best (Japan) performing countries, now standing at a difference of 36 years for life expectancy at birth and 15 years for life expectancy at age 60 years. Population ageing poses challenges for countries’ economies, and the health of older populations is of concern. Older people have greater health and long-term care needs than younger people, leading to increased expenditure. They are also less likely to work if they are unhealthy, and could impose an economic burden on families and society. Like everyone else, older people need both physical and economic security, but the burden of providing these securities will be falling on a smaller portion of the population. Pension systems will be stressed and will need reassessment along with retirement policies. Health systems, which have not in the past been oriented toward the myriad health problems and long-term care needs of older people and have not sufficiently emphasised disease prevention, can respond in different ways to the new demographic reality and the associated changes in population health. Along with behavioural adaptations by individuals and businesses, the nature of such policy responses will establish whether population ageing will lead to major macroeconomic difficulties. PMID:25468167

Mental health literacy in korean older adults: A cross-sectional survey.

PubMed

Kim, Y S; Lee, H Y; Lee, M H; Simms, T; Park, B H

2017-09-01

WHAT IS KNOWN ON THE SUBJECT?: Mental health literacy is a fairly new concept, first introduced in 1997. It refers to what people know and believe about mental health disorders. People's knowledge and beliefs help them to recognize, manage and prevent mental disorders. Generally, older adults have lower health literacy compared to young and middle-aged adults. WHAT THIS STUDY ADDS TO EXISTING KNOWLEDGE?: This is the first study on the mental health literacy of Korean older adults. This study looks beyond peoples' ability to recognize mental health disorders and their opinions about them. It identifies factors that are associated with mental health literacy (level of education and social support, the number of people in one's social circles and how individuals rate their health). WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Older adults might get more out of mental health literacy programmes in group or social settings. Programmes that use older adult peer educators/supporters, such as the "older people's champions" of the Healthy Passport programme in England, might make the programmes more effective. Mental health campaigns, such as Australia's beyondblue, might increase mental health literacy of older adults. Introduction Korea is experiencing rapid population ageing, spurring an increased need for mental health services for the elderly. Approximately one-third of Korean older adults experience depressive symptoms, and Korea has the highest elder suicide rate among 34 developed nations. Mental health literacy is an important component of promoting mental health, yet studies on the concept have been conducted in few countries. Aim This study examines the level of mental health literacy among Korean older adults and identifies factors associated with their mental health literacy. Method A cross-sectional survey was conducted with 596 community-dwelling Korean adults aged 65 and older. Andersen's Behavioral Model of Health Services Use framed the study. Results Overall, participants displayed low levels of mental health literacy. They had difficulty recognizing their mental health issues and had limited knowledge about self-help strategies. Mental health literacy was positively associated with education, social support, social network and health status. Discussion and Implications This study highlights a need for efforts to increase mental health literacy among Korean older adults. Strategies that have the potential to empower this population to proactively attend to their mental health include community-based education and national mental health campaigns. © 2017 John Wiley & Sons Ltd.

Usual coffee intake in Brazil: results from the National Dietary Survey 2008-9.

PubMed

Sousa, Alessandra Gaspar; da Costa, Teresa Helena Macedo

2015-05-28

Coffee is central to the economy of many developing countries, as well as to the world economy. However, despite the widespread consumption of coffee, there are very few available data showing the usual intake of this beverage. Surveying usual coffee intake is a way of monitoring one aspect of a population's usual dietary intake. Thus, the present study aimed to characterise the usual daily coffee intake in the Brazilian population. We used data from the National Dietary Survey collected in 2008-9 from a probabilistic sample of 34,003 Brazilians aged 10 years and older. The National Cancer Institute method was applied to obtain the usual intake based on two nonconsecutive food diaries, and descriptive statistical analyses were performed by age and sex for Brazil and its regions. The estimated average usual daily coffee intake of the Brazilian population was 163 (SE 2.8) ml. The comparison by sex showed that males had a 12% greater usual coffee intake than females. In addition, the highest intake was recorded among older males. Among the five regions surveyed, the North-East had the highest usual coffee intake (175 ml). The most common method of brewing coffee was filtered/instant coffee (71%), and the main method of sweetening beverages was with sugar (87%). In Brazil, the mean usual coffee intake corresponds to 163 ml, or 1.5 cups/d. Differences in usual coffee intake according to sex and age differed among the five Brazilian regions.

Allele Age Under Non-Classical Assumptions is Clarified by an Exact Computational Markov Chain Approach.

PubMed

De Sanctis, Bianca; Krukov, Ivan; de Koning, A P Jason

2017-09-19

Determination of the age of an allele based on its population frequency is a well-studied problem in population genetics, for which a variety of approximations have been proposed. We present a new result that, surprisingly, allows the expectation and variance of allele age to be computed exactly (within machine precision) for any finite absorbing Markov chain model in a matter of seconds. This approach makes none of the classical assumptions (e.g., weak selection, reversibility, infinite sites), exploits modern sparse linear algebra techniques, integrates over all sample paths, and is rapidly computable for Wright-Fisher populations up to N e  = 100,000. With this approach, we study the joint effect of recurrent mutation, dominance, and selection, and demonstrate new examples of "selective strolls" where the classical symmetry of allele age with respect to selection is violated by weakly selected alleles that are older than neutral alleles at the same frequency. We also show evidence for a strong age imbalance, where rare deleterious alleles are expected to be substantially older than advantageous alleles observed at the same frequency when population-scaled mutation rates are large. These results highlight the under-appreciated utility of computational methods for the direct analysis of Markov chain models in population genetics.

Health care for older persons: a country profile--Lebanon.

PubMed

Abyad, A

2001-10-01

Lebanon is a small country, comparable in size to New Hampshire. It is currently estimated that 8% of the population is age 65 and older. The Lebanese population has witnessed a clear demographic transition in the past few decades. Our culture demands respect for older people and values highly the natural bonds of affection between all members of the family. The healthcare system in the country is an adaptation of the European model. Despite the large number of physicians (approximately 10,000) there is a shortage of primary care and geriatric physicians. There are 36 nursing homes in Lebanon, with a total of 6,000 beds, but most of them are understaffed, with the exception of three nursing homes that offer relatively comprehensive services including rehabilitative, preventive, and curative services. The Ain Wizen Elderly Care Centre is well recognized for the program it operates for older people, which is a good model for the region and for Lebanon in terms of services, training, and research. Demographic changes and social and economic developments in Lebanon have created new realities in the unprecedented growth of the older population. Lebanon, like other developing countries, needs to define the policies and programs that will reduce the burden of an aging population on its society and economy. There is a need to ensure the availability of health and social services for older persons and to promote older persons' continuing participation in a socially and economically productive life.

Daily Spiritual Experiences in a Biracial, Community-based Population of Older Adults

PubMed Central

Skarupski, Kimberly A.; Fitchett, George; Evans, Denis A.; Mendes de Leon, Carlos F.

2010-01-01

Objectives The objectives of this study were to describe the levels of daily spiritual experiences in community-dwelling older adults, to compare levels of spiritual experiences with levels of prayer and religious service attendance, and to examine demographic and psychosocial correlates of spiritual experiences. Method The data came from 6,534 participants in the Chicago Health and Aging Project, an ongoing population-based, biracial (65% African American) study of risk factors for incident Alzheimer’s disease among older adults. A five-item version of the Daily Spiritual Experience Scale (DSES) was used in the study. Multivariable linear regression models were used to examine the relationship between sociodemographic and psychosocial factors and DSES scores. Results The majority of participants reported having spiritual experiences at least daily. In the bivariate analyses, African Americans and women had higher DSES scores than Whites and men, respectively (p’s < 0.001). Prayer and worship were moderately associated with DSES scores. In the multivariable analyses, African American race, older age, female gender, better self-rated health, and greater social networks were associated with higher DSES scores, while higher levels of education and depressive symptoms were associated with lower DSES scores. Conclusion We observed high levels of spiritual experiences and found that the DSES is related to, but distinct from traditional measures of religiosity. We found associations between DSES, demographic, and psychosocial factors that are consistent with findings for other R/S measures. Future research should test whether daily spiritual experiences contribute to our understanding of the relationship between R/S and health in older adults. PMID:20635237

Naturalistic Validation of an On-Road Driving Test of Older Drivers

PubMed Central

Ott, Brian R.; Papandonatos, George D.; Davis, Jennifer D.; Barco, Peggy P.

2013-01-01

Objective The objective was to compare a standardized road test to naturalistic driving by older people who may have cognitive impairment to define improvements that could potentially enhance the validity of road testing in this population. Background Road testing has been widely adapted as a tool to assess driving competence of older people who may be at risk for unsafe driving because of dementia; however, the validity of this approach has not been rigorously evaluated. Method For 2 weeks, 80 older drivers (38 healthy elders and 42 with cognitive impairment) who passed a standardized road test were video recorded in their own vehicles. Using a standardized rating scale, 4 hr of video was rated by a driving instructor. The authors examine weighting of individual road test items to form global impressions and to compare road test and naturalistic driving using factor analyses of these two assessments. Results The road test score was unidimensional, reflecting a major factor related to awareness of signage and traffic behavior. Naturalistic driving reflected two factors related to lane keeping as well as traffic behavior. Conclusion Maintenance of proper lane is an important dimension of driving safety that appears to be relatively underemphasized during the highly supervised procedures of the standardized road test. Application Road testing in this population could be improved by standardized designs that emphasize lane keeping and that include self-directed driving. Additional information should be sought from observers in the community as well as crash evidence when advising older drivers who may be cognitively impaired. PMID:22908688

Healthy life expectancy of oral squamous cell carcinoma patients aged 75years and older.

PubMed

Yamada, Shin-Ichi; Kurita, Hiroshi; Tomioka, Takahiro; Ohta, Ryousuke; Yoshimura, Nobuhiko; Nishimaki, Fumihiro; Koyama, Yoshihito; Kondo, Eiji; Kamata, Takahiro

2017-01-01

Healthy life expectancy, an extension of the concept of life expectancy, is a summary measure of population health that takes into account the mortality and morbidity of a population. The aim of the present study was to retrospectively analyze the self-reliance survival times of oral squamous cell carcinoma (OSCC) patients. One hundred and twelve patients aged 75years or older with primary OSCC were included and examined at Shinshu University Hospital. To investigate healthy life expectancy, OSCC patients older than 75years were divided into 3 groups: 75-79, 80-84, and older than 85years. The Kaplan-Meier method was used to estimate the median times of healthy life expectancy. The Log-rank test was used to test significant differences between actual curves. The median self-reliance survival times of patients aged 75-79, 80-84, and older than 85years were 5.7, 1.6, and 1.4years, respectively. Most patients with early stage cancers underwent curative treatments and showed a health expectancy of more than 5years. In patients with advanced cancers, health expectancy was poor (less than one year), except among patients aged 75-79years who underwent standard treatments. It seems that in patients with advanced cancers, health expectancy was poor (less than 1year), except among patients aged 75-79years who underwent standard treatments. In elderly patients, healthy life expectancy (self-reliance survival time) may be one of the measures of patient prognosis as well as overall survival times. Copyright © 2016 Elsevier Ltd. All rights reserved.

Glutathione Peroxidase Enzyme Activity in Aging

PubMed Central

Espinoza, Sara E.; Guo, Hongfei; Fedarko, Neal; DeZern, Amy; Fried, Linda P.; Xue, Qian-Li; Leng, Sean; Beamer, Brock; Walston, Jeremy D.

2010-01-01

Background It is hypothesized that free radical damage contributes to aging. Age-related decline in activity of the antioxidant enzyme glutathione peroxidase (GPx) may contribute to increased free radicals. We hypothesized that GPx activity decreases with age in a population of older women with disability. Methods Whole blood GPx activity was measured in baseline stored samples from participants in the Women's Health and Aging Study I, a cohort of disabled community-dwelling older women. Linear regression was used to determine cross-sectional associations between GPx activity and age, adjusting for hemoglobin, coronary disease, diabetes, selenium, and body mass index. Results Six hundred one participants had complete demographic, disease, and laboratory information. An inverse association was observed between GPx and age (regression coefficient = −2.9, p < .001), indicating that for each 1-year increase in age, GPx activity decreased by 2.9 μmol/min/L. This finding remained significant after adjustment for hemoglobin, coronary disease, diabetes, and selenium, but not after adjustment for body mass index and weight loss. Conclusion This is the first study to examine the association between age and GPx activity in an older adult cohort with disability and chronic disease. These findings suggest that, after age 65, GPx activity declines with age in older women with disability. This decline does not appear to be related to diseases that have been previously reported to alter GPx activity. Longitudinal examination of GPx activity and other antioxidant enzymes in diverse populations of older adults will provide additional insight into age- and disease-related changes in these systems. PMID:18511755

Cross-Sectional Associations of Depressive Symptom Severity and Functioning with Health Service Use by Older People in Low-and-Middle Income Countries

PubMed Central

Twomey, Conal D.; Prince, Martin; Cieza, Alarcos; Baldwin, David S.; Prina, A. Matthew

2015-01-01

Background: Comprehensive understanding of the determinants of health service use (HSU) by older people with depression is essential for health service planning for an ageing global population. This study aimed to determine the extent to which depressive symptom severity and functioning are associated with HSU by older people with depression in low and middle income countries (LMICs). Methods: A cross-sectional analysis of the 10/66 Dementia Research Group population-based surveys dataset. Participants (n = 4590) were those aged 65 or older, in the clinical range for depressive symptoms (defined as scoring four or more on the EURO-D), living in 13 urban and/or rural catchment areas in nine LMICs. Associations were calculated using Poisson regression and random-effects meta-analysis. Results: After adjustment for confounding variables, (EURO-D) depressive symptom severity was significantly associated with “any community HSU” (Pooled Prevalence Ratios = 1.02; 95% CI = 1.01–1.03) but not hospital admission. Conversely, after adjustment, (WHODAS-II) functioning was significantly associated with hospital admission (Pooled PR = 1.14; 95% CI = 1.02–1.26) but not “any community HSU”. Conclusions: Depressive symptom severity does not explain a large proportion of the variance in HSU by older people with depression in LMICs. The association of functioning with this HSU is worthy of further investigation. In LMICs, variables related to accessibility may be more important correlates of HSU than variables directly related to health problems. PMID:25849540

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

PubMed Central

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

2015-01-01

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

Adherence to a Videogame-Based Physical Activity Program for Older Adults with Schizophrenia

PubMed Central

Hubbard, Erin M.; Dowling, Glenna A.

2014-01-01

Abstract Objectives: Adults with schizophrenia are a growing segment of the older adult population. Evidence suggests that they engage in limited physical activity. Interventions are needed that are tailored around their unique limitations. An active videogame-based physical activity program that can be offered at a treatment facility can overcome these barriers and increase motivation to engage in physical activity. The purpose of this report is to describe the adherence to a videogame-based physical activity program using the Kinect® for Xbox® 360 game system (Microsoft®, Redmond, WA) in older adults with schizophrenia. Materials and Methods: This was a descriptive longitudinal study among 34 older adults with schizophrenia to establish the adherence to an active videogame-based physical activity program. In our ongoing program, once a week for 6 weeks, participants played an active videogame, using the Kinect for Xbox 360 game system, for 30 minutes. Adherence was measured with a count of sessions attended and with the total minutes attended out of the possible total minutes of attendance (180 minutes). Results: Thirty-four adults with schizophrenia enrolled in the study. The mean number of groups attended was five out of six total (standard deviation=2), and the mean total minutes attended were 139 out of 180 possible (standard deviation=55). Fifty percent had perfect attendance. Conclusions: Older adults with schizophrenia need effective physical activity programs. Adherence to our program suggests that videogames that use the Kinect for Xbox 360 game system are an innovative way to make physical activity accessible to this population. PMID:26192371

Prostate-Specific Antigen (PSA)–Based Population Screening for Prostate Cancer: An Economic Analysis

PubMed Central

Tawfik, A

2015-01-01

Background The prostate-specific antigen (PSA) blood test has become widely used in Canada to test for prostate cancer (PC), the most common cancer among Canadian men. Data suggest that population-based PSA screening may not improve overall survival. Objectives This analysis aimed to review existing economic evaluations of population-based PSA screening, determine current spending on opportunistic PSA screening in Ontario, and estimate the cost of introducing a population-based PSA screening program in the province. Methods A systematic literature search was performed to identify economic evaluations of population-based PSA screening strategies published from 1998 to 2013. Studies were assessed for their methodological quality and applicability to the Ontario setting. An original cost analysis was also performed, using data from Ontario administrative sources and from the published literature. One-year costs were estimated for 4 strategies: no screening, current (opportunistic) screening of men aged 40 years and older, current (opportunistic) screening of men aged 50 to 74 years, and population-based screening of men aged 50 to 74 years. The analysis was conducted from the payer perspective. Results The literature review demonstrated that, overall, population-based PSA screening is costly and cost-ineffective but may be cost-effective in specific populations. Only 1 Canadian study, published 15 years ago, was identified. Approximately $119.2 million is being spent annually on PSA screening of men aged 40 years and older in Ontario, including close to $22 million to screen men younger than 50 and older than 74 years of age (i.e., outside the target age range for a population-based program). A population-based screening program in Ontario would cost approximately $149.4 million in the first year. Limitations Estimates were based on the synthesis of data from a variety of sources, requiring several assumptions and causing uncertainty in the results. For example, where Ontario-specific data were unavailable, data from the United States were used. Conclusions PSA screening is associated with significant costs to the health care system when the cost of the PSA test itself is considered in addition to the costs of diagnosis, staging, and treatment of screen-detected PCs. PMID:26366237

AsthmaWise - a field of dreams? The results of an online education program targeting older adults with asthma.

PubMed

Burns, Pippa; Jones, Sandra C; Iverson, Don; Caputi, Peter

2013-09-01

The aim of this study was to establish the feasibility and acceptability of an online asthma self-management program developed for older Australians with asthma. AsthmaWise, an internet education self-management program, was piloted for a 3-month period at the beginning of 2012. Participants were recruited using both online and offline strategies and were required to complete surveys, both pre- and post-intervention, in a repeated measures design. Matched data were collected from 51 participants; the results showed AsthmaWise to be a feasible and acceptable method of delivering asthma education to the target population. Self-reported measures showed an increase in participants' asthma knowledge, asthma control and quality of life. Results from the Perceived Health Web Site Usability Questionnaire (PHWSUQ) showed improvements between usability testing and implementation. The need for asthma self-management education will continue to increase as the population ages and a greater number of older adults are living with asthma. This small pilot study indicates that an online asthma self-management education program can result in improved outcome measures in a target group not normally considered technologically literate.

Health Indicators for Older Sexual Minorities: National Health Interview Survey, 2013–2014

PubMed Central

Laffan, Alison M.; Erdem, Erkan; Cahill, Sean R.; Kenefick, Daniel; Ye, Jiahui; Haffer, Samuel C.

2017-01-01

Abstract Purpose: Advances in lesbian, gay, and bisexual (sexual minority [SM]) acceptance and equality have been made in the past decade. However, certain SM subgroups continue to be disadvantaged due to lack of data and, thus, lack of knowledge about these populations. Data for older sexual minorities are especially lacking and will be increasingly important as more sexual minorities enter older age. This research explores results from a nationally representative health survey to elucidate some health indicators for older sexual minorities. Methods: Data from the 2013 and 2014 National Health Interview Surveys (NHIS) were pooled for increased sample size, and established research methods were followed as recommended by prior NHIS sexual orientation studies. We conducted descriptive analyses on the differences between SM and heterosexual groups, aged 65 years and older, for 12 health indicators. Results: Four out of the 12 health indicators were significantly different for sexual minorities, and three out of those four indicated positive health outcomes or behaviors when compared with heterosexuals. Sexual minorities were more than three times as likely to receive HIV testing as heterosexual peers. Sexual minorities were more likely to receive an influenza vaccination, and much more likely to report excellent or very good health, than their heterosexual peers. Sexual minorities were more than twice as likely to report binge drinking, which is consistent with prior research for adult sexual minorities. Conclusion: This analysis is the first to examine national data on health indicators for sexual minorities, aged 65 years and older, using NHIS data. As more surveys begin to collect SMdata and more years of data are collected by NHIS, a clearer picture of the health of older adult sexual minorities should emerge. PMID:29028455

How the built environment affects change in older people's physical activity: A mixed- methods approach using longitudinal health survey data in urban China.

PubMed

Zhou, Peiling; Grady, Sue C; Chen, Guo

2017-11-01

Although the general population in China is physically active, only 45% of older adults meet the World Health Organization's recommendation for weekly moderate-to-vigorous exercise, to achieve health benefits. This percentage is even lower (9.8%) in urban China. It is, therefore, important to understand the pathways by which physical activity behaviors are impacted by the built environment. This study utilized a mixed methods approach-interviews (n = 42) and longitudinal (2010-2015) health survey data (n = 3094) for older people residing in three neighborhoods in Huainan, a mid-sized city in Anhui Province, central eastern China. First, a content analysis of interview data was used to identify individual and built environment factors (motivators and barriers) that impacted physical activity within older people's activity spaces. Second, a multilevel path analysis was conducted using the health survey data to demonstrate the pathways by which these motivators and barriers contributed to the initiation, regulation, and maintenance of physical activity. This study found (a) that the liveliness of an apartment building and its proximity to functional spaces (fast-food stores, farmer's markets, supermarkets, pharmacies, schools, hospitals, PA facilities and natural and man-made water bodies) were important factors in attracting sedentary older people to initiate physical activity; (b) the social networks of apartment neighbors helped to initiate, regulate, and maintain physical activity; and housing closeness to functional spaces was important in maintaining physical activity, particularly for those older people with chronic diseases. To increase older people's overall physical activity, future interventions should focus on residential form and access to functional spaces, prior to investing in large-scale urban design interventions. Copyright © 2017 Elsevier Ltd. All rights reserved.

Singapore Healthy Older People Everyday (HOPE) Study: Prevalence of Frailty and Associated Factors in Older Adults.

PubMed

Merchant, Reshma A; Chen, Matthew Zhixuan; Tan, Linda Wei Lin; Lim, Moses YiDong; Ho, Han Kwee; van Dam, Rob M

2017-08-01

In the context of a rapidly ageing population, Singapore is anticipating a rise in multimorbidity, disability, and dependency, which are driven by physical frailty. Healthy Older People Everyday (HOPE) is an epidemiologic population-based study on community-dwelling older adults aged 65 years and older in Singapore. To investigate the prevalence of frail and prefrail states and their association with polypharmacy, multimorbidity, cognitive and functional status, and perceived health status among community-dwelling older adults in Singapore. Participants for HOPE were older adults aged 65 years and older recruited from a cohort study on the northwest region of Singapore. Analysis was performed on data collected from a combination of interviewer-administered questionnaires (including FRAIL scale, EQ-5D, Mini Mental State Examination, Barthel index, and Lawton IADL scale), clinical assessments, and physical measurements (including hand grip strength and Timed-Up-and-Go [TUG] test). A total of 1051 older adults (mean age 71.2 years) completed the study. More than half (57.2%) were female. The prevalence of frailty and prefrailty was 6.2% and 37%, respectively. Frailty was associated with older age, female gender, Indian (instead of Chinese) ethnicity, multimorbidity, polypharmacy, cognitive and functional impairment, weaker hand grip strength, longer TUG times, and poor perceived health status. Those with underlying cognitive impairment and frailty were at greater risk of adverse health outcome. Frailty is a complex health state with multiple domains and dimensions. In our study in a multiethnic Asian population, we identified nonmodifiable factors and modifiable risk factors (multimorbidity, polypharmacy, cognitive and functional impairment) that were associated with frailty. Interventions will have to be multipronged and will require a collaborated effort in order to effect change and improve the health span in rapidly ageing populations. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Polypharmacy and Polymorbidity in Older Adults in Brazil: a public health challenge

PubMed Central

Ramos, Luiz Roberto; Tavares, Noemia Urruth Leão; Bertoldi, Andréa Dâmaso; Farias, Mareni Rocha; Oliveira, Maria Auxiliadora; Luiza, Vera Lucia; Pizzol, Tatiane da Silva Dal; Arrais, Paulo Sérgio Dourado; Mengue, Sotero Serrate

2016-01-01

ABSTRACT OBJECTIVE To analyze variations in the prevalence of chronic use of medicines by older adults in Brazil according to its possible association with the most prevalent chronic diseases and demographic and health factors, and to identify risk factors for polypharmacy. METHODS A study based on data from the National Survey on Access, Use and Promotion of Rational Use of Medicines (PNAUM), a cross-sectional, population-based survey with probability sampling in Brazilian urban areas. The independent variable was the number of chronic-use medicines taken by older adults, linked to eight chronic diseases investigated. The intervening variables were gender, age group, marital status, level of education, socioeconomic status, Brazilian region, body mass index, smoking, self-perceived health, hospitalization in the previous year and having health insurance, besides the investigated chronic diseases. A multivariable analysis identified risk factors for polypharmacy. RESULTS Prevalence of at least one chronic-use medicines among older adults was 93.0%. Of the total number of older adults, 18.0% used at least five medications (polypharmacy). Polypharmacy was higher among the oldest individuals (20.0%), in the South region (25.0%), in those with poor self-perceived health (35.0%), in obese individuals (26.0%), in those with reported health insurance (23.0%) or hospitalization in the previous year (31.0%), and among those who reported any of the investigated diseases, particularly diabetes (36.0%) and heart diseases (43.0%). The variables remaining in the final risk model for polypharmacy were age, region, perceived health, health insurance, hospitalization in the previous year and all investigated diseases except stroke. CONCLUSIONS Older adults with specific diseases have risk factors for polypharmacy modifiable by actions aimed at the rational use of medicines. With the current population aging and successful drug access policy, the trend is an increase in drug use by older adults, which should feature as a priority in the planning agenda of the Brazilian Unified Health System (SUS). PMID:27982377

Climate Change and Older Americans: State of the Science

PubMed Central

Hurley, Bradford J.; Schultz, Peter A.; Jaglom, Wendy S.; Krishnan, Nisha; Harris, Melinda

2012-01-01

Background: Older adults make up 13% of the U.S. population, but are projected to account for 20% by 2040. Coinciding with this demographic shift, the rate of climate change is accelerating, bringing rising temperatures; increased risk of floods, droughts, and wildfires; stronger tropical storms and hurricanes; rising sea levels; and other climate-related hazards. Older Americans are expected to be located in places that may be relatively more affected by climate change, including coastal zones and large metropolitan areas. Objective: The objective of this review is to assess the vulnerability of older Americans to climate change and to identify opportunities for adaptation. Methods: We performed an extensive literature survey and summarized key findings related to demographics; climate stressors relevant to older adults; factors contributing to exposure, sensitivity, and adaptive capacity; and adaptation strategies. Discussion: A range of physiological and socioeconomic factors make older adults especially sensitive to and/or at risk for exposure to heat waves and other extreme weather events (e.g., hurricanes, floods, droughts), poor air quality, and infectious diseases. Climate change may increase the frequency or severity of these events. Conclusions: Older Americans are likely to be especially vulnerable to stressors associated with climate change. Although a growing body of evidence reports the adverse effects of heat on the health of older adults, research gaps remain for other climate-related risks. We need additional study of the vulnerability of older adults and the interplay of vulnerability, resilience, and adaptive responses to projected climate stressors. PMID:23033457

Do the Definitions of Elder Mistreatment Subtypes Matter? Findings From the PINE Study

PubMed Central

2014-01-01

Background. Elder mistreatment (EM) is a pervasive public health issue and is associated with morbidity and premature mortality. This study aimed to examine how the prevalence of EM and its subtypes vary using different definitions among U.S. Chinese older adults. Methods. The Population Study of Chinese Elderly in Chicago is a population-based epidemiological survey of 3,159 U.S. Chinese older adults in the Greater Chicago area that is guided by a community-based participatory research approach. Participants answered questions regarding psychological, physical, and sexual abuse, caregiver neglect, and financial exploitation. Definitional approaches for EM and its subtypes were constructed from least restrictive to most restrictive. Results. Using different definitional criteria, the prevalence of psychological abuse was 1.1%–9.8%, physical abuse was 1.1%, sexual abuse was 0.2%, caregiver neglect was 4.6%–11.1%, and financial exploitation was 8.8%–9.3%. Overall, EM varied from 13.9% to 25.8%, depending on the defining criteria. Regardless of the definition used, those who experienced EM were more likely to be older and have higher educational attainment, poor health status, poor quality of life, and worsened health change in the last year. However, among the different definitions of overall EM, there were no statistically significant differences across sociodemographic characteristics or self-reported health status associated with EM criteria. Conclusions. Elder mistreatment is prevalent among U.S. Chinese older adults regardless of the definitional criteria. Sociodemographic characteristics associated with EM did not differ by definitional criteria. Future longitudinal studies are needed to quantify the risk and protective factors associated with EM in Chinese aging populations. PMID:25378451

Prevalence of Glaucoma in the United States: The 2005–2008 National Health and Nutrition Examination Survey

PubMed Central

Gupta, Priya; Zhao, Di; Guallar, Eliseo; Ko, Fang; Boland, Michael V.; Friedman, David S.

2016-01-01

Purpose To estimate the prevalence of glaucoma in the US population based on optic nerve head photography, to estimate the prevalence of glaucoma awareness, and to identify demographic and ocular risk factors for being unaware of having glaucoma. Methods The study included 5746 men and women 40 years of age and older participating in the National Health and Nutrition Examination Survey (NHANES) 2005–2008. Each participant had 45° photographs of the macula and optic disc of both eyes. Fundus photographs were first graded by a reading center, and those with a cup-to-disc ratio (CDR) ≥ 0.6 were regraded by three glaucoma specialists to determine the presence or absence of glaucoma. Analyses were performed using NHANES weights to account for the complex multistage probability sampling design. Results The estimated overall prevalence of glaucoma in the US civilian, noninstitutionalized population 40 years of age and older was 2.1% (95% confidence interval [CI], 1.7%–2.6%). Glaucoma affected 2.9 million individuals, including 1.4 million women; 1.5 million men; 2.3 million people 60 years of age and older; and 0.9 million blacks, Mexican Americans, and people of other races. The prevalence of glaucoma was highest in non-Hispanic blacks, followed by non-Hispanic whites, Mexican Americans, and others. Over half of participants with glaucoma were unaware that they had the disease. Conclusions The prevalence of glaucoma based on optic nerve fundus photography assessment in the general US population 40 years of age and older was 2.1%. Approximately half of glaucoma cases were previously undiagnosed. Studies to determine whether and how to identify undiagnosed glaucoma are an important next step. PMID:27168366

Frailty transitions and types of death in Chinese older adults: a population-based cohort study

PubMed Central

Jiang, Xiao-yan; Wang, Xiao-feng; Shi, Yan; Hai, Hua

2018-01-01

Background Little is known about the adverse effects of frailty transitions. In this study, we aimed to characterize the transitions between frailty states and examine their associations with the type of death among older adults in China, a developing country with a rapidly growing aging population. Methods We used data of 11,165 older adults (aged 65–99 years) from the 2002 and 2005 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Overall, 44 health deficits were used to construct frailty index (FI; range: 0–1), which was then categorized into a three-level variable: nonfrail (FI ≤0.10), prefrail (0.10< FI ≤0.21), and frail (FI >0.21). Outcome was four types of death based on bedridden days and suffering state (assessed in the 2008 wave of CLHLS). Results During the 3-year period, 3,394 (30.4%) participants had transitioned between different frailty states (nonfrail, prefrail, and frail), one-third transitioned to death, and one-third remained in previous frailty states. Transitions to greater frailty (ie, “worsening”) were more common than transitions to lesser frailty (ie, “improvement”). Among four categories of frailty transitions, “worsening” and “remaining frail” had increased risks of painful death, eg, with odds ratios of 1.92 (95% confidence interval [CI] =1.41, 2.62) and 4.75 (95% CI =3.32, 6.80), respectively, for type 4 death (ie, ≥30 bedridden days with suffering before death). Conclusion This large sample of older adults in China supports that frailty is a dynamic process, characterized by frequent types of transitions. Furthermore, those who remained frail had the highest likelihood of experiencing painful death, which raises concerns about the quality of life in frail populations. PMID:29805253

Hispanic Baby Boomers: Health Inequities Likely to Persist in Old Age

PubMed Central

Villa, Valentine M.; Wallace, Steven P.; Bagdasaryan, Sofya; Aranda, Maria P.

2012-01-01

Purpose: As the Baby-Boom generation enters the ranks of the elderly adults over the next 4 decades, the United States will witness an unprecedented growth in racial/ethnic diversity among the older adult population. Hispanics will comprise 20% of the next generation of older adults, representing the largest minority population aged 65 years and older, with those of Mexican-origin comprising the majority of Hispanics. Little is known about the health status of this population. Data/Methods: Data are for Baby Boomers born between 1946 and 1964 (ages 43–61) in the 2007 California Health Interview Survey. Logistic regression estimates the odds of diabetes, hypertension, obesity, fair/poor self-rated health (SRH), and functional difficulties among U.S.-born non-Hispanic Whites (NHW), U.S.-born Mexicans, naturalized Mexican immigrants, and noncitizen Mexican immigrants. Results: The Mexican-origin populations are disadvantaged relative to NHW for all socioeconomic status (SES) and several health outcomes. The Mexican origin disadvantage in health attenuates when controlling for SES and demographics, but the disadvantage remains for diabetes, obesity, and fair/poor SRH. Implications: Baby Boomers of Mexican origin do not share the advantages of health, income, and educational attainment enjoyed by U.S.-born NHW. As this cohort moves into old age, the cumulative disadvantage of existing disparities are likely to result in continued or worse health disparities. Reductions in federal entitlement programs for the elderly adults that delay eligibility, scale back programs and services, or increase costs to consumers may exacerbate those inequities. PMID:22399578

[The assessment of vulnerability to floods in Guangdong province at district level].

PubMed

Zhu, Qi; Liu, Tao; Zhang, Yong-hui; Luo, Yuan; Wei, Yao; Xiao, Jian-peng; Zeng, Si-qing; Ma, Wen-jun

2012-11-01

To evaluate the vulnerability to floods in Guangdong province at district level. Data were collected from the sixth census, the 2010 Statistical Yearbook of Guangdong, the 2010 Health Statistics Yearbook of Guangdong and China Disease Prevention and Control information systems, etc. The weight of each indicator was determined based on subjective method and objective method respectively; and finally the results of the two methods were compared. 13 indicators were selected for the assessment of vulnerability to floods, including 6 sensitivity indicators, 5 adaptability indicators and 2 exposure indicators. Indicators with large weight (subjective weight/objective weight) were the proportion of population older than 65 years old (0.31/0.30), the proportion of population older than 65 years old (0.16/0.23), infant mortality rate (0.18/0.20), the total Gross Domestic Product (GDP) per capita (0.33/0.21), the proportion of illiterate in the population older than 15 years old (0.19/0.28), history frequency of floods (0.75/0.75). The mean vulnerability index (VI) calculated by subjective method was 0.35 with the standard deviation of 0.10; the mean vulnerability index calculated by objective method was 0.31 with the standard deviation of 0.08. The two weighting methods showed consistent results of vulnerability index (ICC = 0.975, P < 0.01). VI of most districts dropped in the interval of 0.30 - 0.39. Districts with subjective VI > 0.50 or objective VI > 0.40 should pay more attention to floods, including parts of the coastal areas, Beijiang River Basin, the eastern tributary area of Dongjiang River and the northern part of Pearl River Delta. Dapu district of Meizhou (0.55/0.45), Dianbai district and Maogang district of Maoming (0.54/0.48) were most vulnerable. Districts of Heyuan, Dongguan, Zhaoqing and Huizhou were less vulnerable, Yuancheng district of Heyuan showed least vulnerable to floods (0.15/0.12) followed by Dongguan (0.18/0.16), Duanzhou district (0.18/0.16) and Guangning (0.17/0.15) district of Zhaoqing. The score of indicators differed among different level of vulnerability (P < 0.05). Different regions of Guangdong province showed different vulnerability to floods, vulnerable areas should be priority in the prevention and control of floods.

Effects of an eHealth Literacy Intervention for Older Adults

PubMed Central

2011-01-01

Background Older adults generally have low health and computer literacies, making it challenging for them to function well in the eHealth era where technology is increasingly being used in health care. Little is known about effective interventions and strategies for improving the eHealth literacy of the older population. Objective The objective of this study was to examine the effects of a theory-driven eHealth literacy intervention for older adults. Methods The experimental design was a 2 × 2 mixed factorial design with learning method (collaborative; individualistic) as the between-participants variable and time of measurement (pre; post) as the within-participants variable. A total of 146 older adults aged 56–91 (mean 69.99, SD 8.12) participated in this study during February to May 2011. The intervention involved 2 weeks of learning about using the National Institutes of Health’s SeniorHealth.gov website to access reliable health information. The intervention took place at public libraries. Participants were randomly assigned to either experimental condition (collaborative: n = 72; individualistic: n = 74). Results Overall, participants’ knowledge, skills, and eHealth literacy efficacy all improved significantly from pre to post intervention (P < .001 in all cases; effect sizes were >0.8 with statistical power of 1.00 even at the .01 level in all cases). When controlling for baseline differences, no significant main effect of the learning method was found on computer/Web knowledge, skills, or eHealth literacy efficacy. Thus, collaborative learning did not differ from individualistic learning in affecting the learning outcomes. No significant interaction effect of learning method and time of measurement was found. Group composition based on gender, familiarity with peers, or prior computer experience had no significant main or interaction effect on the learning outcomes. Regardless of the specific learning method used, participants had overwhelmingly positive attitudes toward the intervention and reported positive changes in participation in their own health care as a result of the intervention. Conclusions The findings provide strong evidence that the eHealth literacy intervention tested in this study, regardless of the specific learning method used, significantly improved knowledge, skills, and eHealth literacy efficacy from pre to post intervention, was positively perceived by participants, and led to positive changes in their own health care. Collaborative learning did not differ from individualistic learning in affecting the learning outcomes, suggesting the previously widely reported advantages of collaborative over individualistic learning may not be easily applied to the older population in informal settings, though several confounding factors might have contributed to this finding (ie, the largely inexperienced computer user composition of the study sample, potential instructor effect, and ceiling effect). Further research is necessary before a more firm conclusion can be drawn. These findings contribute to the literatures on adult learning, social interdependence theory, and health literacy. PMID:22052161

Data Sources Available for Modeling Environmental Exposures in Older Adults

EPA Science Inventory

This report, “Data Sources Available for Modeling Environmental Exposures in Older Adults,” focuses on information sources and data available for modeling environmental exposures in the older U.S. population, defined here to be people 60 years and older, with an emphasis on those...

The population approach to falls injury prevention in older people: findings of a two community trial

PubMed Central

2010-01-01

Background There is a sound rationale for the population-based approach to falls injury prevention but there is currently insufficient evidence to advise governments and communities on how they can use population-based strategies to achieve desired reductions in the burden of falls-related injury. The aim of the study was to quantify the effectiveness of a streamlined (and thus potentially sustainable and cost-effective), population-based, multi-factorial falls injury prevention program for people over 60 years of age. Methods Population-based falls-prevention interventions were conducted at two geographically-defined and separate Australian sites: Wide Bay, Queensland, and Northern Rivers, NSW. Changes in the prevalence of key risk factors and changes in rates of injury outcomes within each community were compared before and after program implementation and changes in rates of injury outcomes in each community were also compared with the rates in their respective States. Results The interventions in neither community substantially decreased the rate of falls-related injury among people aged 60 years or older, although there was some evidence of reductions in occurrence of multiple falls reported by women. In addition, there was some indication of improvements in fall-related risk factors, but the magnitudes were generally modest. Conclusions The evidence suggests that low intensity population-based falls prevention programs may not be as effective as those that are intensively implemented. PMID:20167124

A test of Hartnett's revisions to the pubic symphysis and fourth rib methods on a modern sample.

PubMed

Merritt, Catherine E

2014-05-01

Estimating age at death is one of the most important aspects of creating a biological profile. Most adult age estimation methods were developed on North American skeletal collections from the early to mid-20th century, and their applicability to modern populations has been questioned. In 2010, Hartnett used a modern skeletal collection from the Maricopia County Forensic Science Centre to revise the Suchey-Brooks pubic symphysis method and the İşcan et al. fourth rib methods. The current study tests Hartnett's revised methods as well as the original Suchey-Brooks and İşcan et al. methods on a modern sample from the William Bass Skeletal Collection (N = 313, mean age = 58.5, range 19-92). Results show that the Suchey-Brooks and İşcan et al. methods assign individuals to the correct phase 70.8% and 57.5% of the time compared with Hartnett's revised methods at 58.1% and 29.7%, respectively, with correctness scores based on one standard deviation of the mean rather than the entire age range. Accuracy and bias scores are significantly improved for Hartnett's revised pubic symphysis method and marginally better for Hartnett's revised fourth rib method, suggesting that the revised mean ages at death of Hartnett's phases better reflect this modern population. Overall, both Hartnett's revised methods are reliable age estimation methods. For the pubic symphysis, there are significant improvements in accuracy and bias scores, especially for older individuals; however, for the fourth rib, the results are comparable to the original İşcan et al. methods, with some improvement for older individuals. © 2014 American Academy of Forensic Sciences.

The changing well-being of older adult registered Indians: an analysis using the Registered Indian Human Development Index.

PubMed

Cooke, Martin; Guimond, Eric; McWhirter, Jennifer

2008-01-01

The demographic aging of the Registered Indian population suggests that the social, economic, and health conditions of older Registered Indians will be increasingly important for communities and policymakers. We have adapted the United Nations Development Program's Human Development Index using data from the Census of Canada and the Indian Register to measure whether improvements seen in the knowledge, standard of living, and health of the Registered Indian population between 1981 and 2001 are also observed among Registered Indians of older ages. The absolute levels of well-being of older Registered Indians were found to have improved, but gaps with other older Canadians had widened, particularly in terms of income and male life expectancy.

Functional health status among rural and urban older adults in Taiwan: the effect of personal control and social control.

PubMed

Chiu, Tzu-I; Spencer, Gale A

2010-09-01

To assess the relationship between perceived social control/personal control and functional health status among older adults in rural and urban Taiwan. The ageing of the population is poised to emerge as a preeminent worldwide phenomenon. It is assumed that even though older adults experience many decades of autonomy and independence, the potential for illness or bodily decline will induce a serious reduction in the level of perceived control in older adult populations. This is a descriptive correlational study using a secondary data base, Social Environment and Biomarkers of Aging Study. Social Environment and Biomarkers of Aging Study is a nationally representative study of health outcomes in the Taiwanese population. Both perceived levels of social control and personal control had a statistically significant relationship with functional health status. Functional health status was significantly higher for urban older adults than their rural counterparts. Personal control and social control were both found to be predictors of functional health status. Major findings are supported by previous studies. Nurses should create programs and plan activities to assist older adults to enhance their perceptions of social control or personal control in order to improve the health status of older adults and minimize associated health care costs. © 2009 Blackwell Publishing Ltd.

Age correction in monitoring audiometry: method to update OSHA age-correction tables to include older workers

PubMed Central

Dobie, Robert A; Wojcik, Nancy C

2015-01-01

Objectives The US Occupational Safety and Health Administration (OSHA) Noise Standard provides the option for employers to apply age corrections to employee audiograms to consider the contribution of ageing when determining whether a standard threshold shift has occurred. Current OSHA age-correction tables are based on 40-year-old data, with small samples and an upper age limit of 60 years. By comparison, recent data (1999–2006) show that hearing thresholds in the US population have improved. Because hearing thresholds have improved, and because older people are increasingly represented in noisy occupations, the OSHA tables no longer represent the current US workforce. This paper presents 2 options for updating the age-correction tables and extending values to age 75 years using recent population-based hearing survey data from the US National Health and Nutrition Examination Survey (NHANES). Both options provide scientifically derived age-correction values that can be easily adopted by OSHA to expand their regulatory guidance to include older workers. Methods Regression analysis was used to derive new age-correction values using audiometric data from the 1999–2006 US NHANES. Using the NHANES median, better-ear thresholds fit to simple polynomial equations, new age-correction values were generated for both men and women for ages 20–75 years. Results The new age-correction values are presented as 2 options. The preferred option is to replace the current OSHA tables with the values derived from the NHANES median better-ear thresholds for ages 20–75 years. The alternative option is to retain the current OSHA age-correction values up to age 60 years and use the NHANES-based values for ages 61–75 years. Conclusions Recent NHANES data offer a simple solution to the need for updated, population-based, age-correction tables for OSHA. The options presented here provide scientifically valid and relevant age-correction values which can be easily adopted by OSHA to expand their regulatory guidance to include older workers. PMID:26169804

Lifelong Learning and Older Workers

ERIC Educational Resources Information Center

Karmel, Tom; Woods, Davinia

2004-01-01

Discussion about Australia's ageing population has focused on the importance of increasing labour force participation rates of older people. This paper examines the influence of education and training on the participation of older people in the labour market, and the pay-off of undertaking education and training as an older-person compared to…

Nutrition Goals for Older Adults: A Review.

ERIC Educational Resources Information Center

Horwath, Caroline C.

1991-01-01

Discusses specific goals of nutrition education for older adults and high-risk groups within the elderly population through review of three crucial areas: current knowledge of eating patterns, nutrient intake, and supplement use of older adults; existing information on multiple influences on eating habits of older adults; and potential benefits…

Counseling Older Women: Curriculum Guidelines and Strategies.

ERIC Educational Resources Information Center

Cavallaro, Marion L.

Since the population of older persons is predominantly female, counselor educators need to incorporate into their curriculum topics related to the unique issues faced by older women. Most counselors in their practice will be encountering at some point the problems of older women. Therefore, the preparation of counselors needs to incorporate…

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…

Availability and Readability of Emergency Preparedness Materials for Deaf and Hard-of-Hearing and Older Adult Populations: Issues and Assessments

PubMed Central

Neuhauser, Linda; Ivey, Susan L.; Huang, Debbie; Engelman, Alina; Tseng, Winston; Dahrouge, Donna; Gurung, Sidhanta; Kealey, Melissa

2013-01-01

A major public health challenge is to communicate effectively with vulnerable populations about preparing for disasters and other health emergencies. People who are Deaf or Hard of Hearing (Deaf/HH) and older adults are particularly vulnerable during health emergencies and require communications that are accessible and understandable. Although health literacy studies indicate that the readability of health communication materials often exceeds people’s literacy levels, we could find no research about the readability of emergency preparedness materials (EPM) intended for Deaf/HH and older adult populations. The objective of this study was to explore issues related to EPM for Deaf/HH and older adult populations, to assess the availability and readability of materials for these populations, and to recommend improvements. In two California counties, we interviewed staff at 14 community-based organizations (CBOs) serving Deaf/HH clients and 20 CBOs serving older adults selected from a stratified, random sample of 227 CBOs. We collected 40 EPM from 10 CBOs and 2 public health departments and 40 EPM from 14 local and national websites with EPM for the public. We used computerized assessments to test the U.S. grade reading levels of the 16 eligible CBO and health department EPM, and the 18 eligible website materials. Results showed that less than half of CBOs had EPM for their clients. All EPM intended for clients of Deaf/HH-serving CBOs tested above the recommended 4th grade reading level, and 91% of the materials intended for clients of older adult-serving CBOs scored above the recommended 6th grade level. EPM for these populations should be widely available through CBOs and public health departments, adhere to health literacy principles, and be accessible in alternative formats including American Sign Language. Developers should engage the intended users of EPM as co-designers and testers. This study adds to the limited literature about EPM for these populations. PMID:23451029

Availability and readability of emergency preparedness materials for deaf and hard-of-hearing and older adult populations: issues and assessments.

PubMed

Neuhauser, Linda; Ivey, Susan L; Huang, Debbie; Engelman, Alina; Tseng, Winston; Dahrouge, Donna; Gurung, Sidhanta; Kealey, Melissa

2013-01-01

A major public health challenge is to communicate effectively with vulnerable populations about preparing for disasters and other health emergencies. People who are Deaf or Hard of Hearing (Deaf/HH) and older adults are particularly vulnerable during health emergencies and require communications that are accessible and understandable. Although health literacy studies indicate that the readability of health communication materials often exceeds people's literacy levels, we could find no research about the readability of emergency preparedness materials (EPM) intended for Deaf/HH and older adult populations. The objective of this study was to explore issues related to EPM for Deaf/HH and older adult populations, to assess the availability and readability of materials for these populations, and to recommend improvements. In two California counties, we interviewed staff at 14 community-based organizations (CBOs) serving Deaf/HH clients and 20 CBOs serving older adults selected from a stratified, random sample of 227 CBOs. We collected 40 EPM from 10 CBOs and 2 public health departments and 40 EPM from 14 local and national websites with EPM for the public. We used computerized assessments to test the U.S. grade reading levels of the 16 eligible CBO and health department EPM, and the 18 eligible website materials. Results showed that less than half of CBOs had EPM for their clients. All EPM intended for clients of Deaf/HH-serving CBOs tested above the recommended 4(th) grade reading level, and 91% of the materials intended for clients of older adult-serving CBOs scored above the recommended 6(th) grade level. EPM for these populations should be widely available through CBOs and public health departments, adhere to health literacy principles, and be accessible in alternative formats including American Sign Language. Developers should engage the intended users of EPM as co-designers and testers. This study adds to the limited literature about EPM for these populations.

Intervention study for changes in home fire safety knowledge in urban older adults.

PubMed

Lehna, Carlee; Coty, Mary-Beth; Fahey, Erin; Williams, Joe; Scrivener, Drane; Wishnia, Gracie; Myers, John

2015-09-01

Older adults are more likely to experience problems that contribute to an increase in burn-related morbidity and mortality. The purpose of the current study was to determine if the educational home fire safety (HFS) intervention was an effective method of improving HFS knowledge over time in two groups of urban older adults, home bound and community-based. HFS knowledge of 110 urban older adults was assessed at baseline, immediately after watching a HFS DVD (recall), and at 2-week follow-up (retention). The United States Fire Administration Home Safety Checklist which examines HFS practices in the home was also administered. HFS knowledge scores significantly increased over time for both groups (p<0.0001), but no significant differences existed between the two groups over time (p=0.183). In addition, HFS knowledge scores were significantly impacted by the number of chronic illnesses, number of independent activities of daily living, and income. The findings from this study suggest the educational HFS intervention was effective in increasing urban older adults' HFS knowledge over time. Lowering the burns morbidity and mortality in the older adult population is an important public health concern that needs to be addressed through tailored prevention and education strategies. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

Anxiety and Depression during Transition from Hospital to Community in Older Adults: Concepts of a Study to Explain Late Age Onset Depression

PubMed Central

Lalor, Aislinn F.; Brown, Ted; Robins, Lauren; Lee, Den-Ching Angel; O’Connor, Daniel; Russell, Grant; Stolwyk, Rene; McDermott, Fiona; Johnson, Christina; Haines, Terry P.

2015-01-01

The transition between extended hospitalization and discharge home to community-living contexts for older adults is a critical time period. This transition can have an impact on the health outcomes of older adults such as increasing the risk for health outcomes like falls, functional decline and depression and anxiety. The aim of this work is to identify and understand why older adults experience symptoms of depression and anxiety post-discharge and what factors are associated with this. This is a mixed methods study of adults aged 65 years and over who experienced a period of hospitalization longer than two weeks and return to community-living post-discharge. Participants will complete a questionnaire at baseline and additional monthly follow-up questionnaires for six months. Anxiety and depression and their resulting behaviors are major public health concerns and are significant determinants of health and wellbeing among the ageing population. There is a critical need for research into the impact of an extended period of hospitalization on the health status of older adults post-discharge from hospital. This research will provide evidence that will inform interventions and services provided for older adults after they have been discharged home from hospital care. PMID:27417775

Risk Factors Associated with Falls in Older Adults with Dementia: A Systematic Review

PubMed Central

Fernando, Eresha; Fraser, Michelle; Hendriksen, Jane; Kim, Corey H.

2017-01-01

Purpose: People with dementia fall more often than cognitively healthy older adults, but their risk factors are not well understood. A review is needed to determine a fall risk profile for this population. The objective was to critically evaluate the literature and identify the factors associated with fall risk in older adults with dementia. Methods: Articles published between January 1988 and October 2014 in EMBASE, PubMed, PsycINFO, and CINAHL were searched. Inclusion criteria were participants aged 55 years or older with dementia or cognitive impairment, prospective cohort design, detailed fall definition, falls as the primary outcome, and multi-variable regression analysis. Two authors independently reviewed and extracted data on study characteristics, quality assessment, and outcomes. Adjusted risk estimates were extracted from the articles. Results: A total of 17 studies met the inclusion criteria. Risk factors were categorized into demographic, balance, gait, vision, functional status, medications, psychosocial, severity of dementia, and other. Risk factors varied with living setting and were not consistent across all studies within a setting. Conclusion: Falls in older adults with dementia are associated with multiple intrinsic and extrinsic risk factors, some shared with older adults in general and others unique to the disease. Risk factors vary between community- and institution-dwelling samples of adults with dementia or cognitive impairment. PMID:28539696

Older Latina Women and HIV/AIDS: An Examination of Sexuality and Culture as they Relate to Risk and Protective Factors

PubMed Central

Beaulaurier, Richard L.; Craig, Shelley L.; De La Rosa, Mario

2009-01-01

Older Latina women are one of the least studied American demographic groups with regard to social, health, or sexual behavior. This could leave social workers and other geriatric professionals unprepared for dealing with HIV/AIDS in this population. Currently, older Latina women are one of the fastest growing groups of new AIDS cases. Twenty percent of all women ever diagnosed with the disease are Latina and 5.5% of Latinas infected with the virus are older. The number of diagnosed infections is increasing in older women, including Latinas, in spite of recent declines in infection rates with younger populations. There are also a potentially large number of cases that go misdiagnosed or undiagnosed. This article also addresses risk and protective factors related to gender roles, traditional Latino family values, religion, socioeconomic factors, health, and health care, with special attention to the triple jeopardy faced by this population by virtue of being female, seniors, and minorities. The article concludes with recommendations for the development of culturally competent practices with older Latinas and the development of a research agenda to better understand their risk-related and health-seeking behavior. PMID:19197629

Social, Economic and Health Characteristics of Older American Indians (Part 2 of 2). Statistical Reports on Older Americans, June 1978.

ERIC Educational Resources Information Center

Williams, Blanch S.

In 1970 the Indian population of all ages was 763,000; 148,600 were 45 years of age or older and 43,800 were 65 years of age or older. Two-thirds of all older American Indian women and slightly more than one-third of the older men were either single, widowed, or divorced. Half of the older Indians received incomes below $1,408; this was 24% below…

Short term treatment versus long term management of neck and back disability in older adults utilizing spinal manipulative therapy and supervised exercise: a parallel-group randomized clinical trial evaluating relative effectiveness and harms

PubMed Central

2014-01-01

Background Back and neck disability are frequent in older adults resulting in loss of function and independence. Exercise therapy and manual therapy, like spinal manipulative therapy (SMT), have evidence of short and intermediate term effectiveness for spinal disability in the general population and growing evidence in older adults. For older populations experiencing chronic spinal conditions, long term management may be more appropriate to maintain improvement and minimize the impact of future exacerbations. Research is limited comparing short courses of treatment to long term management of spinal disability. The primary aim is to compare the relative effectiveness of 12 weeks versus 36 weeks of SMT and supervised rehabilitative exercise (SRE) in older adults with back and neck disability. Methods/Design Randomized, mixed-methods, comparative effectiveness trial conducted at a university-affiliated research clinic in the Minneapolis/St. Paul, Minnesota metropolitan area. Participants Independently ambulatory community dwelling adults ≥ 65 years of age with back and neck disability of minimum 12 weeks duration (n = 200). Interventions 12 weeks SMT + SRE or 36 weeks SMT + SRE. Randomization Blocked 1:1 allocation; computer generated scheme, concealed in sequentially numbered, opaque, sealed envelopes. Blinding Functional outcome examiners are blinded to treatment allocation; physical nature of the treatments prevents blinding of participants and providers to treatment assignment. Primary endpoint 36 weeks post-randomization. Data collection Self-report questionnaires administered at 2 baseline visits and 4, 12, 24, 36, 52, and 78 weeks post-randomization. Primary outcomes include back and neck disability, measured by the Oswestry Disability Index and Neck Disability Index. Secondary outcomes include pain, general health status, improvement, self-efficacy, kinesiophobia, satisfaction, and medication use. Functional outcome assessment occurs at baseline and week 37 for hand grip strength, short physical performance battery, and accelerometry. Individual qualitative interviews are conducted when treatment ends. Data on expectations, falls, side effects, and adverse events are systematically collected. Primary analysis Linear mixed-model method for repeated measures to test for between-group differences with baseline values as covariates. Discussion Treatments that address the management of spinal disability in older adults may have far reaching implications for patient outcomes, clinical guidelines, and healthcare policy. Trial registry www.ClinicalTrials.gov; Identifier: NCT01057706. PMID:25478141

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, for the shortest duration. For older adults, an NSAID or cyclooxygenase-2 (COX-2) selective inhibitor should be co-prescribed with a proton pump inhibitor (PPI), and the one with the lowest acquisition cost should be chosen. All older people taking NSAIDs should be routinely monitored for gastrointestinal, renal and cardiovascular side effects, and drug–drug and drug–disease interactions. Opioid therapy may be considered for patients with moderate or severe pain, particularly if the pain is causing functional impairment or is reducing their quality of life. However, this must be individualised and carefully monitored. Opioid side effects including nausea and vomiting should be anticipated and suitable prophylaxis considered. Appropriate laxative therapy, such as the combination of a stool softener and a stimulant laxative, should be prescribed throughout treatment for all older people who are prescribed opioid therapy. Tricyclic antidepressants and anti-epileptic drugs have demonstrated efficacy in several types of neuropathic pain. But, tolerability and adverse effects limit their use in an older population. Intra-articular corticosteroid injections in osteoarthritis of the knee are effective in relieving pain in the short term, with little risk of complications and/or joint damage. Intra-articular hyaluronic acid is effective and free of systemic adverse effects. It should be considered in patients who are intolerant to systemic therapy. Intra-articular hyaluronic acid appears to have a slower onset of action than intra-articular steroids, but the effects seem to last longer. The current evidence for the use of epidural steroid injections in the management of sciatica is conflicting and, until further larger studies become available, no firm recommendations can be made. There is, however, a limited body of evidence to support the use of epidural injections in spinal stenosis. The literature review suggests that assistive devices are widely used and that the ownership of devices increases with age. Such devices enable older people with chronic pain to live in the community. However, they do not necessarily reduce pain and can increase pain if used incorrectly. Increasing activity by way of exercise should be considered. This should involve strengthening, flexibility, endurance and balance, along with a programme of education. Patient preference should be given serious consideration. A number of complementary therapies have been found to have some efficacy among the older population, including acupuncture, transcutaneous electrical nerve stimulation (TENS) and massage. Such approaches can affect pain and anxiety and are worth further investigation. Some psychological approaches have been found to be useful for the older population, including guided imagery, biofeedback training and relaxation. There is also some evidence supporting the use of cognitive behavioural therapy (CBT) among nursing home populations, but of course these approaches require training and time. There are many areas that require further research, including pharmacological management where approaches are often tested in younger populations and then translated across. Prevalence studies need consistency in terms of age, diagnosis and terminology, and further work needs to be done on evaluating non-pharmacological approaches.

The Health of Aging Populations in China and India

PubMed Central

Chatterji, Somnath; Kowal, Paul; Mathers, Colin; Naidoo, Nirmala; Verdes, Emese; Smith, James P.; Suzman, Richard

2013-01-01

China and India are home to two of the world’s largest populations, and both populations are aging rapidly. Our data compare health status, risk factors, and chronic diseases among people age forty-five and older in China and India. By 2030, 65.6 percent of the Chinese and 45.4 percent of the Indian health burden are projected to be borne by older adults, a population with high levels of noncommunicable diseases. Smoking (26 percent in both China and India) and inadequate physical activity (10 percent and 17.7 percent, respectively) are highly prevalent. Health policy and interventions informed by appropriate data will be needed to avert this burden. By 2030, older adults will bear two-thirds of the total disease burden in China and nearly half in India. PMID:18607041

Challenges and Opportunities for Developing and Implementing Incentives to Improve Health-Related Behaviors in Older Adults

PubMed Central

Klein, Eran; Karlawish, Jason

2010-01-01

There is growing interest in using patient-directed incentives to change health-related behaviors. Advocates of incentive programs have proposed an ambitious research agenda for moving patient incentive programs forward. Older adults may pose a challenge to such a research agenda. The cognitive and psychological features of this population, in particular, age-related changes in emotional regulation, executive function and cognitive capacities, and a preference for collaborative decision-making raise questions about the suitability of these programs, particularly the structure of current financial incentives, to older adults. Differences in decision-making in older adults need to be accounted for in the design and implementation of financial incentive programs. Financial incentive programs tailored to characteristics of older adult populations may be more likely to improve the lives of older persons and the economic success of programs that serve them. PMID:20863335

The minimal clinically important difference of six-minute walk in Asian older adults.

PubMed

Kwok, Boon Chong; Pua, Yong Hao; Mamun, Kaysar; Wong, Wai Pong

2013-03-06

Rehabilitation interventions promote functional recovery among frail older adults and little is known about the clinical significance of physical outcome measure changes. The purpose of our study is to examine the minimal clinically important difference (MCID) for the 6-minute walk distance (6MWD) among frail Asian older adults. Data from the "Evaluation of the Frails' Fall Efficacy by Comparing Treatments" study were analyzed. Distribution-based and anchor-based methods were used to estimate the MCID of the 6MWD. Participants who completed the trial rated their perceived change of overall health on the Global Rating of Change (GROC) scale. The receiver operating characteristic curve (ROC) was used to analyze the sensitivity and specificity of the cut-off values of 6MWD (in meters) for GROC rating of "a little bit better" (+2), based on feedback from participants. The mean (SD) change in 6MWD was 37.3(46.2) m among those who perceived a change (GROC ≥ 2), while those who did not was 9.3(18.2) m post-intervention (P = 0.011). From the anchor-based method, the MCID value for the 6MWD was 17.8 m (sensitivity 56.7% and specificity 83.3%) while distribution-based method estimated 12.9 m. The MCID estimate for 6MWD was 17.8 m in the moderately frail Asian older adults with a fear of falling. The results will aid the clinicians in goal setting for this patient population.

International Spotlight: Israel

ERIC Educational Resources Information Center

Glicksman, Allen; Litwin, Howard

2011-01-01

The State of Israel provides significant opportunities to study social processes that can enhance our understanding of the aging experience. It has high life expectancy and rapid growth of its older population. With an older cohort that is composed largely of former immigrants and includes a minority Arab population, Israel provides much diversity…

Multidimensional attitudes of emergency medicine residents toward older adults.

PubMed

Hogan, Teresita M; Chan, Shu B; Hansoti, Bhakti

2014-07-01

The demands of our rapidly expanding older population strain many emergency departments (EDs), and older patients experience disproportionately high adverse health outcomes. Trainee attitude is key in improving care for older adults. There is negligible knowledge of baseline emergency medicine (EM) resident attitudes regarding elder patients. Awareness of baseline attitudes can serve to better structure training for improved care of older adults. The objective of the study is to identify baseline EM resident attitudes toward older adults using a validated attitude scale and multidimensional analysis. Six EM residencies participated in a voluntary anonymous survey delivered in summer and fall 2009. We used factor analysis using the principal components method and Varimax rotation, to analyze attitude interdependence, translating the 21 survey questions into 6 independent dimensions. We adapted this survey from a validated instrument by the addition of 7 EM-specific questions to measures attitudes relevant to emergency care of elders and the training of EM residents in the geriatric competencies. Scoring was performed on a 5-point Likert scale. We compared factor scores using student t and ANOVA. 173 EM residents participated showing an overall positive attitude toward older adults, with a factor score of 3.79 (3.0 being a neutral score). Attitudes trended to more negative in successive post-graduate year (PGY) levels. EM residents demonstrate an overall positive attitude towards the care of older adults. We noted a longitudinal hardening of attitude in social values, which are more negative in successive PGY-year levels.

Understanding the Potential of PARO for Healthy Older Adults

PubMed Central

McGlynn, Sean A.; Kemple, Shawn; Mitzner, Tracy L.; King, Chih-Hung Aaron; Rogers, Wendy A.

2017-01-01

As the population ages, there is an increasing need for socio-emotional support for older adults. A potential way to meet this need is through interacting with pet-type robots such as the seal robot, PARO. There was a need to extend research on PARO’s potential benefits beyond cognitively impaired and dependently living older adults. Because independently living, cognitively intact older adults may also have socio-emotional needs, the primary goal of this study was to investigate their attitudes, emotions, and engagement with PARO to identify its potential applicability to this demographic. Thirty older adults participated in an interaction period with PARO, and their attitudes and emotions toward PARO were assessed before and after using a multi-method approach. Video of the interaction was coded to determine the types and frequency of engagements participants initiated with PARO. Overall, there were no pre-post interaction differences on these measures. However, semi-structured interviews suggested that these older adults had positive attitudes towards PARO’s attributes, thought it would be easy to use, and perceived potential uses for both themselves and others. Participants varied in their frequency of engagement with PARO. A novel finding is that this active engagement frequency uniquely predicted post-interaction period positive affect. This study advances understanding of healthy older adults’ attitudes, emotions, and engagement with PARO and of possible ways in which PARO could provide social and emotional support to healthy older adults. The results are informative for future research and design of pet-type robots. PMID:28943748

Military Service, Exposure to Trauma, and Health in Older Adulthood: An Analysis of Northern Vietnamese Survivors of the Vietnam War

PubMed Central

Teerawichitchainan, Bussarawan

2014-01-01

Objectives. We sought to better understand the association between early life exposure to war and trauma and older adult health status in a developing setting. Methods. We analyzed data of 405 Vietnamese men and women in 1 northern Vietnam commune who entered early adulthood during the Vietnam War and who are now entering late adulthood (i.e., ages 55 years and older in 2010). Results. The toll of war’s trauma in the aging northern Vietnamese population was perceptible in the association between exposure to war trauma and various measures of physical health, including negative self-reported health and somatic symptoms. Killing another person and being exposed to toxic substances in warfare was especially detrimental to health in older adulthood. War traumas were likely implicated more strongly as determinants of late adulthood health in men than in women. The weak association between trauma exposure and reported depressive symptoms raised questions about measuring mental health. Conclusions. Military service and war trauma were important determinants of older adult health beyond the US context, given the widespread waging of war and concentration of recent armed conflicts within developing societies. PMID:24922129

Reducing Avoidable Deaths Among Veterans: Directing Private-Sector Surgical Care to High-Performance Hospitals

PubMed Central

Weeks, William B.; West, Alan N.; Wallace, Amy E.; Lee, Richard E.; Goodman, David C.; Dimick, Justin B.; Bagian, James P.

2007-01-01

Objectives. We quantified older (65 years and older) Veterans Health Administration (VHA) patients’ use of the private sector to obtain 14 surgical procedures and assessed the potential impact of directing that care to high-performance hospitals. Methods. Using a merged VHA–Medicare inpatient database for 2000 and 2001, we determined where older VHA enrollees obtained 6 cardiovascular surgeries and 8 cancer resections and whether private-sector care was obtained in high- or low-performance hospitals (based on historical performance and determined 2 years in advance of the service year). We then modeled the mortality and travel burden effect of directing private-sector care to high-performance hospitals. Results. Older veterans obtained most of their procedures in the private sector, but that care was equally distributed across high- and low-performance hospitals. Directing private-sector care to high-performance hospitals could have led to the avoidance of 376 to 584 deaths, most through improved cardiovascular care outcomes. Using historical mortality to define performance would produce better outcomes with lower travel time. Conclusions. Policy that directs older VHA enrollees’ private-sector care to high-performance hospitals promises to reduce mortality for VHA’s service population and warrants further exploration. PMID:17971543

Development of a New Multidimensional Individual and Interpersonal Resilience Measure for Older Adults

PubMed Central

Martin, A’verria Sirkin; Distelberg, Brian; Palmer, Barton W.; Jeste, Dilip V.

2015-01-01

Objectives Develop an empirically grounded measure that can be used to assess family and individual resilience in a population of older adults (aged 50-99). Methods Cross-sectional, self-report data from 1,006 older adults were analyzed in two steps. The total sample was split into two sub-samples and the first step identified the underlying latent structure through principal component Exploratory Factor Analysis (EFA). The second step utilized the second half of the sample to validate the derived latent structure through Confirmatory Factor Analysis (CFA). Results EFA produced an eight-factor structure that appeared clinically relevant for measuring the multidimensional nature of resilience. Factors included self-efficacy, access to social support network, optimism, perceived economic and social resources, spirituality and religiosity, relational accord, emotional expression and communication, and emotional regulation. CFA confirmed the eight-factor structure previously achieved with covariance between each of the factors. Based on these analyses we developed the Multidimensional Individual and Interpersonal Resilience Measure (MIIRM), a broad assessment of resilience for older adults. Conclusion This study highlights the multidimensional nature of resilience and introduces an individual and interpersonal resilience measure developed for older adults which is grounded in the individual and family resilience literature. PMID:24787701

Community-based adapted tango dancing for individuals with Parkinson's disease and older adults.

PubMed

Hackney, Madeleine E; Hackney, Madeleine; McKee, Kathleen

2014-12-09

Adapted tango dancing improves mobility and balance in older adults and additional populations with balance impairments. It is composed of very simple step elements. Adapted tango involves movement initiation and cessation, multi-directional perturbations, varied speeds and rhythms. Focus on foot placement, whole body coordination, and attention to partner, path of movement, and aesthetics likely underlie adapted tango's demonstrated efficacy for improving mobility and balance. In this paper, we describe the methodology to disseminate the adapted tango teaching methods to dance instructor trainees and to implement the adapted tango by the trainees in the community for older adults and individuals with Parkinson's Disease (PD). Efficacy in improving mobility (measured with the Timed Up and Go, Tandem stance, Berg Balance Scale, Gait Speed and 30 sec chair stand), safety and fidelity of the program is maximized through targeted instructor and volunteer training and a structured detailed syllabus outlining class practices and progression.

Nutritional support of the elderly cancer patient: the role of the nurse.

PubMed

Hopkinson, Jane B

2015-04-01

Cancer in the geriatric population is a growing problem. Malnutrition is common in cancer. A number of factors increase the risk for malnutrition in older people with cancer, including chronic comorbid conditions and normal physiological changes of aging. Nurses have an important role in the nutritional support of older cancer patients. To contribute to the improvement of nutritional support of these patients, nurses need appropriate training to be able to identify risk for malnutrition and offer a range of interventions tailored to individual need. Factors to consider in tailoring interventions include disease status, cancer site, cancer treatment, comorbidity, physiological age, method of facilitating dietary change, and family support. This article identifies ways in which nurses can contribute to the nutritional support of older cancer patients and thus help mitigate the effects of malnutrition. Copyright © 2015 Elsevier Inc. All rights reserved.

Rurality and Other Determinants of Early Colorectal Cancer Diagnosis in Nebraska: A 6-Year Cancer Registry Study, 1998-2003

ERIC Educational Resources Information Center

Sankaranarayanan, Jayashri; Watanabe-Galloway, Shinobu; Sun, Junfeng; Qiu, Fang; Boilesen, Eugene; Thorson, Alan G.

2009-01-01

Background: There are no studies of rurality, and other determinants of colorectal cancer (CRC) stage at diagnosis with population-based data from the Midwest. Methods: This retrospective study identified, incident CRC patients, aged 19 years and older, from 1998-2003 Nebraska Cancer Registry (NCR) data. Using federal Office of Management and…

The Effect of Self-Reported and Performance-Based Functional Impairment on Future Hospital Costs of Community-Dwelling Older Persons

ERIC Educational Resources Information Center

Reuben, David B.; Seeman, Teresa E.; Keeler, Emmett; Hayes, Risa P.; Bowman, Lee; Sewall, Ase; Hirsch, Susan H.; Wallace, Robert B.; Guralnik, Jack M.

2004-01-01

Purpose: We determined the prognostic value of self-reported and performance-based measurement of function, including functional transitions and combining different measurement approaches, on utilization. Design and Methods: Our cohort study used the 6th, 7th, and 10th waves of three sites of the Established Populations for Epidemiologic Studies…

The Role of Perceived Control in Explaining Depressive Symptoms Associated with Driving Cessation in a Longitudinal Study

ERIC Educational Resources Information Center

Windsor, Timothy D.; Anstey, Kaarin J.; Butterworth, Peter; Luszcz, Mary A.; Andrews, Gary R.

2007-01-01

Purpose: The purpose of this article was to investigate the role of control beliefs in mediating the relationship between driving cessation and change in depressive symptoms in a population-based sample of older adults. Design and Methods: We report results from a prospective, community-based cohort study that included two waves of data collected…

Training of Older Workers in Canada. Training Discussion Paper No. 22.

ERIC Educational Resources Information Center

Trueman, Mary

Canadians aged 55 or older are a growing proportion of the population. Involuntary unemployment among older workers is gaining attention as an urgent social problem. The special training needs of older workers and retired individuals have received increasing recognition in Canada. However, concern expressed in the media and in government…

Appreciating the Predicament of Housebound Older Adults with Arthritis: Portrait of a Population

ERIC Educational Resources Information Center

Nour, Kareen; Laforest, Sophie; Gignac, Monique; Gauvin, Lise

2005-01-01

This paper draws a socio-demographic, physical, psychosocial, and behavioural profile of housebound older adults with arthritis and compares older adults with rheumatoid arthritis to those with osteoarthritis. Data from 125 housebound older adults with osteoarthritis (65%) or rheumatoid arthritis (35%) were compared to published samples and to…

Usage of Complementary Medicine in Switzerland: Results of the Swiss Health Survey 2012 and Development Since 2007

PubMed Central

Klein, Sabine D.; Torchetti, Loredana; Frei-Erb, Martin; Wolf, Ursula

2015-01-01

Background Complementary medicine (CM) is popular in Switzerland. Several CM methods (traditional Chinese medicine/acupuncture, homeopathy, anthroposophic medicine, neural therapy, and herbal medicine) are currently covered by the mandatory basic health insurance when performed by a certified physician. Treatments by non-medical therapists are partially covered by a supplemental and optional health insurance. In this study, we investigated the frequency of CM use including the evolvement over time, the most popular methods, and the user profile. Methods Data of the Swiss Health Surveys 2007 and 2012 were used. In 2007 and 2012, a population of 14,432 and 18,357, respectively, aged 15 years or older answered the written questionnaire. A set of questions queried about the frequency of use of various CM methods within the last 12 months before the survey. Proportions of usage and 95% confidence intervals were calculated for these methods and CM in general. Users and non-users of CM were compared using logistic regression models. Results The most popular methods in 2012 were homeopathy, naturopathy, osteopathy, herbal medicine, and acupuncture. The average number of treatments within the 12 months preceding the survey ranged from 3 for homeopathy to 6 for acupuncture. 25.0% of the population at the age of 15 and older had used at least one CM method in the previous 12 months. People with a chronic illness or a poor self-perceived health status were more likely to use CM. Similar to other countries, women, people of middle age, and those with higher education were more likely to use CM. 59.9% of the adult population had a supplemental health insurance that partly covered CM treatments. Conclusions Usage of CM in Switzerland remained unchanged between 2007 and 2012. The user profile in Switzerland was similar to other countries, such as Germany, United Kingdom, United States or Australia. PMID:26513370

Libraries: Aids to Life Satisfaction for Older Women. A 1981 White House Conference on the Aging Background Paper.

ERIC Educational Resources Information Center

Mathews, Virginia

This report discusses the ability of public libraries to address the problems of older Americans, particularly older women, and to make their lives more satisfying. A review of facts and figures about the older population is followed by a discussion of programs and responses to the needs of older Americans by libraries and other agencies, such as…

Health and quality of life among older rural people in Purworejo District, Indonesia

PubMed Central

Ng, Nawi; Hakimi, Mohammad; Byass, Peter; Wilopo, Siswanto; Wall, Stig

2010-01-01

Introduction Increasing life expectancy and longevity for people in many highly populated low- and middle-income countries has led to an increase in the number of older people. The population aged 60 years and over in Indonesia is projected to increase from 8.4% in 2005 to 25% in 2050. Understanding the determinants of healthy ageing is essential in targeting health-promotion programmes for older people in Indonesia. Objective To describe patterns of socio-economic and demographic factors associated with health status, and to identify any spatial clustering of poor health among older people in Indonesia. Methods In 2007, the WHO Study on global AGEing and adult health (SAGE) was conducted among 14,958 people aged 50 years and over in Purworejo District, Central Java, Indonesia. Three outcome measures were used in this analysis: self-reported quality of life (QoL), self-reported functioning and disability, and overall health score calculated from self-reported health over eight health domains. The factors associated with each health outcome were identified using multivariable logistic regression. Purely spatial analysis using Poisson regression was conducted to identify clusters of households with poor health outcomes. Results Women, older age groups, people not in any marital relationship and low educational and socio-economic levels were associated with poor health outcomes, regardless of the health indices used. Older people with low educational and socio-economic status (SES) had 3.4 times higher odds of being in the worst QoL quintile (OR = 3.35; 95% CI = 2.73–4.11) as compared to people with high education and high SES. This disadvantaged group also had higher odds of being in the worst functioning and most disabled quintile (OR = 1.67; 95% CI = 1.35–2.06) and the lowest overall health score quintile (OR = 1.66; 95% CI = 1.36–2.03). Poor health and QoL are not randomly distributed among the population over 50 years old in Purworejo District, Indonesia. Spatial analysis showed that clusters of households with at least one member being in the worst quintiles of QoL, functioning and health score intersected in the central part of Purworejo District, which is a semi-urban area with more developed economic activities compared with other areas in the district. Conclusion Being female, old, unmarried and having low educational and socio-economic levels were significantly associated with poor self-reported QoL, health status and disability among older people in Purworejo District. This study showed the existence of geographical pockets of vulnerable older people in Purworejo District, and emphasized the need to take immediate action to address issues of older people's health and QoL. PMID:20959875

Clinical prediction and the idea of a population.

PubMed

Armstrong, David

2017-04-01

Using an analysis of the British Medical Journal over the past 170 years, this article describes how changes in the idea of a population have informed new technologies of medical prediction. These approaches have largely replaced older ideas of clinical prognosis based on understanding the natural histories of the underlying pathologies. The 19 th -century idea of a population, which provided a denominator for medical events such as births and deaths, was constrained in its predictive power by its method of enumerating individual bodies. During the 20 th century, populations were increasingly constructed through inferential techniques based on patient groups and samples seen to possess variable characteristics. The emergence of these new virtual populations created the conditions for the emergence of predictive algorithms that are used to foretell our medical futures.

Enhancing medication adherence: in older adults with bipolar disorder.

PubMed

Depp, Colin A; Lebowitz, Barry D

2007-06-01

The number of older adults with bipolar disorder is increasing, yet little is known about the optimal clinical management of these patients. Medication adherence is a vital to effective long-term treatment of these patients; thus enhancement of adherence is often an important clinical goal. We reviewed available evidence about the characteristics of later-life bipolar disorder along with behavioral and organizational strategies to enhance adherence in this population. Based on available data, cognitive impairment, medical comorbidity, and functional limitations are frequent and are likely to impact treatment adherence in this population. In terms of treatment, there have been no placebo-controlled randomized clinical trials of medications or psychosocial interventions for this population. Based on extrapolation from intervention research on younger adults with bipolar disorder and older adults with other chronic illness, psychosocial interventions that reduce effortful cognitive processing in managing medications and reduce organizational barriers to adherence may be beneficial in enhancing adherence in this population. Much more research needs to be done to understand the impact of aging on bipolar disorder, along with optimization of treatment. Interventions to enhance adherence in this population need to be adapted to fit with the unique needs of older adults with bipolar disorder.

Characteristics of Older Adults on Waiting Lists for Meals on Wheels: Identifying Areas for Intervention

PubMed Central

Thomas, Kali S.; Smego, Raul; Akobundu, Ucheoma; Dosa, David

2016-01-01

The purpose of this study was to characterize the population of seniors on Meals on Wheels’ (MOW) waiting lists and identify their rate of depression, anxiety, falls, and fear of falling. Data come from surveys of 626 seniors on waiting lists across the country and the 2013 National Health and Aging Trends Study (NHATS). Results suggest that seniors on waiting lists for MOW were more likely to be widowed, less educated, older, Black, Hispanic, and receive Medicaid than the population of community-dwelling older adults. In addition, 31% of seniors on MOW waiting lists were depressed, compared with 12% of seniors in the national population (p < .001), and 28% exhibited signs and symptoms of anxiety, compared with 10% of the national population of seniors (p < .001). Seniors on waiting lists were significantly more likely to have fallen in the last month and be fearful of falling than the national population of seniors (p < .001). Individuals on MOW waiting lists are a vulnerable and high-risk group. By seeking to better understand clients’ needs, appropriate services can be tailored to promote independent living and improve older adults’ well-being. PMID:26597791

Public Health Impact of Frailty: Role of Physical Therapists.

PubMed

Gustavson, A M; Falvey, J R; Jankowski, C M; Stevens-Lapsley, J E

2017-01-01

Frailty is an emerging and immediate public health concern given the growing aging population. The condition of frailty is characterized by a reduction in physiologic reserve, which places frail older adults at considerable risk for further functional decline, hospitalization, institutionalization, and death. Recent research suggests that frailty may be reversible, which could result in significant improvement in public health. Thus, a strong impetus exists to develop strategies for frail older adults that achieve the Triple Aim through better promotion of population health, optimization of patient experiences, and delivery of high-quality care at minimal cost. Physical therapists often treat frail older adults, yet how physical therapists can contribute to preventing or reversing frailty in healthcare settings has not been described, and may potentially influence patient outcomes and healthcare spending. Therefore, the purpose of this publication is to outline the potential role of physical therapists in achieving the Triple Aim for the frail older adult population.

PUBLIC HEALTH IMPACT OF FRAILTY: ROLE OF PHYSICAL THERAPISTS

PubMed Central

GUSTAVSON, A.M.; FALVEY, J.R.; JANKOWSKI, C.M.; STEVENS-LAPSLEY, J.E.

2017-01-01

Frailty is an emerging and immediate public health concern given the growing aging population. The condition of frailty is characterized by a reduction in physiologic reserve, which places frail older adults at considerable risk for further functional decline, hospitalization, institutionalization, and death. Recent research suggests that frailty may be reversible, which could result in significant improvement in public health. Thus, a strong impetus exists to develop strategies for frail older adults that achieve the Triple Aim through better promotion of population health, optimization of patient experiences, and delivery of high-quality care at minimal cost. Physical therapists often treat frail older adults, yet how physical therapists can contribute to preventing or reversing frailty in healthcare settings has not been described, and may potentially influence patient outcomes and healthcare spending. Therefore, the purpose of this publication is to outline the potential role of physical therapists in achieving the Triple Aim for the frail older adult population. PMID:28244550

Physical Activity and Functional Limitations in Older Adults: The Influence of Self-Efficacy and Functional Performance

PubMed Central

Mullen, Sean P.; Satariano, William A.; Kealey, Melissa; Prohaska, Thomas R.

2012-01-01

Objectives. Data from the Healthy Aging Network (HAN) study (Prohaska, T., Eisenstein, A., Satariano, W., Hunter, R., Bayles, C., Kurtovich, E., … Ivey, S. [2009]. Walking and the preservation of cognitive function in older populations. The Gerontologist, 49[Suppl. 1], S86–S93; and Satariano, W., Ivey, S., Kurtovich, E., Kealey, M., Hubbard, A., Bayles, C., … Prohaska, T. [2010]. Lower-body function, neighborhoods, and walking in an older population. American Journal of Preventive Medicine, 38, 419–428.) were used to examine the relationships among physical activity, self-efficacy, functional performance, and limitations. Method. Interviews were conducted within homes and senior centers in 4 geographic regions across the United States. Participants were 884 older adults (M age = 74.8; 77% female; 35% minority status) who completed measures of walking behavior, way-finding self-efficacy, walking self-efficacy, functional performance, functional limitations, and demographic characteristics. Results. Path analysis within a covariance modeling framework revealed significant direct effects of walking on self-efficacy constructs, functional performance on functional limitations, and efficacy on limitations. Additionally, significant indirect effects were also found, including walking on limitations via walking self-efficacy and performance and walking self-efficacy on limitations via performance. Furthermore, we found support for invariance of the model across geographical grouping. Discussion. Our findings provide further validation for an efficacy-based model of functional limitations. Walking-related efficacy may help reduce or possibly delay the onset of functional limitations. PMID:22473023

Long-term prescribing of antidepressants in the older population: a qualitative study

PubMed Central

Dickinson, Rebecca; Knapp, Peter; House, Allan O; Dimri, Vandana; Zermansky, Arnold; Petty, Duncan; Holmes, John; Raynor, David K

2010-01-01

Background High rates of long-term antidepressant prescribing have been identified in the older population. Aims To explore the attitudes of older patients and their GPs to taking long-term antidepressant therapy, and their accounts of the influences on long-term antidepressant use. Design of study Qualitative study using in-depth semi-structured interviews. Setting One primary care trust in North Bradford. Method Thirty-six patients aged ≥75 years and 10 GPs were interviewed. Patients were sampled to ensure diversity in age, sex, antidepressant type, and home circumstances. Results Participants perceived significant benefits and expressed little apprehension about taking long-term antidepressants, despite being aware of the psychological and social factors involved in onset and persistence of depression. Barriers to discontinuation were identified following four themes: pessimism about the course and curability of depression; negative expectations and experiences of ageing; medicine discontinuation perceived by patients as a threat to stability; and passive (therapeutic momentum) and active (therapeutic maintenance) decisions to accept the continuing need for medication. Conclusion There is concern at a public health level about high rates of long-term antidepressant prescribing, but no evidence was found of a drive for change either from the patients or the doctors interviewed. Any apprehension was more than balanced by attitudes and behaviours supporting continuation. These findings will need to be incorporated into the planning of interventions aimed at reducing long-term antidepressant prescribing in older people. PMID:20353660

Older Age Relates to Worsening of Fine Motor Skills: A Population-Based Study of Middle-Aged and Elderly Persons

PubMed Central

Hoogendam, Yoo Young; van der Lijn, Fedde; Vernooij, Meike W.; Hofman, Albert; Niessen, Wiro J.; van der Lugt, Aad; Ikram, M. Arfan; van der Geest, Jos N.

2014-01-01

Introduction: In a population-based study of 1,912 community-dwelling persons of 45 years and older, we investigated the relation between age and fine motor skills using the Archimedes spiral-drawing test. Also, we studied the effect of brain volume on fine motor skills. Methods: Participants were required to trace a template of a spiral on an electronic drawing board. Clinical scores from this test were obtained by visual assessment of the drawings. Quantitative measures were objectively determined from the recorded data of the drawings. As tremor is known to occur increasingly with advancing age, we also rated drawings to assess presence of tremor. Results: We found presence of a tremor in 1.3% of the drawings. In the group without tremor, we found that older age was related to worse fine motor skills. Additionally, participants over the age of 75 showed increasing deviations from the template when drawing the spiral. Larger cerebral volume and smaller white matter lesion volume were related to better spiral-drawing performance, whereas cerebellar volume was not related to spiral-drawing performance. Conclusion: Older age is related to worse fine motor skills, which can be captured by clinical scoring or quantitative measures of the Archimedes spiral-drawing test. Persons with a tremor performed worse on almost all measures of the spiral-drawing test. Furthermore, larger cerebral volume is related to better fine motor skills. PMID:25309436

Traffic safety for older people : 5-year plan.

DOT National Transportation Integrated Search

2013-12-01

This document is intended to serve as the plan for National Highway Traffic Safety Administration activities to address traffic safety concerns of older people. Given the increasing proportion of older people in the population, NHTSA must work in con...

Assessing the needs of Delaware's older drivers.

DOT National Transportation Integrated Search

2007-06-01

In light of Delawares growing population age 60 and older (60+), it is important to plan for the : states projected increase in older drivers. Information from the United States Census Bureau : (2005) indicates that Delaware is projected to hav...

Levels of Acculturation of Chinese Older Adults in the Greater Chicago Area - The Population Study of Chinese Elderly in Chicago.

PubMed

Dong, XinQi; Bergren, Stephanie M; Chang, E-Shien

2015-09-01

Acculturation is a difficult process for minority older adults for a variety of reasons, including access and exposure to mainstream culture, competing ethnic identities, and linguistic ability and preference. There is a paucity of research regarding overall level of acculturation for Chinese older adults in the United States. This study aimed to provide an overall estimate of level of acculturation of Chinese older adults in the United States and to examine correlations between sociodemographic characteristics, self-reported health measures, and level of acculturation. Data were collected through the Population Study of Chinese Elderly in Chicago (PINE) study. This community-based participatory research study surveyed 3,159 Chinese older adults aged 60 and older. The PINE Study Acculturation Scale was used to assess level of acculturation in three dimensions: language preference, media use, and ethnic social relations. Mean acculturation level for all items was 15.3 ± 5.1, indicating low levels of acculturation. Older age, more offspring, lower income, fewer years living in the United States, lower overall health status, and lower quality of life were associated with lower levels of acculturation. Level of acculturation was low in Chinese older adults, and certain subsets of the population were more likely to have a lower level of acculturation. Future research should investigate causality and effects of level of acculturation. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.

Reduction of feral cat (Felis catus Linnaeus 1758) colony size following hysterectomy of adult female cats.

PubMed

Mendes-de-Almeida, Flavya; Remy, Gabriella L; Gershony, Liza C; Rodrigues, Daniela P; Chame, Marcia; Labarthe, Norma V

2011-06-01

The size of urban cat colonies is limited only by the availability of food and shelter; therefore, their population growth challenges all known population control programs. To test a new population control method, a free-roaming feral cat colony at the Zoological Park in the city of Rio de Janeiro was studied, beginning in 2001. The novel method consisted of performing a hysterectomy on all captured female cats over 6 months of age. To estimate the size of the colony and compare population from year to year, a method of capture-mark-release-recapture was used. The aim was to capture as many individuals as possible, including cats of all ages and gender to estimate numbers of cats in all population categories. Results indicated that the feral cat population remained constant from 2001 to 2004. From 2004 to 2008, the hysterectomy program and population estimates were performed every other year (2006 and 2008). The population was estimated to be 40 cats in 2004, 26 in 2006, and 17 cats in 2008. Although pathogens tend to infect more individuals as the population grows older and maintains natural behavior, these results show that free-roaming feral cat colonies could have their population controlled by a biannual program that focuses on hysterectomy of sexually active female cats. Copyright © 2011 ISFM and AAFP. Published by Elsevier Ltd. All rights reserved.

Prevalence, risk factors and health outcomes associated with polypharmacy among urban community-dwelling older adults in multi-ethnic Malaysia

PubMed Central

Lim, Li Min; McStea, Megan; Chung, Wen Wei; Nor Azmi, Nuruljannah; Abdul Aziz, Siti Azdiah; Alwi, Syireen; Kamarulzaman, Adeeba; Kamaruzzaman, Shahrul Bahyah; Chua, Siew Siang

2017-01-01

Background Polypharmacy has been associated with increased morbidity and mortality in the older population. Objectives The aim of this study was to determine the prevalence, risk factors and health outcomes associated with polypharmacy in a cohort of urban community-dwelling older adults receiving chronic medications in Malaysia. Methods This was a baseline study in the Malaysian Elders Longitudinal Research cohort. The inclusion criteria were individuals aged ≥55years and taking at least one medication chronically (≥3 months). Participants were interviewed using a structured questionnaire during home visits where medications taken were reviewed. Health outcomes assessed were frequency of falls, functional disability, potential inappropriate medication use (PIMs), potential drug-drug interactions (PDDIs), healthcare utilisation and quality of life (QoL). Risk factors and health outcomes associated with polypharmacy (≥5 medications including dietary supplements) were determined using multivariate regression models. Results A total of 1256 participants were included with a median (interquartile range) age of 69(63–74) years. The prevalence of polypharmacy was 45.9% while supplement users made up 56.9% of the cohort. The risk factors associated with increasing medication use were increasing age, Indian ethnicity, male, having a higher number of comorbidities specifically those diagnosed with cardiovascular, endocrine and gastrointestinal disorders, as well as supplement use. Health outcomes significantly associated with polypharmacy were PIMS, PDDIs and increased healthcare utilisation. Conclusion A significant proportion of older adults on chronic medications were exposed to polypharmacy and use of dietary supplements contributed significantly to this. Medication reviews are warranted to reduce significant polypharmacy related issues in the older population. PMID:28273128

The risk of pancreatitis with sitagliptin therapy in older adults: a population-based cohort study

PubMed Central

McArthur, Eric; Fleet, Jamie L.; Hramiak, Irene; Garg, Amit X.

2015-01-01

Background The risk of pancreatitis with sitagliptin use in routine care remains to be established in older patients. We aimed to determine this risk in older adults who were newly prescribed sitagliptin versus an alternative hypoglycemic agent in the outpatient setting. Methods In a population-based retrospective cohort study in Ontario from 2010 until 2012 involving adults aged 66 years and older, we studied those who were newly prescribed sitagliptin or an alternative hypoglycemic agent. Our primary outcome of interest was a hospital encounter (emergency department visit or hospital admission) with acute pancreatitis within 90 days. We used inverse probability of treatment weighting to balance the 2 groups and logistic regression with a robust variance estimate to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Results A total of 57 689 patients (mean age 74 yr) were newly prescribed sitagliptin, and 83 405 patients (mean age 75 yr) were given an alternative hypoglycemic agent (metformin, glyburide, gliclazide or insulin) during the study period. After weighting, there were no significant differences in measured baseline characteristics between groups. In the weighted sample, sitagliptin was not associated with an increased risk of a hospital encounter with pancreatitis compared with alternative hypoglycemic agents (weighted total 46 of 57 689 patients taking sitagliptin [0.08%] v. 48 of 55 705 patients taking alternative hypoglycemic agents [0.09%], absolute risk difference –0.01% [95% CI –0.05% to 0.02%], OR 0.92 [95% CI 0.55 to 1.55]). Interpretation Older adults newly prescribed sitagliptin in routine care were not at a substantially higher risk of pancreatitis than those prescribed alternative hypoglycemic agents. These findings are reassuring for those who use or prescribe sitagliptin in the management of type 2 diabetes. PMID:26389095

Use of the Brazilian People’s Pharmacy Program by older adults

PubMed Central

Miranda, Vanessa Iribarrem Avena; Fassa, Anaclaudia Gastal; Meucci, Rodrigo Dalke; Lutz, Bárbara Heather

2016-01-01

ABSTRACT OBJECTIVE To assess the prevalence and factors associated with the use of the expanded Brazilian People’s Pharmacy Program among older adults and the reasons for not using it. METHODS In this population-based cross-sectional study conducted in the urban area of Pelotas, RS, Southern Brazil, we evaluated 1,305 older adults (aged 60 years or over) who had used medication in the last 15 days. Independent variables were socioeconomic factors, economic status, household income in minimum wages, educational attainment in years of schooling and occupational status. Demographic variables were sex, age, marital status, and self-reported skin color/race. Poisson regression was employed to analyze the factors associated with the use of the program. RESULTS The prevalence of use was 57.0% whilst the prevalence of knowledge of the program was 87.0%. In individuals aged 80 years or over, use of the program was 41.0%. As to the origin of the prescriptions used by older adults, 46.0% were from the Brazilian Unified Health System. The main reasons for not using the program were: difficulty in getting prescriptions, medication shortage, and ignorance about the medications offered and about the program. Higher age, lower income, presence of chronic diseases, and use of four or more medications were associated with use of the program. CONCLUSIONS It is necessary to expand the knowledge and use of the Brazilian People’s Pharmacy Program, especially among older adults, and to improve the dissemination of its list of medications to users and physicians. Thus it will be possible to reduce spending on long-term medications, which are especially important for this population. PMID:27143613

Resource allocation of in vitro fertilization: a nationwide register-based cohort study

PubMed Central

Klemetti, Reija; Gissler, Mika; Sevón, Tiina; Hemminki, Elina

2007-01-01

Background Infertility is common and in vitro fertilization (IVF) is a widely used treatment. In IVF the need increases and the effectiveness and appropriateness decrease by age. The purpose of this study was to describe allocation of resources for IVF by women's age, socioeconomic position, area of residence and treatment sector (public vs. private) and to discuss how fairly the IVF resources are allocated in Finland. Methods Women who received IVF between 1996 and 1998 (N = 9175) were identified from the reimbursement records of the Social Insurance Institution (SII). Information on IVF women's background characteristics came from the Central Population Register and the SII, on treatment costs from IVF clinics and the SII, and on births from the Medical Birth Register. The main outcome measures were success of IVF by number of cycles and treated women, expenditures per IVF cycles, per women, per live-birth, and per treatment sector, and private and public expenditures. Expenditures were estimated from health care visits and costs. Results During a mean period of 1.5 years, older women (women aged 40 or older) received 1.4 times more IVF treatment cycles than younger women (women aged below 30). The success rate decreased by age: from 22 live births per 100 cycles among younger women to 6 per 100 among older women. The mean cost of a live birth increased by age: compared to younger women, costs per born live birth of older women were 3-fold. Calculated by population, public expenditure was allocated most to young women and women from the highest socioeconomic position. Regional differences were not remarkable. Conclusion Children of older infertile women involve more expense due to the lower success rates of IVF. Socioeconomic differences suggest unfair resource allocation in Finland. PMID:18154645

An individually-tailored multifactorial intervention program for older fallers in a middle-income developing country: Malaysian Falls Assessment and Intervention Trial (MyFAIT)

PubMed Central

2014-01-01

Background In line with a rapidly ageing global population, the rise in the frequency of falls will lead to increased healthcare and social care costs. This study will be one of the few randomized controlled trials evaluating a multifaceted falls intervention in a low-middle income, culturally-diverse older Asian community. The primary objective of our paper is to evaluate whether individually tailored multifactorial interventions will successfully reduce the number of falls among older adults. Methods Three hundred community-dwelling older Malaysian adults with a history of (i) two or more falls, or (ii) one injurious fall in the past 12 months will be recruited. Baseline assessment will include cardiovascular, frailty, fracture risk, psychological factors, gait and balance, activities of daily living and visual assessments. Fallers will be randomized into 2 groups: to receive tailored multifactorial interventions (intervention group); or given lifestyle advice with continued conventional care (control group). Multifactorial interventions will target 6 specific risk factors. All participants will be re-assessed after 12 months. The primary outcome measure will be fall recurrence, measured with monthly falls diaries. Secondary outcomes include falls risk factors; and psychological measures including fear of falling, and quality of life. Discussion Previous studies evaluating multifactorial interventions in falls have reported variable outcomes. Given likely cultural, personal, lifestyle and health service differences in Asian countries, it is vital that individually-tailored multifaceted interventions are evaluated in an Asian population to determine applicability of these interventions in our setting. If successful, these approaches have the potential for widespread application in geriatric healthcare services, will reduce the projected escalation of falls and fall-related injuries, and improve the quality of life of our older community. Trial registration ISRCTN11674947 PMID:24951180

Tender point count, pain, and mobility in the older population: the mobilize Boston study.

PubMed

Eggermont, Laura H P; Shmerling, Robert H; Leveille, Suzanne G

2010-01-01

Prevalence of tender points (TP), and widespread pain and fibromyalgia, as well as the relationship between TP and widespread pain and mobility, was examined in 585 community-dwelling older adults (mean age 78.2 years, 63.4% female). Pain was based on location (none, single site, multisite, widespread). Mobility was measured by the Short Physical Performance Battery (SPPB), gait speed, and self-reported (S-R) mobility difficulty. Tender-point count and health characteristics (ie, BMI, chronic conditions, analgesic use, number of medications, depression, and blocks walked per week) were assessed. Several participants had 3 or more TP (22.1%) although prevalence of criteria-based fibromyalgia was low (.3%). Mobility was more limited in persons with higher tender-point counts. After adjustment for pain and other risk factors, higher tender-point count was associated with poorer SPPB performance (score < 10, aOR = 1.09 per TP, 95%CI, 1.01-1.17), and slow gait speed (< .784m/sec, aOR = 1.14 per TP, 95%CI, 1.05-1.24), but not with S-R mobility difficulty. S-R mobility difficulty was associated with more disseminated pain (multisite pain, aOR = 2.01, 95%CI, 1.21-3.34; widespread pain, aOR = 2.47, 95%CI, 1.09-5.62). These findings portray a significant mobility burden related to tender-point count and multisite and widespread pain in the older population. Future studies using longitudinal methods are warranted. Higher tender-point count, multisite pain, and widespread pain are common in community-dwelling older adults and associated with mobility problems. Both the manual tender-point exam and the McGill Pain Map may provide important yet different information about risks for mobility disability in older individuals. Copyright 2010 American Pain Society. All rights reserved.

Self-transcendence in older men attending a prostate cancer support group.

PubMed

Chin-A-Loy, S S; Fernsler, J I

1998-10-01

Self-transcendence has been shown to be related to well-being in older adults, women with breast cancer, women with AIDS, gay men with AIDS, and a healthy population. The purpose of this descriptive pilot study was to examine self-transcendence in another high-priority population: older men with prostate cancer. A convenience sample of 23 men, age 60 and older (M = 69), from three prostate cancer support groups completed Reed's Self-Transcendence Scale (STS) and a demographic data form. The men were predominantly white (82.6%), of the Catholic faith (56.5%), married (78.3%), and not working (87.0%). Over half (65.2%) had a college degree or higher; most viewed their health as good (69.6%) or excellent (21.7%); and the majority (56.5%) viewed their prostate cancer as affecting some of their daily activities. These men scored high on the STS (M = 50.07), which was consistent with previous findings in other populations. Findings of this study contribute to Reed's middle-range theory of self-transcendence. The discovery that self-transcendence is relevant to this group of older men with prostate cancer provides a basis for nurses to investigate the phenomenon in this population and help their clients explore the benefits of the self-transcendence resource.

Implementation of an innovative web-based conference table for community-dwelling frail older people, their informal caregivers and professionals: a process evaluation

PubMed Central

2012-01-01

Background Due to fragmentation of care, continuity of care is often limited in the care provided to frail older people. Further, frail older people are not always enabled to become involved in their own care. Therefore, we developed the Health and Welfare Information Portal (ZWIP), a shared Electronic Health Record combined with a communication tool for community-dwelling frail older people and primary care professionals. This article describes the process evaluation of its implementation, and aims to establish (1) the outcomes of the implementation process, (2) which implementation strategies and barriers and facilitators contributed to these outcomes, and (3) how its future implementation could be improved. Methods Mixed methods study, consisting of (1) a survey among professionals (n = 118) and monitoring the use of the ZWIP by frail older people and professionals, followed by (2) semi-structured interviews with purposively selected professionals (n = 12). Results 290 frail older people and 169 professionals participated in the ZWIP. At the end of the implementation period, 55% of frail older people and informal caregivers, and 84% of professionals had logged on to their ZWIP at least once. For professionals, the exposure to the implementation strategies was generally as planned, they considered the interprofessional educational program and the helpdesk very important strategies. However, frail older people’s exposure to the implementation strategies was less than intended. Facilitators for the ZWIP were the perceived need to enhance interprofessional collaboration and the ZWIP application being user-friendly. Barriers included the low computer-literacy of frail older people, a preference for personal communication and limited use of the ZWIP by other professionals and frail older people. Interviewees recommended using the ZWIP for other target populations as well and adding further strategies that may help frail older people to feel more comfortable with computers and the ZWIP. Conclusions This study describes the implementation process of an innovative e-health intervention for community-dwelling frail older people, informal caregivers and primary care professionals. As e-health is an important medium for overcoming fragmentation of healthcare and facilitating patient involvement, but its adoption in everyday practice remains a challenge, the positive results of this implementation are promising. PMID:22894654

Health Promotion Behaviors and Chronic Diseases of Aging in the Elderly People of Iranshahr*- IR Iran.

PubMed

Pishkar Mofrad, Zahra; Jahantigh, Mozhgan; Arbabisarjou, Azizollah

2015-07-13

Aging is considered as the phenomenon of the day in the health arena of the world and Iran. It is anticipated that there will be an explosion of aging population in Iran in about 2031 and 20-25% of the population will be aged over 60 years. With aging, chronic diseases also increase and diminish the functional ability of older people. On the other hand, increased healthcare costs should be also added to this issue. Health promotion is a concept of process that continues throughout life. As much as health promotion is important in children and adults, it is equally important in older people. In fact, the elderlies, as a group, also acquire many benefits from health promotion behaviors. Due to the increasing elderly population, geriatric health promotion and enhancing the health level of older people is proposed as a health priority that should be properly planned. Hence, the present study has been conducted in this regard and aims to identify behaviors of health promotion and chronic diseases of aging in the elderly people of Iranshahr-Iran. The present research is a cross-sectional descriptive study whose population consists of 425 elderly people aged 60 years and over, who lived in the city of Iranshahr*, IR Iran. The random cluster sampling method has been used to select the research samples. The required information was collected using a questionnaire which was distributed among the older people through visiting their homes; then, the collected data was statistically analyzed using the statistical software of SPSS version 13. the research findings show that the mean age of older people is and the highest frequency belongs to the age group of 60 years and the maximum age is 92 years. 69.5% of the older people were in the age group of the young elderly (60-69 years) and 44% of them lived with their married children; also 55.8%, 81.9%, 70.5%, and 74.4% of them were respectively female, illiterate, married, and unemployed. The mean score of geriatric health promotion behaviors was in the range of 0-11 and 54.9% of them got the score of the inappropriate health promotion behavior. The most frequent chronic diseases of older people were respectively joint problems (78.9%), sensory problems (64.1%), and hypertension (56.6%). No significant relationship was observed between the score of health promotion behaviors and "the gender, lifestyle and marital status of the older people", but there was statistically a significant relationship between the score of health promotion behaviors and "the age, education, and job of the older people". Providing training programs for health promotion behaviors in elderly people can improve these behaviors and enhance their health and quality of life and reduce the incidence of chronic diseases in them. The goal of health promotion behaviors is to maintain performance, independence and quality of life; and many studies have demonstrated that the elderly people who aged 60 years and over benefit from health promotion behaviors more than middle-aged people.

Decision-making capacity and competency in the elderly: a clinical and neuropsychological perspective.

PubMed

Moberg, Paul J; Rick, Jacqueline H

2008-01-01

With our ageing population, the number of older adults with cognitive impairment has also increased. There is both an acute and growing need for evidence-based assessments to identify their decision making capacity and competence. In the present article we (1) present definitions of decision-making capacity and competence, (2) review cognitive functions that are central to decision-making capacity as well as the methods and procedures commonly used to assess these domains, and (3) address the communication of assessment findings to patients and their loved ones. The importance of assessing decision-making capacity in the context of specific functions and of respecting the values and interests of older adults are emphasized.

Major depressive and anxiety disorders in visually impaired older adults.

PubMed

van der Aa, Hilde P A; Comijs, Hannie C; Penninx, Brenda W J H; van Rens, Ger H M B; van Nispen, Ruth M A

2015-01-20

We assessed the prevalence of subthreshold depression and anxiety, and major depressive, dysthymic, and anxiety disorders (panic disorder, agoraphobia, social phobia, and general anxiety disorder) in visually impaired older adults and compared these estimates with those of normally sighted peers. Cross-sectional data were analyzed based on telephone interviews with visually impaired older adults aged ≥ 60 years (n = 615) with a visual acuity of ≥ 0.30 logMAR (20/40 Snellen) in the best eye from outpatient low vision rehabilitation centers, and face-to-face interviews with community-dwelling normally sighted peers (n = 1232). To determine prevalence rates, the normally sighted population was weighted on sex and age to fit the visually impaired population. Logistic regression analyses were used to compare the populations and to correct for confounders. The prevalence of major depressive disorder (5.4%) and anxiety disorders (7.5%), as well as the prevalence of subthreshold depression (32.2%) and subthreshold anxiety (15.6%), were significantly higher in visually impaired older adults compared to their normally sighted peers (P < 0.05). Agoraphobia and social phobia were the most prevalent anxiety disorders in visually impaired older adults. This study shows that depression and anxiety are major public health problems in visually impaired older adults. Research on psychotherapeutic and psychopharmacologic interventions to improve depression and anxiety in this population is warranted. (http://www.trialregister.nl number, NTR3296.). Copyright 2015 The Association for Research in Vision and Ophthalmology, Inc.

Identifying the poorest older Americans.

PubMed

Fisher, Jonathan D; Johnson, David S; Marchand, Joseph T; Smeeding, Timothy M; Torrey, Barbara B

2009-11-01

Public policies target a subset of the population defined as poor or needy, but rarely are people poor or needy in the same way. This is particularly true among older adults. This study investigates poverty among older adults in order to identify who among them is financially worst off. We use 20 years of data from the Consumer Expenditure Survey to examine the income and consumption of older Americans. The poverty rate is cut in fourth if both income and consumption are used to define poverty. Those most likely to be poor defined by only income but not poor defined by income and consumption together are married, White, and homeowners and have a high school diploma or higher. The income poor alone display sufficient assets to raise consumption above poverty thresholds, whereas the consumption poor are shown to have income just above the poverty threshold and few assets. The poorest among the older population are those who are income and consumption poor. Understanding the nature of this double poverty population is important in measuring the success of future public policies to reduce poverty among this group.

HIV/AIDS interventions in an aging U.S. population.

PubMed

Jacobson, Stephanie A

2011-05-01

According to the Centers for Disease Control and Prevention (CDC), 25 percent of people living with HIV in the United States in 2006 were age 50 and older. HIV prevention for people over 50 is an important health concern, especially as the U.S. population grows older. Scholarly research has identified the need for HIV/AIDS interventions in the population of people over age 50, but few interventions have been established. The ecological perspective, which integrates intrapersonal, interpersonal, organizational, community, and policy factors, was used to review the current interventions and propose possible new HIV/AIDS prevention efforts for older adults. Intrapersonal interventions are often based on the health belief model. The precaution adoption process model was explored as an alternative intrapersonal theory for modeling prevention efforts. Community interventions using diffusion of innovations theory are fully explored, and new interventions are proposed as an option for preventing HIV/AIDS in older adults. An agenda for future research and interventions is proposed. Social workers will be at the forefront of the effort to prevent HIV/AIDS in older adults. They must accept this responsibility, propose interventions, and evaluate their effectiveness.

Lifestyle Factors and Visible Skin Aging in a Population of Japanese Elders

PubMed Central

Asakura, Keiko; Nishiwaki, Yuji; Milojevic, Ai; Michikawa, Takehiro; Kikuchi, Yuriko; Nakano, Makiko; Iwasawa, Satoko; Hillebrand, Greg; Miyamoto, Kukizo; Ono, Masaji; Kinjo, Yoshihide; Akiba, Suminori; Takebayashi, Toru

2009-01-01

Background The number of studies that use objective and quantitative methods to evaluate facial skin aging in elderly people is extremely limited, especially in Japan. Therefore, in this cross-sectional study we attempted to characterize the condition of facial skin (hyperpigmentation, pores, texture, and wrinkling) in Japanese adults aged 65 years or older by using objective and quantitative imaging methods. In addition, we aimed to identify lifestyle factors significantly associated with these visible signs of aging. Methods The study subjects were 802 community-dwelling Japanese men and women aged at least 65 years and living in the town of Kurabuchi (Takasaki City, Gunma Prefecture, Japan), a mountain community with a population of approximately 4800. The facial skin condition of subjects was assessed quantitatively using a standardized facial imaging system and subsequent computer image analysis. Lifestyle information was collected using a structured questionnaire. The association between skin condition and lifestyle factors was examined using multivariable regression analysis. Results Among women, the mean values for facial texture, hyperpigmentation, and pores were generally lower than those among age-matched men. There was no significant difference between sexes in the severity of facial wrinkling. Older age was associated with worse skin condition among women only. After adjusting for age, smoking status and topical sun protection were significantly associated with skin condition among both men and women. Conclusions Our study revealed significant differences between sexes in the severity of hyperpigmentation, texture, and pores, but not wrinkling. Smoking status and topical sun protection were significantly associated with signs of visible skin aging in this study population. PMID:19700917

Mental illness and a high-risk, elderly Japanese population: characteristic differences related to gender and residential location.

PubMed

Kikuchi, Hiroyuki; Takamiya, Tomoko; Odagiri, Yuko; Ohya, Yumiko; Shimomitsu, Teruichi; Inoue, Shigeru

2013-12-01

Examining the sociodemographic determinants of psychological distress is important in identifying specific subgroups in need of further intervention. However, there are few studies focusing on older populations and on the role of gender or location of residence. To try to clarify characteristics of a population at high risk for mental illness, we examined the sociodemographic determinants of psychological distress in older adults living in three different locations. A mail survey was used to collect data on levels of psychological distress and sociodemographic characteristics from a population-based sample of 1894 older adults who lived in Bunkyo (urban setting), Fuchu (suburban setting) and Oyama (rural setting) in Japan (aged 65-74 years, 51.3% men). Psychological distress level was measured based on Kessler's six-item psychological distress scale (K6) and dichotomized into two groups with a cut-off score of 5 (0-4 or 5-24). Multiple logistic regression analyses were used to examine the associations between sociodemographic factors, specifically gender and location of residence, and psychological distress levels. The variables of older age, living in Bunkyo, living in Oyama and living alone were significantly associated with high psychological distress. Although these associations were observed in men, no associations were observed in women. Location-specific analyses showed significant associations between sociodemographic and psychological distress among men living in Oyama, but not among those in Bunkyo or Fuchu. Sociodemographic factors were significantly correlated with psychological distress, particularly among older men in rural areas. Characteristics of a population at high risk for mental illness may vary based on gender and location of residence. Health promotion initiatives for older adults may be more effective if they take these demographic factors into account. © 2013 The Authors. Psychogeriatrics © 2013 Japanese Psychogeriatric Society.

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

PubMed

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

2015-04-01

"Productive aging" puts forward the fundamental view that the capacity of older adults must be better developed and utilized in activities that make economic contributions to society-working, caregiving, volunteering. It is suggested that productive engagement can lead to multiple positive ends: offsetting fiscal strains of a larger older population, contributing to the betterment of families and civil society, and maintaining the health and economic security of older adults. Advocates claim that outdated social structures and discriminatory behaviors limit participation of older adults in these important social roles as well as prevent the optimization of outcomes for older adults, families, and society. We ask two important questions: (a) How can we shape policies and programs to optimally engage the growing resources of an aging population for the sake of society and older adults themselves? and (b) How can policies pertaining to productive engagement reduce health and economic disparities? We answer these questions by first describing the current state of engagement in each of the three productive activities and summarize some current policies and programs that affect engagement. Next we highlight challenges that cross-cut productive engagement. Finally, we provide policy recommendations to address these challenges. © The Author 2015. 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.

Mortality in traffic accidents with older adults in Colombia

PubMed Central

Cardona, Angela Maria Segura; Arango, Doris Cardona; Fernández, Dedsy Yajaira Berbesí; Martínez, Alejandra Agudelo

2017-01-01

ABSTRACT OBJECTIVE To analyze the traffic accident mortality in the Colombian older adults during the 1998-2012 period and show the loss of productive years and mortality from this cause. METHODS Quantitative study of the trend analysis of deaths in Colombia in traffic accidents, from 1998 to 2012, according to death records and population projected by the Colombian National Administrative Department of Statistics. Frequency distribution profile of the deceased, death rates per hundred thousand inhabitants, potential years of life lost and calculation of excess mortality by age in the over 60 were made. RESULTS In the study period 100,758 deaths occurred in traffic accidents, 6,717 annual average, of which 18.5% occurred in people aged 60 years and over. The predominated deaths were men; the risk of dying was 32.15 per hundred thousand people in this age range, with double risk of dying those under 60 years. CONCLUSIONS The young population has a higher proportion of deaths, but those over 60 years are at increased risk of death, leading to the need to turn our gaze to the improvement of road infrastructure and standards, to educate the population in self-care and compliance with safety measures and prepare society for an ever more adult population, more numerous and more prone to take risks. PMID:28355347

Rural Ageing in the United States: Trends and Contexts

ERIC Educational Resources Information Center

Glasgow, Nina; Brown, David L.

2012-01-01

This paper examines rural population ageing in the United States with a particular focus on the contrasting contexts in which older rural residents live. We compare the characteristics of the older population by rural versus urban residence, and explore challenges and opportunities associated with the ageing of rural baby boomers. The United…

Serving New Populations. New Directions for Community Colleges, Number 27.

ERIC Educational Resources Information Center

Walsh, Patricia Ann, Ed.

1979-01-01

Improving the reponsiveness of community colleges to the needs of non-traditional students is the topic of 14 essays, grouped into sections focusing on older adults, the handicapped, and women. David Demko describes a program designed to integrate older adults into a community college's service population. Jared Sharon provides guidelines for…

Estimated prevalence of dementia based on analysis of drug databases in the Region of Madrid (Spain).

PubMed

de Hoyos-Alonso, M C; Bonis, J; Tapias-Merino, E; Castell, M V; Otero, A

2016-01-01

The progressive rise in dementia prevalence increases the need for rapid methods that complement population-based prevalence studies. To estimate the prevalence of dementia in the population aged 65 and older based on use of cholinesterase inhibitors and memantine. Descriptive study of use and prescription of cholinesterase inhibitors and/or memantine in 2011 according to 2 databases: Farm@drid (pharmacy billing records for the Region of Madrid) and BIFAP (database for pharmacoepidemiology research in primary care, with diagnosis and prescription records). We tested the comparability of drug use results from each database using the chi-square test and prevalence ratios. The prevalence of dementia in Madrid was estimated based on the dose per 100 inhabitants/day, adjusting the result for data obtained from BIFAP on combination treatment in the general population (0.37%) and the percentage of dementia patients undergoing treatment (41.13%). Cholinesterase inhibitors and memantine were taken by 2.08% and 0.72% of Madrid residents aged 65 and older was respectively. Both databases displayed similar results for use of these drugs. The estimated prevalence of dementia in individuals aged 65 and older is 5.91% (95% CI%, 5.85-5.95) (52 287 people), and it is higher in women (7.16%) than in men (4.00%). The estimated prevalence of dementia is similar to that found in population-based studies. Analysing consumption of specific dementia drugs can be a reliable and inexpensive means of updating prevalence data periodically and helping rationalise healthcare resources. Copyright © 2014 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.

Barriers to using fixed-route public transit for older adults.

DOT National Transportation Integrated Search

2010-06-01

For older adults, unmet transportation needs are linked to reduced well-being (Cvitkovich and Wister 2001). Current research indicates that, as a society, we are ill-prepared to provide adequate transit for the growing increasing population of older ...

Driving Decisions and Vehicle Crashes Among Older Drivers

DOT National Transportation Integrated Search

1995-07-01

American society is undergoing a major demographic transformation. A larger proportion of the population is becoming older and an increasing number of older individuals are licensed to drive and they drive more than their age cohorts a decade ago. Th...

Extracting and summarizing white matter hyperintensities using supervised segmentation methods in Alzheimer's disease risk and aging studies.

PubMed

Ithapu, Vamsi; Singh, Vikas; Lindner, Christopher; Austin, Benjamin P; Hinrichs, Chris; Carlsson, Cynthia M; Bendlin, Barbara B; Johnson, Sterling C

2014-08-01

Precise detection and quantification of white matter hyperintensities (WMH) observed in T2-weighted Fluid Attenuated Inversion Recovery (FLAIR) Magnetic Resonance Images (MRI) is of substantial interest in aging, and age-related neurological disorders such as Alzheimer's disease (AD). This is mainly because WMH may reflect co-morbid neural injury or cerebral vascular disease burden. WMH in the older population may be small, diffuse, and irregular in shape, and sufficiently heterogeneous within and across subjects. Here, we pose hyperintensity detection as a supervised inference problem and adapt two learning models, specifically, Support Vector Machines and Random Forests, for this task. Using texture features engineered by texton filter banks, we provide a suite of effective segmentation methods for this problem. Through extensive evaluations on healthy middle-aged and older adults who vary in AD risk, we show that our methods are reliable and robust in segmenting hyperintense regions. A measure of hyperintensity accumulation, referred to as normalized effective WMH volume, is shown to be associated with dementia in older adults and parental family history in cognitively normal subjects. We provide an open source library for hyperintensity detection and accumulation (interfaced with existing neuroimaging tools), that can be adapted for segmentation problems in other neuroimaging studies. Copyright © 2014 Wiley Periodicals, Inc.

Factor Structure and Psychometric Properties of the Center for Epidemiologic Studies Depression Scale (CES-D) in Older Populations with and without Cognitive Impairment

ERIC Educational Resources Information Center

Ros, L.; Latorre, J. M.; Aguilar, M. J.; Serrano, J. P.; Navarro, B.; Ricarte, J. J.

2011-01-01

The CES-D is widely used for the assessment of depressive symptoms in the adult population. However, few studies have been performed to assess the utility of this scale in an older population with cognitive impairment. The factor structure of the Spanish version of the CES-D was examined in an observational, cross sectional study in 623 older…

Short term treatment versus long term management of neck and back disability in older adults utilizing spinal manipulative therapy and supervised exercise: a parallel-group randomized clinical trial evaluating relative effectiveness and harms.

PubMed

Vihstadt, Corrie; Maiers, Michele; Westrom, Kristine; Bronfort, Gert; Evans, Roni; Hartvigsen, Jan; Schulz, Craig

2014-01-01

Back and neck disability are frequent in older adults resulting in loss of function and independence. Exercise therapy and manual therapy, like spinal manipulative therapy (SMT), have evidence of short and intermediate term effectiveness for spinal disability in the general population and growing evidence in older adults. For older populations experiencing chronic spinal conditions, long term management may be more appropriate to maintain improvement and minimize the impact of future exacerbations. Research is limited comparing short courses of treatment to long term management of spinal disability. The primary aim is to compare the relative effectiveness of 12 weeks versus 36 weeks of SMT and supervised rehabilitative exercise (SRE) in older adults with back and neck disability. Randomized, mixed-methods, comparative effectiveness trial conducted at a university-affiliated research clinic in the Minneapolis/St. Paul, Minnesota metropolitan area. Independently ambulatory community dwelling adults ≥ 65 years of age with back and neck disability of minimum 12 weeks duration (n = 200). 12 weeks SMT + SRE or 36 weeks SMT + SRE. Blocked 1:1 allocation; computer generated scheme, concealed in sequentially numbered, opaque, sealed envelopes. Functional outcome examiners are blinded to treatment allocation; physical nature of the treatments prevents blinding of participants and providers to treatment assignment. 36 weeks post-randomization. Self-report questionnaires administered at 2 baseline visits and 4, 12, 24, 36, 52, and 78 weeks post-randomization. Primary outcomes include back and neck disability, measured by the Oswestry Disability Index and Neck Disability Index. Secondary outcomes include pain, general health status, improvement, self-efficacy, kinesiophobia, satisfaction, and medication use. Functional outcome assessment occurs at baseline and week 37 for hand grip strength, short physical performance battery, and accelerometry. Individual qualitative interviews are conducted when treatment ends. Data on expectations, falls, side effects, and adverse events are systematically collected. Linear mixed-model method for repeated measures to test for between-group differences with baseline values as covariates. Treatments that address the management of spinal disability in older adults may have far reaching implications for patient outcomes, clinical guidelines, and healthcare policy. www.ClinicalTrials.gov; Identifier: NCT01057706.

The prevalence of diabetes and associated coronary risk factors in urban and rural older Mexican populations.

PubMed

Lerman, I G; Villa, A R; Martinez, C L; Cervantes Turrubiatez, L; Aguilar Salinas, C A; Wong, B; Gómez Pérez, F J; Gutierrez Robledo, L M

1998-11-01

To determine the prevalence of diabetes and examine its association with food intake, anthropometric and metabolic variables, and other coronary risk factors in urban and rural older Mexican populations. A cross-sectional study. Three Mexican communities (urban areas of medium and low income and a rural area). A total of 121 men and 223 women aged 60 years and older and 93 men and 180 women aged 35 to 59 years were selected randomly for inclusion in the survey, which was derived from the CRONOS study (Cross-Cultural Research on Nutrition in the Older Adult Study Group) promoted by the European Economic Community. A personal interview assessed demographic information, personal medical history, and functional status, and a 24-hour diet recall was obtained. A physical examination included anthropometric and blood pressure measurements. A fasting blood sample was obtained for measurements of lipids, insulin, and glucose. Diabetes prevalence was higher in men than in women for all age groups: 16.7% versus 9.5% in younger adults and 30.8% versus 22.8% in older adults. For all age groups, diabetes was more highly prevalent in urban communities. Using a multivariate stepwise logistic regression, variables associated independently with diabetes in older individuals were: gender (male sex: OR = 2.1; P < .009); diminished carbohydrate intake in the diet (OR = 0.77; P < .03); central distribution of adiposity (OR = 1.9; P < .03); and functional disability (OR = 2.3; P < .01). This relationship was not observed with living area, income, education, fiber and alcohol intake, body mass index, or age. Individuals 80 years and older had a diminished atherogenic risk profile. Diabetes in older people was associated significantly with hypertriglyceridemia, impaired functional status, and an increased prevalence of ischemic heart disease; in younger adults diabetes was associated with low density lipoprotein (LDL) hypercholesterolemia, hypertriglyceridemia, and a proportionally higher fat intake. This survey confirms the high prevalence of diabetes in the older Mexican population - particularly in men and in individuals living in urban areas - associated with an increased prevalence of other coronary risk factors. Diabetes was associated with higher fat, low carbohydrate, low fiber diets and increased prevalence of central distribution of adiposity. In the older subjects, diabetes was associated significantly with hypertriglyceridemia, impaired functional status, and increased prevalence of ischemic heart disease. A bias produced by early mortality and a survivorship effect must be considered in studies of older individuals. The health situation in the older Mexican population presents a complex problem that needs correct diagnosis and better strategies to benefit those segments of the population at increased risk.

Older people's dependence on caregivers' help in their own homes and their lived experiences of their opportunity to make independent decisions.

PubMed

Breitholtz, Agneta; Snellman, Ingrid; Fagerberg, Ingegerd

2013-05-01

The aim of this study was to illuminate the meaning of older people's dependence on caregivers' help, and of their opportunity to make independent decisions. Throughout the world, the older population is growing, and in Sweden, the system of care for older people is currently undergoing change. Older people in the need of care are expected to live at home for as long as possible. A qualitative and life world approach was used. Audio-taped interviews were conducted with twelve older persons living at home, dependent on daily municipal home help service. A phenomenological hermeneutic method was utilised to disclose the meanings of lived experiences. The findings revealed three themes: being facilitated to make one's own decisions, being hindered from making one's own decisions, struggling for vs. resigning oneself to losing the opportunity to make one's own decisions. The comprehensive understanding revealed that as older people become more dependent on caregivers' help, their opportunity to self-determine is challenged and this is stressful for them. The older persons assess their opportunity to self-determine differently, depending on who they are as a person. The caregivers need an awareness of this, and further research is needed to gain knowledge and understanding of how caregivers can improve the way they support and enhance older people's opportunity to decide for themselves. The findings revealed older persons need to exercise more self-determination and caregivers' need for knowledge to enable this. Further, it indicates a move towards a person-centred approach to focus on persons as individuals and see them as interdependent. The findings contribute to improvements in similar contexts worldwide. © 2012 Blackwell Publishing Ltd.

Service-Learning in Communities of Elders (SLICE): Development and Evaluation of an Introductory Geriatrics Course for Medical Students.

PubMed

Laks, Jordana; Wilson, Lindsay A; Khandelwal, Christine; Footman, Eleni; Jamison, Margaret; Roberts, Ellen

2016-01-01

Medical students have limited exposure to Geriatrics in their traditional training. Service-learning offers students the opportunity to engage with older adult communities and become more comfortable interacting with this population. A preclinical elective course was developed to expand medical students' experiences in Geriatrics through service-learning. In this course, students conducted needs assessments in diverse older adult communities, created health education projects to address community-identified needs, and reflected on their experiences through written assignments and presentations. The course instructor presented lectures on special topics in Geriatrics, including ageism and health literacy. The curriculum aimed to familiarize students with older adults' needs in a variety of settings. Over 3 years, 74 students participated in the service-learning course. Students were assigned to older adult community sites, where they conducted needs assessments and designed and implemented original educational projects targeting community concerns. Program evaluation methods included a validated survey assessing students' attitudes toward older adults, course evaluations, review of student assignments and projects, and feedback from older adult participants and site coordinators. Students gained hands-on experience working with older adults and designing appropriate health education projects. Analysis of attitude surveys demonstrated students' increased interest in Geriatrics as a career. Both students and older adult participants described enjoyable, valuable experiences gained from service-learning activities. Students appreciated the combination of community and classroom learning about Geriatrics. Service-learning was most constructive at sites with responsive coordinators, engaged older adults, and a need for health education resources. The course challenged students to assess health needs in communities that included cognitively impaired elders and to design educational projects tailored to older adults.

Cognitive-Behavioral Therapy for Depression in an Older Gay Man: A Clinical Case Study

PubMed Central

Satterfield, Jason M.; Crabb, Rebecca

2012-01-01

Although strong evidence supports cognitive-behavioral therapy for late-life depression and depression in racial and ethnic minorities, there are no empirical studies on the treatment of depression in older sexual minorities. Three distinct literatures were tapped to create a depression treatment protocol for an older gay male. Interventions were deduced from the late-life depression literature, culturally adapted CBT protocols for racial minorities, and the emerging social and developmental psychological theories for lesbian, gay, and bisexual populations. Specific treatment interventions, processes, and outcomes are described to illustrate how these literatures may be used to provide more culturally appropriate and effective health care for the growing, older sexual minority population. PMID:23144559

High risk prescribing in older adults: prevalence, clinical and economic implications and potential for intervention at the population level

PubMed Central

2013-01-01

Background High risk prescribing can compromise independent wellbeing and quality of life in older adults. The aims of this project are to determine the prevalence, risk factors, clinical consequences, and costs of high risk prescribing, and to assess the impact of interventions on high risk prescribing in older people. Methods The proposed project will utilise data from the 45 and Up Study, a large scale cohort of 267,153 men and women aged 45 and over recruited during 2006–2009 from the state of New South Wales, Australia linked to a range of administrative health datasets. High risk prescribing will be assessed using three indicators: polypharmacy (use of five or more medicines); Beers Criteria (an explicit measure of potentially inappropriate medication use); and Drug Burden Index (a pharmacologic dose-dependent measure of cumulative exposure to anticholinergic and sedative medicines). Individual risk factors from the 45 and Up Study questionnaire, and health system characteristics from health datasets that are associated with the likelihood of high risk prescribing will be identified. The main outcome measures will include hospitalisation (first admission to hospital, total days in hospital, cause-specific hospitalisation); admission to institutionalised care; all-cause mortality, and, where possible, cause-specific mortality. Economic costs to the health care system and implications of high risk prescribing will be also investigated. In addition, changes in high risk prescribing will be evaluated in relation to certain routine medicines-related interventions. The statistical analysis will be conducted using standard pharmaco-epidemiological methods including descriptive analysis, univariate and multivariate regression analysis, controlling for relevant confounding factors, using a number of different approaches. Discussion The availability of large-scale data is useful to identify opportunities for improving prescribing, and health in older adults. The size of the 45 and Up Study, along with linkage to health databases provides an important opportunity to investigate the relationship between high risk prescribing and adverse outcomes in a real-world population of older adults. PMID:23388494

Older Americans: An Untapped Resource. Why this Resource Must be Tapped. How it can be Done.

ERIC Educational Resources Information Center

National Committee on Careers for Older Americans, Washington, DC.

Identifying issues that confront the nation concerning older Americans as an untapped resource of workers, this book is divided into eight chapters. The first chapter discusses the need to change negative attitudes toward older Americans and the second defines older Americans and their relationship to the entire population. The third chapter…

Concepts and Causation of Depression: A Cross-Cultural Study of the Beliefs of Older Adults

ERIC Educational Resources Information Center

Lawrence, Vanessa; Murray, Joanna; Banerjee, Sube; Turner, Sara; Sangha, Kuljeet; Byng, Richard; Bhurgra, Dinesh; Huxley, Peter; Tylee, Andre; Macdonald, Alastair

2006-01-01

Purpose: This U.K. study explored how older adults with depression (treated and untreated) and the general older population conceptualize depression. A multicultural approach was used that incorporated the perspectives of Black Caribbean, South Asian, and White British older adults. The study sought to explore and compare beliefs about the nature…

Development and Validation of the Attitudes toward Education for Older Adults (AEOA) Scale

ERIC Educational Resources Information Center

Kim, Hyejin; Abell, Neil; Cheatham, Leah; Paek, Insu

2017-01-01

The purpose of this study is to validate a multidimensional measure assessing attitudes toward education for older adults. As the elderly population and the demands of education among older adults have increased, the engagement of social workers in educational settings for older adults has also increased. Therefore, assessing social workers'…

A report on older-age bipolar disorder from the International Society for Bipolar Disorders Task Force

PubMed Central

Sajatovic, Martha; Strejilevich, Sergio A; Gildengers, Ariel G; Dols, Annemiek; Al Jurdi, Rayan K; Forester, Brent P; Kessing, Lars Vedel; Beyer, John; Manes, Facundo; Rej, Soham; Rosa, Adriane R; Schouws, Sigfried NTM; Tsai, Shang-Ying; Young, Robert C; Shulman, Kenneth I

2015-01-01

Objectives In the coming generation, older adults with bipolar disorder (BD) will increase in absolute numbers as well as proportion of the general population. This is the first report of the International Society for Bipolar Disorder (ISBD) Task Force on Older-Age Bipolar Disorder (OABD). Methods This task force report addresses the unique aspects of OABD including epidemiology and clinical features, neuropathology and biomarkers, physical health, cognition, and care approaches. Results The report describes an expert consensus summary on OABD that is intended to advance the care of patients, and shed light on issues of relevance to BD research across the lifespan. Although there is still a dearth of research and health efforts focused on older adults with BD, emerging data has brought some answers, innovative questions, and novel perspectives related to the notion of late onset, medical comorbidity, and the vexing issue of cognitive impairment and decline. Conclusions Improving our understanding of the biological, clinical, and social underpinnings relevant to OABD is an indispensable step in building a complete map of BD across the lifespan. PMID:26384588

Ethnic and Sex Differences in Ownership of Preventive Health Equipment Among Rural Older Adults With Diabetes

PubMed Central

Bell, Ronny A.; Arcury, Thomas A.; Stafford, Jeanette M.; Golden, Shannon L.; Snively, Beverly M.; Quandt, Sara A.

2008-01-01

Context Diabetes self-management is important for achieving successful health outcomes. Different levels of self-management have been reported among various populations, though little is known about ownership of equipment that can enhance accomplishment of these tasks. Purpose This study examined diabetes self-management equipment ownership among rural older adults. Methods Participants included African American, American Indian, and white men and women 65 years of age and older. Data included equipment ownership overall and by ethnicity and sex across diabetes self-management domains (glucose monitoring, foot care, medication adherence, exercise, and diet). Associations between equipment ownership and demographic and health characteristics were assessed using logistic regression. Findings Equipment ownership ranged from 85.0% for blood glucose meters to less than 11% for special socks, modified dishes, and various forms of home exercise equipment. Equipment ownership was associated with ethnicity, living arrangements, mobility, poverty status, and formal education. Conclusions Rural older adults with diabetes are at risk because they lack equipment to perform some self-management tasks. Providers should be sensitive to and assist patients in overcoming this barrier. PMID:17868240

Perceived Income Adequacy Among Older Adults in 12 Countries: Findings From the Survey of Health, Ageing, and Retirement in Europe

PubMed Central

Litwin, Howard; Sapir, Eliyahu V.

2009-01-01

Purpose: To validate a survey research measure of subjective income, as measured by perceived income adequacy, in an international context. Design and Methods: The study population comprised persons aged 50 years and older in 12 countries from the Survey of Health, Ageing and Retirement in Europe (n = 28,939). Perceived difficulty in making ends meet was regressed on sociodemographic variables, economic indicators, health status measures, and expectations regarding one's financial future. Country differences were also controlled. Results: The findings confirm a multidimensional explanation of perceived income adequacy but also point to the primacy of objective economic indicators in predicting household financial distress. Respondents aged 80 years and older report less financial difficulty. Poor health status and pessimistic financial expectations also predict greater household financial distress but to a lesser degree. Implications: Self-rated economic status is a robust indicator of financial capacity in older age and can be used by practitioners to gain meaningful information. However, practitioners should keep in mind that the oldest-old may underestimate financial difficulties. PMID:19386829

Urban-rural differences in social capital in relation to self-rated health and subjective well-being in older residents of six regions in Poland.

PubMed

Tobiasz-Adamczyk, Beata; Zawisza, Katarzyna

2017-06-12

The aim of the study was to assess the differences between rural and urban areas as regards the role of social capital and its effect on self-rated health and subjective well-being among older people in Poland. The sample was selected on the basis of multi-stage clustered design from the non-institutionalized adult population. Analysis was based on 1,299 elderly people aged 65 and over from the general Polish population who participated in the COURAGE in Europe project. Six regions of Poland were distinguished according to first level of Nomenclature of Units for Territorial Statistics (NUTS) classification . As an indicator of social capital, the COURAGE Social Network Index, the OSLO-3 Social Support Scale, and the three item UCLA Loneliness scale were used, as well as social participation and trust was assessed. Self-rated health (SRH) was measured by WHO-Europe recommended version (ranging from 'very good' to 'very bad'). Well-being was assessed by the Day Reconstruction Method. Results: The results showed that in urban areas, social network and social participation supported positive self-rated health; in rural, older residents the number of years of education and social support played the same role, while self-rated health decreased with an increasing level of loneliness. Self-rated health decreased in both groups of older people with a growing number of diseases. The multivariate linear regression model of predictors of well-being in older age also confirmed differences between urban and rural elderly residents. In rural residents, subjective well-being significantly increased with the positive effect of the social network. In both urban and rural areas, poor assessment of subjective well-being in older age increased with a higher level of loneliness and growing number of chronic diseases.

Psychotropic Medication Burden and Factors Associated with Antipsychotic Use: An Analysis of a Population-Based Sample of Community-Dwelling Older Persons with Dementia

PubMed Central

Rhee, YongJoo; Csernansky, John G.; Emanuel, Linda L.; Chang, Chang-Gok; Shega, Joseph W.

2011-01-01

Objectives To estimate the proportion of community dwelling older adults with dementia being prescribed a psychotropic and identify patient and caregiver factors associated with antipsychotics use. Methods Retrospective cohort study of The Aging, Demographics, and Memory Study (ADAMS) from 2002 to 2004 designed to assess dementia severity and service use among community-dwelling older adults. The frequency of psychotropic medication (antipsychotics, antidepressants, anticonvulsants and benzodiazepines) use was tabulated and weighted to the US population by dementia diagnosis. Logistic regression analysis identified factors associated with antipsychotic use. Results The 307 participants of ADAMS had the following dementia diagnosis: Alzheimer’s disease (69.29%), vascular dementia (17.74%) and other dementia (12.39%). The proportion of participants prescribed a psychotropic medication broken down by therapeutic class was as 19.07% antipsychotics, 29.08% antidepressants, 9.84% benzodiazepines, and 8.85% anticonvulsants. Older adults with dementia were significantly more likely to receive an antipsychotic if they had moderate dementia (OR =7.4, p<0.05), or severe dementia (OR=5.80, p<0.05), compared to mild dementia or were diagnosed with Alzheimer (OR =6.7, p<0.05) dementia compared to vascular dementia. Older adults with dementia who lived with their caregivers in were significantly less likely to be medicated with antipsychotics (OR= 0.19, p<0.05) compared to those who lived alone. Also, persons with dementia were significantly less likely to be prescribed an antipsychotic if the caregivers were clinically depressed (OR=0.03, p<0.05) compared to those who were not depressed. Conclusion We found psychotropic medication use is common among community-dwelling older adults with dementia. Caregivers appear to have a substantial impact on whether or not an antipsychotic is prescribed, which adds additional complexity to conversations discussing the risk-benefit ratio of this medication class. PMID:22092099

Health policy and ethnic diversity in older Americans. Dissonance or harmony?

PubMed Central

Wray, L A

1992-01-01

The rapid growth and diversity of the older population have long-term implications for health care policies in the United States. Current policies designed for a homogeneous population are increasingly obsolete. To ameliorate obstacles that handicap many ethnic minority elders and to provide equal access to adequate and acceptable health care, several factors need to be considered. Enhanced data collection and analytic techniques are needed. The effects of race or ethnicity must be separated from other biologic, environmental, socioeconomic, cultural, and temporal factors on health status and behavior. Health care professionals and organizations serving minority elders must continue to expand their advocacy efforts to articulate the findings and their concerns to policymakers. Policymakers must understand and acknowledge the implications of an increasingly diverse society and determine what will constitute adequate, accessible, and acceptable health care within continuing fiscal constrains. Program planning, implementation, and evaluation methods must be revised to meet future health care needs effectively and efficiently. PMID:1413784

Cross-Country Differences in Basal and Stress-Induced Cortisol Secretion in Older Adults

PubMed Central

Lupien, Sonia J.; Fiocco, Alexandra; Suchecki, Deborah

2014-01-01

Objective Several studies have emphasized the association between socioeconomic status (SES) and inadequate response of the biological stress system. However, other factors related to SES are rarely considered, such as cultural values, social norms, organization, language and communication skills, which raises the need to investigate cross-country differences in stress response. Although some studies have shown differences in cortisol levels between immigrants and natives, there is no cross-country evidence regarding cortisol levels in country-native elders. This is particularly important given the high prevalence of stress-related disorders across nations during aging. The current study examined basal diurnal and reactive cortisol levels in healthy older adults living in two different countries. Methods Salivary cortisol of 260 older adults from Canada and Brazil were nalyzed. Diurnal cortisol was measured in saliva samples collected at home throughout two working days at awakening, 30 min after waking, 1400 h, 1600 h and before bedtime. Cortisol reactivity was assessed in response to the Trier Social Stress Test (TSST) in both populations. Results Our results showed that even under similar health status, psychological and cognitive characteristics, Brazilian elders exhibited higher basal and stress-induced cortisol secretion compared to the Canadian participants. Conclusion These findings suggest that country context may modulate cortisol secretion and could impact the population health. PMID:25153322

Risk Factors for Falls in Older Adults with Lower Extremity Arthritis: A Conceptual Framework of Current Knowledge and Future Directions

PubMed Central

Gyurcsik, Nancy C.

2012-01-01

ABSTRACT Purpose: As the numbers of Canadians aged 65 years and over increases over the next 20 years, the prevalence of chronic conditions, including arthritis, will rise as will the number of falls. Although known fall-risk factors are associated with hip and knee osteoarthritis (OA), minimal research has evaluated fall and fracture risk and/or rates in this population. Thus, the purpose was to summarize research on fall and fracture risk in older adults with hip or knee OA and to develop a conceptual framework of fall-risk screening and assessment. Method: The International Classification of Functioning, Disability and Health, clinical practice guidelines for fall-risk screening, and a selected literature review were used. Results: Gaps exist in our knowledge of fall and fracture risk for this population. Muscle performance, balance, and mobility impairments have been identified, but little is known about whether personal and environmental contextual factors impact fall and fracture risk. Physical activity may help to prevent falls, but non-adherence is a problem. Conclusion: A need exists to assess fall risk in older adults with hip and knee OA. Promoting regular physical activity by focusing on disease- and activity-specific personal contextual factors may help direct treatment planning. PMID:23729967

Population-based health promotion perspective for older driver safety: Conceptual framework to intervention plan

PubMed Central

Classen, Sherrilene; Lopez, Ellen DS; Winter, Sandra; Awadzi, Kezia D; Ferree, Nita; Garvan, Cynthia W

2007-01-01

The topic of motor vehicle crashes among the elderly is dynamic and multi-faceted requiring a comprehensive and synergistic approach to intervention planning. This approach must be based on the values of a given population as well as health statistics and asserted through community, organizational and policy strategies. An integrated summary of the predictors (quantitative research), and views (qualitative research) of the older drivers and their stakeholders, does not currently exist. This study provided an explicit socio-ecological view explaining the interrelation of possible causative factors, an integrated summary of these causative factors, and empirical guidelines for developing public health interventions to promote older driver safety. Using a mixed methods approach, we were able to compare and integrate main findings from a national crash dataset with perspectives of stakeholders. We identified: 11 multi-causal factors for safe elderly driving; the importance of the environmental factors - previously underrated in the literature- interacting with behavioral and health factors; and the interrelatedness among many socio-ecological factors. For the first time, to our knowledge, we conceptualized the fundamental elements of a multi-causal health promotion plan, with measurable intermediate and long-term outcomes. After completing the detailed plan we will test the effectiveness of this intervention on multiple levels. PMID:18225470

Associations of Grip Strength and Change in Grip Strength With All-Cause and Cardiovascular Mortality in a European Older Population

PubMed Central

Prasitsiriphon, Orawan; Pothisiri, Wiraporn

2018-01-01

Objective: (1) To examine the associations between 3 measures of grip strength: static grip strength, change in grip strength, and the combination of grip strength and its change, with all-cause and cardiovascular mortality, and (2) to determine which measure is the most powerful predictor of all-cause and cardiovascular mortality among the European older population. Method: Data come from the first 4 waves of the Survey of Health, Ageing and Retirement in Europe (SHARE). A Cox proportional hazard model and a competing risk regression model were used to assess the associations. To determine the best predictor, Akaike information criterion was applied. Results: Grip strength and the combination of grip strength and its change were associated with all-cause and cardiovascular mortality. Change in grip strength was correlated with only all-cause mortality. Among the 3 measures, the static measure of grip strength was the best predictor of cardiovascular mortality whereas the combined measure is that of all-cause mortality. Discussion: Grip strength is a significant indicator of all-cause and cardiovascular mortality. The combination of grip strength and its change can be used to increase the accuracy for prediction of all-cause mortality among older persons.

Age identity, self-rated health, and life satisfaction among older adults in Dakar, Senegal.

PubMed

Macia, Enguerran; Duboz, Priscilla; Montepare, Joann M; Gueye, Lamine

2012-09-01

The objectives of this quantitative study were to (1) ascertain to what extent older adults aged 50 and above feel and desire to be younger than their age, and classify themselves as young versus old; (2) compare these patterns with those found among other cross-cultural populations; and (3) assess the extent to which self-rated health and life satisfaction predict age identities. This study was carried out on a sample of 500 dwellers of the Senegalese capital aged 50 and older. This sample was constructed using the quota method to strive for representativeness. Most of the respondents wanted to be younger than their chronological age (51.8 %), but only 27.8 % felt younger than they were. Moreover, 80 % of the sample claimed to be old. Self-rated health predicted felt age and the feeling of being old. Furthermore, the less-satisfied Dakar residents were with their life, the younger they wanted to be. We first discuss our results in a comparative perspective focused on how orientations toward individualism and collectivism could be related to age identity, and on demographic characteristics of the Senegalese population-where life expectancy is 59.3 years old. We then analyze the relevance of age identity dimensions as indicators of successful aging in Dakar.

Developing positive attitudes toward geriatric nursing among Millennials and Generation Xers.

PubMed

Heise, Barbara A; Johnsen, Vickie; Himes, Deborah; Wing, Debra

2012-01-01

Despite the increase of the older adult population, there exists a shortage of health care professionals trained to help this population remain independent as long as possible. Ageism, common among younger adults, affects the capacity building of health care for older adults. Research has indicated that increased knowledge about older adults, as well as exposure to the elderly, may alter nursing students' attitudes regarding careers in gerontological nursing. However, questions remain as to what are the most effective ways to provide gerontological content in nursing programs and enhance attitudes toward older adults.With the understanding that younger adults see a need to balance work and play, a baccalaureate nursing program provides examples of ways to accomplish this through integration of courses, simulations, positive images of aging, and learning activities that enhance empathy for both frail and healthy older adults.

Crash Prediction Models for Older Drivers: A Panel Data Analysis Approach

DOT National Transportation Integrated Search

1996-01-01

The graying of America is resulting in a larger proportion of older individuals : in the population. Recent transportation surveys show that an increasing number : of older individuals are licensed to drive and that they drive more than their : same ...

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

PubMed Central

McNeely, ME; Duncan, RP; Earhart, GE

2015-01-01

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

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

PubMed

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

2015-05-01

It is important for our aging population to remain active, particularly those with chronic diseases, like Parkinson disease (PD), which limit mobility. Recent studies in older adults and people with PD suggest dance interventions provide various motor benefits. The literature for dance in PD is growing, but many knowledge gaps remain, relative to what is known in older adults. The purpose of this review is to: (1) detail results of dance intervention studies in older adults and in PD, (2) describe limitations of dance research in these populations, and (3) identify directions for future study. Generally, a wide variety of dance styles have been investigated in older adults, while a more limited subset has been evaluated in PD. Measures vary widely across studies and a lack of standardized outcomes measures hinders cross-studies comparisons. Compared to the dance literature in older adults, there is a notable absence of evidence in the PD literature in outcome domains related to cardiovascular health, muscle strength, body composition, flexibility, and proprioception. As a whole, the dance literature supports substantial and wide-ranging benefits in both populations, but additional effort should be dedicated to well-designed comparative studies using standardized outcome measures to identify optimal treatment programs. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Prenatal influences on sexual orientation: digit ratio (2D:4D) and number of older siblings.

PubMed

Kangassalo, Katariina; Pölkki, Mari; Rantala, Markus J

2011-10-10

Prenatal androgen levels are suggested to influence sexual orientation in both sexes. The 2D:4D digit ratio has been found to associate with sexual orientation, but published findings have often been contradictory, which may partly be due to the large ethnic diversity between and within studied populations. In men, number of older brothers has been found to correlate positively with homosexuality. This phenomenon has been explained with a maternal immune reaction, which is provoked only by male fetuses and which gets stronger after each pregnancy. Here we assessed the relationship of sexual orientation to 2D:4D ratios and number of older siblings in Finland, where the population is found to be genetically relatively homogeneous. As in many previous studies, heterosexual men had lower 2D:4D than non-heterosexual men, which supports the notion that non- heterosexual men experience higher androgen levels in utero than population norms. Contrary to previous reports, non-heterosexual women had higher 2D:4D than heterosexual women. Non-heterosexual men had more older brothers and older sisters than heterosexual men. The greater number of older sisters in non-heterosexual men indicates that there are other factors that contribute to the higher birth order of homosexual men than the maternal immunization.

Disparity in Dental Out-of-Pocket Payments Among Older Adult Populations: A Comparative Analysis Across Selected European Countries and the United States

PubMed Central

Manski, Richard; Moeller, John; Chen, Haiyan; Widström, Eeva; Listl, Stefan

2017-01-01

Background The current study addresses the extent to which diversity exists in dental out-of-pocket payments across population subgroups within and between the United States and selected European countries. This represents the final paper in a series in which the previous 2 papers addressed diversity in dental coverage and dental utilization, respectively, using similar data and methods. Method We use 2006/2007 HRS and 2004-2006 SHARE data for respondents aged 51 years and older. We estimated the impacts of dental care coverage and demographic, socioeconomic, and health status on the likelihood and amount of dental out of pocket payments. Results Our findings show that older persons with the least education, lowest income, and worst health are most likely to pay nothing out of pocket (OOP) for their dental care and for persons with a payment OOP increase with income and education and are greater for persons who are uninsured, and in fair or poor health. These results were found in the USA but were not consistently found in the 10 European countries we studied. Conclusions European countries classified by social welfare state or presence of social health insurance (SHI) had no effect on the likelihood of making payments out of pocket for dental care nor, when OOP payments were made, on the amounts paid. Variation in generosity of coverage and procedures reimbursed by insurance, even within SHI countries, as well as differing needs, tastes and access to care across countries, contribute to this finding. PMID:28213893

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, held in a familiar and culturally safe location and delivered free of cost. This study identified a gap in the availability of acceptable fall prevention programs designed for, and delivered to, older Aboriginal people in NSW. Further consultation with older Aboriginal people is necessary to determine how an appropriate and effective program can be designed and delivered. Terminology: The authors recognise the two distinctive Indigenous populations of Australia: Aboriginal and Torres Strait Islander people. Because the vast majority of the NSW Aboriginal and Torres Strait Islander population is Aboriginal (95.4%)1, this population will be referred to as 'Aboriginal' in this manuscript.

Financial Exploitation and Psychological Mistreatment among Older Adults: Differences between African Americans and Non-African Americans in a Population-Based Survey

ERIC Educational Resources Information Center

Beach, Scott R.; Schulz, Richard; Castle, Nicholas G.; Rosen, Jules

2010-01-01

Purpose: To examine racial differences in (a) the prevalence of financial exploitation and psychological mistreatment since turning 60 and in the past 6 months and (b) the experience--perpetrator, frequency, and degree of upset--of psychological mistreatment in the past 6 months. Design and methods: Random digit dial telephone recruitment and…

Examination of the Philadelphia Geriatric Morale Scale as a Subjective Quality-of-Life Measure in Elderly Hong Kong Chinese

ERIC Educational Resources Information Center

Wong, Eric; Woo, Jean; Hui, Elsie; Ho, Suzanne C.

2004-01-01

Purpose: We examine the psychometric properties of the Philadelphia Geriatric Morale Scale (PGMS) in an elderly Chinese population in Hong Kong. Design and Methods: The study consisted of two cohorts: (a) 759 participants aged 70 years and older living in the community who were recruited as part of a territory-wide health survey and interviewed in…

Influence of visual control, conduction, and central integration on static and dynamic balance in healthy older adults.

PubMed

Perrin, P P; Jeandel, C; Perrin, C A; Béné, M C

1997-01-01

Aging is associated with decreased balance abilities, resulting in an increased risk of fall. In order to appreciate the visual, somatosensory, and central signals involved in balance control, sophisticated methods of posturography assessment have been developed, using static and dynamic tests, eventually associated with electromyographic measurements. We applied such methods to a population of healthy older adults in order to appreciate the respective importance of each of these sensorial inputs in aging individuals. Posture control parameters were recorded on a force-measuring platform in 41 healthy young (age 28.5 +/- 5.9 years) and 50 older (age 69.8 +/- 5.9 years) adults, using a static test and two dynamic tests performed by all individuals first with eyes open, then with eyes closed. The distance covered by the center of foot pressure, sway area, and anteroposterior oscillations were significantly higher, with eyes open or closed, in older people than in young subjects. Significant differences were noted in dynamic tests with longer latency responses in the group of old people. Dynamic recordings in a sinusoidal test had a more regular pattern when performed eyes open in both groups and evidenced significantly greater instability in old people. These data suggest that vision remains important in maintaining postural control while conduction and central integration become less efficient with age.

Can cognitive enhancers reduce the risk of falls in older people with Mild Cognitive Impairment? A protocol for a randomised controlled double blind trial

PubMed Central

2009-01-01

Background Older adults with cognitive problems have a higher risk of falls, at least twice that of cognitively normal older adults. The consequences of falls in this population are very serious: fallers with cognitive problems suffer more injuries due to falls and are approximately five times more likely to be admitted to institutional care. Although the mechanisms of increased fall risk in cognitively impaired people are not completely understood, it is known that impaired cognitive abilities can reduce attentional resource allocation while walking. Since cognitive enhancers, such as cholinesterase inhibitors, improve attention and executive function, we hypothesise that cognitive enhancers may reduce fall risk in elderly people in the early stages of cognitive decline by improving their gait and balance performance due to an enhancement in attention and executive function. Method/Design Double blinded randomized controlled trial with 6 months follow-up in 140 older individuals with Mild Cognitive Impairment (MCI). Participants will be randomized to the intervention group, receiving donepezil, and to the control group, receiving placebo. A block randomization by four and stratification based on fall history will be performed. Primary outcomes are improvements in gait velocity and reduction in gait variability. Secondary outcomes are changes in the balance confidence, balance sway, attention, executive function, and number of falls. Discussion By characterizing and understanding the effects of cognitive enhancers on fall risk in older adults with cognitive impairments, we will be able to pave the way for a new approach to fall prevention in this population. This RCT study will provide, for the first time, information regarding the effect of a medication designed to augment cognitive functioning have on the risk of falls in older adults with Mild Cognitive Impairment. We expect a significant reduction in the risk of falls in this vulnerable population as a function of the reduced gait variability achieved by treatment with cognitive enhancers. This study may contribute to a new approach to prevent and treat fall risk in seniors in early stages of dementia. Trial Registration The protocol for this study is registered with the Clinical Trials Registry, identifier number: NCT00934531 http://www.clinicaltrials.gov PMID:19674471

Detection of walking periods and number of steps in older adults and patients with Parkinson's disease: accuracy of a pedometer and an accelerometry-based method.

PubMed

Dijkstra, Baukje; Zijlstra, Wiebren; Scherder, Erik; Kamsma, Yvo

2008-07-01

The aim of this study was to examine if walking periods and number of steps can accurately be detected by a single small body-fixed device in older adults and patients with Parkinson's disease (PD). Results of an accelerometry-based method (DynaPort MicroMod) and a pedometer (Yamax Digi-Walker SW-200) worn on each hip were evaluated against video observation. Twenty older adults and 32 PD patients walked straight-line trajectories at different speeds, of different lengths and while doing secondary tasks in an indoor hallway. Accuracy of the instruments was expressed as absolute percentage error (older adults versus PD patients). Based on the video observation, a total of 236.8 min of gait duration and 24,713 steps were assessed. The DynaPort method predominantly overestimated gait duration (10.7 versus 11.1%) and underestimated the number of steps (7.4 versus 6.9%). Accuracy decreased significantly as walking distance decreased. Number of steps were also mainly underestimated by the pedometers, the left Yamax (6.8 versus 11.1%) being more accurate than the right Yamax (11.1 versus 16.3%). Step counting of both pedometers was significantly less accurate for short trajectories (3 or 5 m) and as walking pace decreased. It is concluded that the Yamax pedometer can be reliably used for this study population when walking at sufficiently high gait speeds (>1.0 m/s). The accelerometry-based method is less speed-dependent and proved to be more appropriate in the PD patients for walking trajectories of 5 m or more.

A Metabolic–Epidemiological Microsimulation Model to Estimate the Changes in Energy Intake and Physical Activity Necessary to Meet the Healthy People 2020 Obesity Objective

PubMed Central

Seligman, Hilary; Winkleby, Marilyn

2014-01-01

Objectives. We combined a metabolic and an epidemiological model of obesity to estimate changes in calorie intake and physical activity necessary to achieve the Healthy People 2020 objective of reducing adult obesity prevalence from 33.9% to 30.5%. Methods. We used the National Health and Nutrition Examination Survey (1999–2010) to construct and validate a microsimulation model of the US population aged 10 years and older, for 2010 to 2020. Results. Obesity prevalence is expected to shift toward older adults, and disparities are expected to widen between White, higher-income groups and minority, lower-income groups if recent calorie consumption and expenditure trends continue into the future. Although a less than 10% reduction in daily calorie intake or increase in physical activity would in theory achieve the Healthy People 2020 objective, no single population-level intervention is likely to achieve the target alone, and individual weight-loss attempts are even more unlikely to achieve the target. Conclusions. Changes in calorie intake and physical activity portend rising inequalities in obesity prevalence. These changes require multiple simultaneous population interventions. PMID:24832140

Addressing the Health Needs of High-Risk Filipino Americans in the Greater Philadelphia Region

PubMed Central

Bhimla, Aisha; Yap, Lauren; Lee, Minsun; Seals, Brenda; Aczon, Hermie; Ma, Grace X.

2016-01-01

Background Filipino Americans represent one of the largest and most diverse immigrant populations in the United States. It has been established that chronic diseases are a significant public health issue affecting this population. Methods We conducted a health needs assessment of two hundred Filipino Americans aged 18 years or older residing in the greater Philadelphia region. Study participants were recruited from eight Filipino community-based organizations in the region. Information about demographic and acculturative characteristics, health behaviors, self-reported chronic health conditions, and chronic disease perception were collected. Results Participants were older and highly acculturated. With regards to health behaviors, several did not meet dietary fruit and vegetables intake and physical activity guidelines. The top five health conditions were high blood pressure (67.5%), high blood cholesterol (57.1%), arthritis (28.9%), diabetes (21.8%), and cancer (14.7%). Several participants perceived high blood pressure, high blood cholesterol, and diabetes to be a concern in their community, and had high awareness of the risk factors associated with these diseases. Conclusion Reported rates of hypertension, high cholesterol, and diabetes suggest that lifestyle interventions targeting diet and physical activity, in addition to health education, are needed in this population. PMID:27639868

InterACTIVE Interpreted Interviews (I3): A multi-lingual, mobile method to examine the neighbourhood environment with older adults.

PubMed

Tong, Catherine; Sims-Gould, Joanie; McKay, Heather

2016-11-01

The global population is aging and older adults overwhelmingly wish to age in place. A positive neighbourhood context is crucial for the wellbeing of older adults. The ability to age in place is predicated on mobility; mobility is the capacity to move oneself around the home and community using a variety of modes. Segments of the population have been entirely overlooked within the mobility and built environment literature; we know surprisingly little about foreign-born older adults (FBOAs). We sought to understand the impact of the neighbourhood environment on the mobility and physical activity of FBOAs. To do so we endeavoured to develop an interview tool that would allow us to interact with the environment alongside, or through the eyes of, our participants. This article outlines lessons learned following design and implementation of an interview approach that we conducted with FBOAs -- "InterACTIVE Interpreted Interviews (I 3 )". We used the interACTIVE interview approach in a large mixed-method study on FBOA mobility in Vancouver, Canada. All aspects of the study were offered in Hindi, Punjabi, Cantonese, Mandarin and English, with the aid of professional interpreters. Twenty FBOAs completed in-depth qualitative interviews. Of these, thirteen completed the mobile, interACTIVE interview. The interACTIVE interview consisted of a neighbourhood walk, guided by the participant. Our approach integrated elements of participant observation, researcher participation, and unstructured interviewing to enrich discussions with participants. The interACTIVE approach deepened our understanding of neighbourhood context and allowed researchers and participants to overcome issues inherent in language interpretation. We were able to overcome concerns of privacy, safety and comfort to successfully implement this observational tool and recommend it as an attractive, alternative approach for those conducting studies with FBOAs. Copyright © 2016 Elsevier Ltd. All rights reserved.

Cohabitation among older adults: a national portrait.

PubMed

Brown, Susan L; Lee, Gary R; Bulanda, Jennifer Roebuck

2006-03-01

Older adults are increasingly likely to experience cohabitation, or living together unmarried in an intimate, heterosexual union. In order to begin building a conceptual framework, we provide a descriptive portrait of older adult cohabitors, emphasizing how they compare to older remarrieds and unpartnereds. We used data from both Census 2000 and the 1998 Health and Retirement Study ( HRS; Health and Retirement Study, 1998) to estimate the size and composition of the cohabiting population aged 51 and older. Also, using HRS data, we estimated multinomial logistic regression models to identify the correlates associated with cohabitation and remarriage (vs being unpartnered) among women and men who were previously married. More than 1 million older adults, composing 4% of the unmarried population, currently cohabit. About 90% of these individuals were previously married. We identify significant differences among cohabitors, remarrieds, and unpartnereds across several dimensions, including sociodemographic characteristics, economic resources, physical health, and social relationships. Cohabitors appear to be more disadvantaged than remarrieds, and this is especially evident for women. Older cohabitors differ from individuals of other marital statuses, and therefore future work on marital status should explicitly incorporate cohabitation.

Normative functional fitness standards and trends of Portuguese older adults: cross-cultural comparisons.

PubMed

Marques, Elisa A; Baptista, Fátima; Santos, Rute; Vale, Susana; Santos, Diana A; Silva, Analiza M; Mota, Jorge; Sardinha, Luís B

2014-01-01

This cross-sectional study was designed to develop normative functional fitness standards for the Portuguese older adults, to analyze age and gender patterns of decline, to compare the fitness level of Portuguese older adults with that of older adults in other countries, and to evaluate the fitness level of Portuguese older adults relative to recently published criterion fitness standards associated with maintaining physical independence. A sample of 4,712 independent-living older adults, age 65-103 yr, was evaluated using the Senior Fitness Test battery. Age-group normative fitness scores are reported for the 10th, 25th, 50th, 75th, and 90th percentiles. Results indicate that both women and men experience age-related losses in all components of functional fitness, with their rate of decline being greater than that observed in other populations, a trend which may cause Portuguese older adults to be at greater risk for loss of independence in later years. These newly established normative standards make it possible to assess individual fitness level and provide a basis for implementing population-wide health strategies to counteract early loss of independence.

Post-traumatic stress disorder in older adults: a systematic review of the psychotherapy treatment literature.

PubMed

Dinnen, Stephanie; Simiola, Vanessa; Cook, Joan M

2015-01-01

Older adults represent the fastest growing segment of the US and industrialized populations. However, older adults have generally not been included in randomized clinical trials of psychotherapy for post-traumatic stress disorder (PTSD). This review examined reports of psychological treatment for trauma-related problems, primarily PTSD, in studies with samples of at least 50% adults aged 55 and older using standardized measures. A systematic review of the literature was conducted on psychotherapy for PTSD with older adults using PubMed, Medline, PsychInfo, CINAHL, PILOTS, and Google Scholar. A total of 42 studies were retrieved for full review; 22 were excluded because they did not provide at least one outcome measure or results were not reported by age in the case of mixed-age samples. Of the 20 studies that met review criteria, there were: 13 case studies or series, three uncontrolled pilot studies, two randomized clinical trials, one non-randomized concurrent control study and one post hoc effectiveness study. Significant methodological limitations in the current older adult PTSD treatment outcome literature were found reducing its internal validity and generalizability, including non-randomized research designs, lack of comparison conditions and small sample sizes. Select evidence-based interventions validated in younger and middle-aged populations appear acceptable and efficacious with older adults. There are few treatment studies on subsets of the older adult population including cultural and ethnic minorities, women, the oldest old (over 85), and those who are cognitively impaired. Implications for clinical practice and future research directions are discussed.

Older Adults with Intellectual Disabilities: Targets for Increasing Victimization, a Call for a Preemptive Screening Policy

ERIC Educational Resources Information Center

Strasser, Sheryl; O'Quin, Karen; Price, Thomas; Leyda, Elizabeth

2012-01-01

The aging population is a rapidly growing demographic in the United States. Isolation, limited autonomy, and declining physical and mental health render many older adults vulnerable to abuse, neglect, and exploitation. As the population grows, so does the need for Adult Protective Services (APS). This article highlights an ultrasensitive subgroup…

Older Workers and VET. At a Glance

ERIC Educational Resources Information Center

Dawe, Susan

2009-01-01

Australia, in common with many industrialised countries, must adjust in the coming years to an ageing population. The labour force participation rate is projected to fall and there will be a record number of older people who have retired from work. Thus, there will be fewer workers as a share of the population to generate the income needed to…

Hispanic Baby Boomers: Health Inequities Likely to Persist in Old Age

ERIC Educational Resources Information Center

Villa, Valentine M.; Wallace, Steven P.; Bagdasaryan, Sofya; Aranda, Maria P.

2012-01-01

Purpose: As the Baby-Boom generation enters the ranks of the elderly adults over the next 4 decades, the United States will witness an unprecedented growth in racial/ethnic diversity among the older adult population. Hispanics will comprise 20% of the next generation of older adults, representing the largest minority population aged 65 years and…

Correlates of Sense of Control among Older Korean-American Immigrants: Financial Status, Physical Health Constraints, and Environmental Challenges

ERIC Educational Resources Information Center

Jang, Yuri; Kim, Giyeon; Chiriboga, David A.

2006-01-01

Responding to the need for more research on minority older populations, the present study assessed sense of control among older Korean-American immigrants. The association of sense of control with financial status, physical health constraints, and environmental challenges was examined with a sample of 230 older Korean-Americans (M[age] = 69.8,…

The Social Outcomes of Older Adult Learning in Taiwan: Evaluation Framework and Indicators

ERIC Educational Resources Information Center

Lin, Li-Hui

2015-01-01

The purpose of this study is to explore the social outcomes of older adult learning in Taiwan. In light of our society's aging population structure, the task of establishing evaluation framework and indicators for the social outcomes of learning (SOL) as applied to older adults is urgent. In order to construct evaluation indicators for older adult…

Validity and usability of a safe driving behaviors measure for older adults : strategy for congestion mitigation.

DOT National Transportation Integrated Search

2012-01-01

Statistics project that crash/injury/fatality rates of older drivers will increase with the future growth of : this population. Accurate and precise measurement of older driver behaviors becomes imperative to : curtail these crash trends and resultin...

Diagnosis and Management of Oropharyngeal Dysphagia Among Older Persons, State of the Art.

PubMed

Ortega, Omar; Martín, Alberto; Clavé, Pere

2017-07-01

Oropharyngeal dysphagia (OD) is a condition recognized by the World Health Organization and defined as the difficulty or inability to move a bolus safely and effectively from the oral cavity to the esophagus, and can include aspirations, choking, and residue. OD is pandemic among different phenotypes of older people, affecting between 27% and 91% of the population 70 years or older. Although OD can be diagnosed by well-defined clinical methods and complementary explorations, in the clinical setting OD is seldom systematically screened and treated, and awareness among the medical/geriatric community is scarce. The etiology of OD in this population includes many concomitant risk factors with neurogenic and neurodegenerative processes, muscular weakness, and sarcopenia. The pathophysiology includes mechanical deficits in the swallow response (mainly delayed laryngeal vestibule closure time and weak tongue thrust), reduced pharyngeal sensitivity, and sensory/motor central nervous system impairments. Recently, OD has been recognized as a geriatric syndrome due to its high prevalence and its relationship with many comorbidities and their poor outcomes, including malnutrition, respiratory infections and aspiration pneumonia, functional disability and frailty, institutionalization and increased readmissions, and mortality. There is an evidence-based and effective treatment for OD in the elderly mainly oriented to compensating swallow impairments through adaptation of fluid viscosity and solid food textures to avoid aspiration and choking, and improving nutritional status and oral health to avoid respiratory infections. This has been defined as the minimal effective treatment to be provided to this population. New treatments aiming at recovering the swallowing function are under research with promising results, and the near future will provide us with methods to stimulate the swallow response with pharmacological or physical stimuli. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Building communities that promote successful aging.

PubMed Central

Fried, L P; Freedman, M; Endres, T E; Wasik, B

1997-01-01

Despite the fact that, in a few years, a fifth of the US population will be older than 65 years and people will be living a third of their lives after retirement, we have developed few avenues that would permit older adults to play meaningful roles as they age and few institutions to harness the experience that older adults could contribute to society. In fact, older adults constitute this country's only increasing natural resource--and the least used one. In this article we consider the rationale for developing institutions that harness the abilities and time of older adults, rather than focusing solely on their needs. Such an approach would decrease the structural lag between a social concept of retirement as unproductive leisure and an aging population that is larger, healthier, and with a need for more productive opportunities. Gerontologically designed opportunities for contribution on a large social scale could well provide a national approach to primary prevention to maintain health and function in older adults. PMID:9348750

Socioeconomic Correlates of Gender Differential in Poor Health Status Among Older Adults in India.

PubMed

Pandey, Anamika; Ladusingh, Laishram

2015-10-01

Assessment of the health status of the older adults can go a long way in controlling the disease burden and monitoring the path to healthy aging in India. In the absence of a population-based clinical survey to collect data on morbidities and other health conditions through biomarkers, self-rated health by nationally representative older population is used for understanding factors contributing to the gender differential in health status. Socioeconomic status is the most important factor explaining 59% of the gender gap in self-assessed health among older adults. The vulnerability of older women in terms of educational attainment, occupational status, and economic dependency is responsible for the higher level of poor self-assessed health. The gender gap in self-assessed poor health among older Indian adults, which perpetuates over the life course resulting in severe health disadvantages at old age can be reduced considerably through social empowerment and gender sensitive public policies. © The Author(s) 2013.

Overview of persistent pain in older adults.

PubMed

Molton, Ivan R; Terrill, Alexandra L

2014-01-01

With the shifting age demographics of the U.S. population, more psychologists will be asked to provide clinical services to older adults. Given the high prevalence of persistent pain in aging, in many cases this will mean providing empirically supported interventions for pain and the interference it creates. The purpose of this review is to provide a broad overview of the scope and impact of persistent pain in older people and to discuss mechanisms by which persistent geriatric pain can lead to suffering and disability. We consider the unique context of pain in older adulthood and review differences between older and younger people in terms of pain perception, the social network, beliefs about pain, pain-related coping, and adherence to pain medication. Finally, we discuss special issues affecting pain management in older adults, including dementia, polypharmacy, and barriers to accessing adequate pain care. This review also highlights a need for greater provider training in pain management to meet the needs of a changing U.S. population. PsycINFO Database Record (c) 2014 APA, all rights reserved.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Harris, Eleanor E.R.; Hwang, W.-T.; Urtishak, Sandra L.

Purpose: Breast cancer incidence increases with age and is a major cause of morbidity and mortality in elderly women, but is not well studied in this population. Comorbidities often impact on the management of breast cancer in elderly women. Methods and Materials: From 1979 to 2002, a total of 238 women aged 70 years and older with Stage I or II invasive carcinoma of the breast underwent breast-conservation therapy. Outcomes were compared by age groups and comorbidities. Median age at presentation was 74 years (range, 70-89 years). Age distribution was 122 women (51%) aged 70-74 years, 71 women (30%) agedmore » 75-79 years, and 45 women (19%) aged 80 years or older. Median follow-up was 6.2 years. Results: On outcomes analysis by age groups, 10-year cause-specific survival rates for women aged 70-74, 75-79, and 80 years or older were 74%, 81%, and 82%, respectively (p = 0.87). Intercurrent deaths at 10 years were significantly higher in older patients: 20% in those aged 70-74 years, 36% in those aged 75-79 years, and 53% in those 80 years and older (p = 0.0005). Comorbidities were not significantly more common in the older age groups and did not correlate with cause-specific survival adjusted for age. Higher comorbidity scores were associated with intercurrent death. Conclusions: Older age itself is not a contraindication to standard breast-conservation therapy, including irradiation. Women of any age with low to moderate comorbidity indices should be offered standard breast-conservation treatment if otherwise clinically eligible.« less

Factors Associated with Variations in Population HIV Prevalence across West Africa: Findings from an Ecological Analysis.

PubMed

Prudden, Holly J; Beattie, Tara S; Bobrova, Natalia; Panovska-Griffiths, Jasmina; Mukandavire, Zindoga; Gorgens, Marelize; Wilson, David; Watts, Charlotte H

2015-01-01

Population HIV prevalence across West Africa varies substantially. We assess the national epidemiological and behavioural factors associated with this. National, urban and rural data on HIV prevalence, the percentage of younger (15-24) and older (25-49) women and men reporting multiple (2+) partners in the past year, HIV prevalence among female sex workers (FSWs), men who have bought sex in the past year (clients), and ART coverage, were compiled for 13 countries. An Ecological analysis using linear regression assessed which factors are associated with national variations in population female and male HIV prevalence, and with each other. National population HIV prevalence varies between 0 4-2 9% for men and 0 4-5.6% for women. ART coverage ranges from 6-23%. National variations in HIV prevalence are not shown to be associated with variations in HIV prevalence among FSWs or clients. Instead they are associated with variations in the percentage of younger and older males and females reporting multiple partners. HIV prevalence is weakly negatively associated with ART coverage, implying it is not increased survival that is the cause of variations in HIV prevalence. FSWs and younger female HIV prevalence are associated with client population sizes, especially older men. Younger female HIV prevalence is strongly associated with older male and female HIV prevalence. In West Africa, population HIV prevalence is not significantly higher in countries with high FSW HIV prevalence. Our analysis suggests, higher prevalence occurs where more men buy sex, and where a higher percentage of younger women, and older men and women have multiple partnerships. If a sexual network between clients and young females exists, clients may potentially bridge infection to younger females. HIV prevention should focus both on commercial sex and transmission between clients and younger females with multiple partners.

Population-based incidence of exudative age-related macular degeneration and ranibizumab treatment load.

PubMed

Geirsdottir, Asbjorg; Jonsson, Oskar; Thorisdottir, Sigridur; Helgadottir, Gudleif; Jonasson, Fridbert; Stefansson, Einar; Sigurdsson, Haraldur

2012-03-01

The use of intravitreal vascular endothelial growth factor antibodies for exudative age-related macular degeneration (AMD) has stressed ophthalmology services and drug budgets throughout the world. The authors study the population-based incidence of exudative AMD in Iceland and the use of intravitreal ranibizumab in a defined population. This is a prospective study of 439 consecutive patients aged 60 years and older with exudative AMD starting intravitreal ranibizumab for exudative AMD in Iceland from March 2007 to December 2009. All patients initially received three consecutive ranibizumab injections, with regular follow-up visits and re-treatment as needed. In total, 517 eyes from 439 patients received treatment for exudative AMD (mean age 79 years). The annual incidence of exudative AMD in the population 60 years and older is 0.29%. The incidence increased with advancing age, double for patients 85 years and older compared with those 75-79 years. Approximately 2400 ranibizumab injections per 100,000 persons aged 60 years and older were given each year for exudative AMD. These data allow an estimation of the incidence of exudative AMD in a Caucasian population and the treatment load with ranibizumab, which may help plan anti-vascular endothelial growth factor treatment programmes and estimate costs.

Is the Nintendo Wii Fit really acceptable to older people?: a discrete choice experiment

PubMed Central

2011-01-01

Background Interactive video games such as the Nintendo Wii Fit are increasingly used as a therapeutic tool in health and aged care settings however, their acceptability to older people is unclear. The aim of this study was to determine the acceptability of the Nintendo Wii Fit as a therapy tool for hospitalised older people using a discrete choice experiment (DCE) before and after exposure to the intervention. Methods A DCE was administered to 21 participants in an interview style format prior to, and following several sessions of using the Wii Fit in physiotherapy. The physiotherapist prescribed the Wii Fit activities, supervised and supported the patient during the therapy sessions. Attributes included in the DCE were: mode of therapy (traditional or using the Wii Fit), amount of therapy, cost of therapy program and percentage of recovery made. Data was analysed using conditional (fixed-effects) logistic regression. Results Prior to commencing the therapy program participants were most concerned about therapy time (avoiding programs that were too intensive), and the amount of recovery they would make. Following the therapy program, participants were more concerned with the mode of therapy and preferred traditional therapy programs over programs using the Wii Fit. Conclusions The usefulness of the Wii Fit as a therapy tool with hospitalised older people is limited not only by the small proportion of older people who are able to use it, but by older people's preferences for traditional approaches to therapy. Mainstream media portrayals of the popularity of the Wii Fit with older people may not reflect the true acceptability in the older hospitalised population. PMID:22011360

The Rural – Urban Divide: Health Services Utilization Among Older Mexicans in Mexico

PubMed Central

Salinas, Jennifer J.; Al Snih, Soham; Markides, Kyriakos; Ray, Laura A.; Angel, Ronald J.

2010-01-01

Context Mexico Purpose Using the health care service utilization model as a framework, this paper will analyze the differences in health care service use among older Mexicans living in urban and rural areas in Mexico. Methods The Mexican Health and Aging Survey (MHAS) data were used to test the applicability of Andersen’s “model of health services” of predisposing (ie, age, sex, etc.), enabling (education, insurance coverage, etc.) and need factors (diabetes, hypertension, etc.) to predict ever being in the hospital and physician visits in the past year by place of residence (urban, rural, semi-rural). Findings Results showed that older Mexicans living in the most rural areas (populations of 2500 or fewer) were significantly less likely to have been hospitalized in the previous year and visited the physician less often (P < .0001) than their urban counterparts. The significant difference in hospitalization between rural and urban residing older Mexicans was largely accounted for by having health care coverage. Certain need factors such as diabetes, previous heart attack, hypertension, depression, and functional limitations predicted frequency of physician visits and hospitalization, but they did not explain variations between rural and urban older Mexicans. Conclusions Not having insurance coverage was associated with a lower likelihood of spending an overnight visit in the hospital and visiting a physician for older Mexicans. This lower utilization may be due to barriers to access rather than better health. PMID:21029168

Higher frequency of dementia in older HIV-1 individuals

PubMed Central

Valcour, V.; Shikuma, C.; Shiramizu, B.; Watters, M.; Poff, P.; Selnes, O.; Holck, P.; Grove, J.; Sacktor, N.

2006-01-01

Background Antiretroviral therapy has improved survival for HIV-1-infected individuals. The neuroepidemiologic implications of HIV-1 in an aging population are not well known, particularly the prevalence of HIV-associated dementia (HAD). Methods The authors report a baseline cross-sectional analysis of 202 HIV-1-seropositive individuals enrolled into one of two groups of the Hawaii Aging with HIV Cohort: older (50 or more years old, n = 106) and younger (20 to 39 years old, n = 96). Neuropsychological, neurologic, medical, and laboratory data were obtained at enrollment. Participant cognitive status was classified (research case definitions) using American Academy of Neurology (1991) criteria in a consensus conference of physicians and neuropsychologists. Results HAD was more frequent in older (25.2%) compared to younger (13.7%) individuals (p = 0.041) corresponding to an OR of 2.13 (95% CI: 1.02 to 4.44) for the older compared to the younger group. After adjusting for education, race, substance dependence, antiretroviral medication status, viral load, CD4 lymphocyte count, and Beck Depression Inventory score, the odds of having HAD among individuals in the older group was 3.26 (1.32 to 8.07) times that of the younger group. Conclusions Older age is associated with increased HAD in this HIV-1 cohort. Underlying mechanisms are unclear but do not appear related to duration of HIV-1 infection. PMID:15365130

Hand grip strength and associated factors in non-institutionalised men and women 50 years and older in South Africa

PubMed Central

2014-01-01

Background Little is known about the prevalence, predictors and gender differences in hand grip strength of older adults in Africa. This study aims to investigate social and health differences in hand grip strength among older adults in a national probability sample of older South Africans who participated in the Study of Global Ageing and Adults Health (SAGE wave 1) in 2008. Methods We conducted a national population-based cross-sectional study with a sample of 3840 men and women aged 50 years or older in South Africa. The questionnaire included socio-demographic characteristics, health variables, and anthropometric measurements. Linear multivariate regression analysis was performed to assess the association of social factors, health variables and grip strength. Results The mean overall hand grip strength was 37.9 kgs for men (mean age 61.1 years, SD = 9.1) and 31.5 kgs for women (mean age 62.0 years, SD = 9.7). In multivariate analysis among men, greater height, not being underweight and lower functional disability was associated with greater grip strength, and among women, greater height, better cognitive functioning, and lower functional disability were associated with greater grip strength. Conclusions Greater height and lower functional disability were found for both older South African men and women to be significantly associated with grip strength. PMID:24393403

Prevalence, Types, Risk Factors and Clinical Correlates of Anaemia in Older People in a Rural Ugandan Population

PubMed Central

Mugisha, Joseph O.; Baisley, Kathy; Asiki, Gershim; Seeley, Janet; Kuper, Hannah

2013-01-01

Background Studies conducted in high income countries have shown that anaemia is a common medical condition among older people, but such data are scarce in Africa. The objectives of this study were to estimate the prevalence, types, risk factors and clinical correlates of anaemia in older people. Methods Participants were aged (≥ 50) years recruited from a general population cohort from January 2012 to January 2013. Blood samples were collected for assessing hemoglobin, serum ferritin, serum vitamin B12, serum folate, C-reactive protein, malaria infection and stool samples for assessment of hookworm infection. HIV status was assessed using an algorithm for HIV rapid testing. Questionnaires were used to collect data on sociodemographic characteristics and other risk factors for anaemia. Results In total, 1449 people participated (response rate 72.3%). The overall prevalence of anaemia was 20.3 % (95% CI 18.2-22.3%), and this was higher for males (24.1%, 95% CI=20.7-27.7%) than females (17.5%, 95% CI=15.0-20.1%). In males, the prevalence of anaemia increased rapidly with age almost doubling between 50 and 65 years (p-trend<0.001). Unexplained anaemia was responsible for more than half of all cases (59.7%). Anaemia was independently associated with infections including malaria (OR 3.49, 95% CI 1.78-6.82), HIV (OR 2.17, 1.32-3.57) heavy hookworm infection (OR 3.45, 1.73-6.91), low fruit consumption (OR 1.55, 1.05-2.29) and being unmarried (OR 1.37 , 95% CI 1.01-1.89). However, the odds of anaemia were lower among older people with elevated blood pressure (OR 0.47, 95% CI 0.29-0.77). Conclusion Anaemia control programmes in Uganda should target older people and should include interventions to treat and control hookworms and educational programs on diets that enhance iron absorption. Clinicians should consider screening older people with HIV or malaria for anaemia. Further studies should be done on unexplained anaemia and serum ferritin levels that predict iron deficiency anaemia in older people. PMID:24194926

‘Familiarity’ as a key factor influencing rural family carers’ experience of the nursing home placement of an older relative: a qualitative study

PubMed Central

2013-01-01

Background Admission to a nursing home is generally regarded as a stressful time for older people and their carers. Although the choice of home is significant in facilitating a more positive transition, few studies have explored this issue in detail, particularly in the context of rural communities. With a worldwide ageing population and an increasing demand for long-term care facilities, it is important to highlight the factors that can improve the experience of entry to long-term care and the role of nursing home staff in facilitating a more positive transition for older people and their families. Methods The overall aim of this qualitative study was to explore rural family carers’ experience of the nursing home placement of an older relative. Semi structured interviews were conducted with 29 relatives of nursing home residents. Participants were selected from a large health and social care trust in the United Kingdom. Data were analysed using grounded theory principles and procedures and NVivo software. Results Rural family carers had a strong sense of familiarity with the nursing homes in their area and this appeared to permeate all aspects of their experience. Carers who reported a high degree of familiarity appeared to experience a more positive transition than others. This familiarity was influenced by the high degree of social capital that was present in the rural community where the study was conducted. This familiarity, in turn, influenced the choice of nursing home and the responses of family carers. The theory that emerged suggests that familiarity was the key factor influencing rural family carers’ experience of the nursing home placement of an older relative. Conclusions The population of the world is ageing and nursing homes are increasingly providing care to older people with multiple and complex needs. This study makes an important contribution to the ways in which the move to long term care can be managed more effectively by increasing awareness of the importance of familiarity, stability and social capital in the lives of older people and their carers. PMID:23822872

Are mental health problems associated with use of Accident and Emergency and health-related harm?

PubMed

Keene, J; Rodriguez, J

2007-08-01

Previous findings indicate that mental health problems are common in Emergency departments; however, there are few studies of the extent of health-related problems and emergency service use in mental health populations as a whole. Record linkage methods were used to map the association between mental health, age, gender, and health-related harm across total health and mental health care populations in one geographical area, over three years. By examining patterns of health-related harm, an accurate profile of mentally ill Emergency patients was generated enabling identification of factors that increased vulnerability to harm. Of the total population of 625 964 individuals, 10.7% contacted Accident and Emergency (A&E) over three years, this proportion rose to 28.6% among the total secondary care mental health population. Young men and older women were more likely to contact A&E, both overall and within mental health populations and were also more likely to be frequent attendees at A&E. Four distinct groups (typologies) of mental health patients attending A&E emerged: young, male frequent attendees with self-inflicted and other traumatic injuries; young females also presenting with self-harm; older patients with multiple medical conditions; and very old patients with cardiac conditions and fractures. The study indicates increased A+E service use and unmet health-related need within a total mental health population. It identifies specific 'care populations' particularly vulnerable to accidents and self-harm and highlights the need for targeted services for mentally ill groups who may not access traditional health and social care services effectively.

An intensely sympathetic awareness: Experiential similarity and cultural norms as means for gaining older African Americans’ trust of scientific research

PubMed Central

Sabir, Myra G.; Pillemer, Karl A.

2014-01-01

Well-known trust-building methods are routinely used to recruit and retain older African Americans into scientific research studies, yet the quandary over how to overcome this group’s hesitance to participate in research remains. We present two innovative and testable methods for resolving the dilemma around increasing older African Americans’ participation in scientific research studies. Certain specific and meaningful experiential similarities between the primary researcher and the participants, as well as clear recognition of the elders’ worth and dignity, improved older African Americans’ willingness to adhere to a rigorous research design. Steps taken in an intervention study produced a potentially replicable strategy for achieving strong results in recruitment, retention and engagement of this population over three waves of assessment. Sixty-two (n = 62) older African Americans were randomized to treatment and control conditions of a reminiscence intervention. Sensitivity to an African-American cultural form of respect for elders (recognition of worth and dignity), and intersections between the lived experience of the researcher and participants helped dispel this population’s well-documented distrust of scientific research. Results suggest that intentional efforts to honor the worth and dignity of elders through high level hospitality and highlighting meaningful experiential similarities between the researcher and the participants can improve recruitment and retention results. Experiential similarities, in particular, may prove more useful to recruitment and retention than structural similarities such as age, race, or gender, which may not in themselves result in the trust experiential similarities elicit. PMID:24655682

Community covariates of malnutrition based mortality among older adults.

PubMed

Lee, Matthew R; Berthelot, Emily R

2010-05-01

The purpose of this study was to identify community level covariates of malnutrition-based mortality among older adults. A community level framework was delineated which explains rates of malnutrition-related mortality among older adults as a function of community levels of socioeconomic disadvantage, disability, and social isolation among members of this group. County level data on malnutrition mortality of people 65 years of age and older for the period 2000-2003 were drawn from the CDC WONDER system databases. County level measures of older adult socioeconomic disadvantage, disability, and social isolation were derived from the 2000 US Census of Population and Housing. Negative binomial regression models adjusting for the size of the population at risk, racial composition, urbanism, and region were estimated to assess the relationships among these indicators. Results from negative binomial regression analysis yielded the following: a standard deviation increase in socioeconomic/physical disadvantage was associated with a 12% increase in the rate of malnutrition mortality among older adults (p < 0.001), whereas a standard deviation increase in social isolation was associated with a 5% increase in malnutrition mortality among older adults (p < 0.05). Community patterns of malnutrition based mortality among older adults are partly a function of levels of socioeconomic and physical disadvantage and social isolation among older adults. 2010 Elsevier Inc. All rights reserved.

A mixed methods evaluation of televised health promotion advertisements targeted at older adults

PubMed Central

Berry, Tanya R.; Spence, John C.; Plotnikoff, Ronald C.; Bauman, Adrian; McCargar, Linda; Witcher, Chad; Clark, Marianne; Stolp, Sean

2016-01-01

The purpose of this research was to evaluate television advertisements targeted at 55–70-year olds that promoted physical activity and fruit and vegetable consumption. Awareness of the campaign, perceived credibility of the source, intentions to visit a promoted website, and intentions to perform the healthy behaviors were evaluated using mixed methods research. Results from a population level survey (n = 1600) showed low unprompted and prompted awareness of the campaign and no differences in intentions or behaviors among those who were aware of the campaign. Unprompted recall resulted in a very wide range of responses including the citation of many commercial advertisers. Qualitative themes that emerged from the focus groups included neutral, positive, and negative comments about the advertisements, source credibility, website considerations specific to seniors, and suggestions about appropriate advertising for older adults. This research showed that the increased attention paid to the advertisements was due in a large part to negative reactions to the character used in the advertisements. Another important finding was the government was not considered to be a credible source of health information. Finally, health promoters should be cautious about websites as the primary source of information, particularly for older adults. PMID:19493572

Decrease in incidence of colorectal cancer among individuals 50 years or older following recommendations for population-based screening

PubMed Central

Murphy, Caitlin C.; Sandler, Robert S.; Sanoff, Hanna K.; Yang, Y. Claire; Lund, Jennifer L.; Baron, John A.

2016-01-01

Background & Aims The incidence of colorectal cancer (CRC) in the U.S. is increasing among adults younger than age 50 years, but incidence has decreased among older populations after population-based screening was recommended in the late 1980s. Blacks have higher incidence than whites. These patterns have prompted suggestions to lower the screening age for average-risk populations or in blacks. At the same time, there has been controversy over whether reductions in CRC incidence can be attributed to screening. We examined age- and race-related differences in CRC incidence over a 40-year time period. Methods We determined the age-standardized incidence of CRC, from 1975 through 2013, using the population-based Surveillance, Epidemiology, and End Results (SEER) program of cancer registries. We calculated incidence for 5-year age categories (20—24 years through 80—84 years and 85 years or older) for different time periods (1975—1979, 1980—1984, 1985—1989, 1990—1994, 1995—1999, 2000—2004, 2005—2009, and 2010—2013), tumor subsite (proximal colon, descending colon, and rectum), and stages at diagnosis (localized, regional, and distant). Analyses were stratified by race (white vs. black). Results There were 450,682 incident cases of CRC reported to the SEER registries over the entire period (1975—2013). Overall incidence was 75.5/100,000 white persons and 83.6/100,000 black persons. CRC incidence peaked during 1980 through 1989 and began to decrease in 1990. In whites and blacks, the decreases in incidence between the time periods of 1980—1984 and 2010—2013 were limited to the screening-age population (ages 50 years or older). Between these time periods, there was a 40% decrease in incidence among whites compared with a 26% decrease in incidence among blacks. Decreases in incidence were greater for cancers of the distal colon and rectum, and reductions in these cancers were greater among whites than blacks. CRC incidence among persons younger than 50 years decreased slightly between 1975—1979 and 1990. However, among persons 20—49 years old, CRC incidence decreased from 8.3/100,000 persons in 1990—1994 to 11.4/100,000 persons in 2010—2013; incidence rates in younger adults were similar for whites and blacks. Conclusions Based on an analysis of the SEER cancer registries from 1975 through 2013, CRC incidence decreased only among individuals 50 years or older between the time periods of 1980—1984 and 2010—2013. Incidence increased modestly among individuals 20—49 years old between the time periods of 1990—1994 and 2010—2013; the decision of whether to recommend screening for younger populations requires a formal analysis of risks and benefits. Our observed trends provide compelling evidence that screening has had an important role in reducing CRC incidence. PMID:27609707

Susceptibility to mortality related to temperature and heat and cold wave duration in the population of Stockholm County, Sweden

PubMed Central

Rocklöv, Joacim; Forsberg, Bertil; Ebi, Kristie; Bellander, Tom

2014-01-01

Background Ambient temperatures can cause an increase in mortality. A better understanding is needed of how health status and other factors modify the risk associated with high and low temperatures, to improve the basis of preventive measures. Differences in susceptibility to temperature and to heat and cold wave duration are relatively unexplored. Objectives We studied the associations between mortality and temperature and heat and cold wave duration, stratified by age and individual and medical factors. Methods Deaths among all residents of Stockholm County between 1990 and 2002 were linked to discharge diagnosis data from hospital admissions, and associations were examined using the time stratified case-crossover design. Analyses were stratified by gender, age, pre-existing disease, country of origin, and municipality level wealth, and adjusted for potential confounding factors. Results The effect on mortality by heat wave duration was higher for lower ages, in areas with lower wealth, for hospitalized patients younger than age 65. Odds were elevated among females younger than age 65, in groups with a previous hospital admission for mental disorders, and in persons with previous cardiovascular disease. Gradual increases in summer temperatures were associated with mortality in people older than 80 years, and with mortality in groups with a previous myocardial infarction and with chronic obstructive pulmonary disease (COPD) in the population younger than 65 years. During winter, mortality was associated with a decrease in temperature particularly in men and with the duration of cold spells for the population older than 80. A history of hospitalization for myocardial infarction increased the odds associated with cold temperatures among the population older than 65. Previous mental disease or substance abuse increased the odds of death among the population younger than 65. Conclusion To increase effectiveness, we suggest preventive efforts should not assume susceptible groups are the same for warm and cold days and heat and cold waves, respectively. PMID:24647126

Validation Study of the Body Adiposity Index as a Predictor of Percent Body Fat in Older Individuals: Findings From the BLSA

PubMed Central

Chang, Hui; Simonsick, Eleanor M.; Ferrucci, Luigi

2014-01-01

A new body adiposity index (BAI = (hip circumference)/((height)1.5) − 18) has been developed and validated in adult populations. We aimed to assess the validity of BAI in an older population. We compared the concordance correlation coefficient between BAI, body mass index (BMI), and percent body fat (fat%; by dual-energy X-ray absorptiometry) in an older population (n = 954) participating in the Baltimore Longitudinal Study of Aging. BAI was more strongly correlated with fat% than BMI (r of .7 vs .6 for BAI vs BMI and fat%, respectively, p < .01) and exhibited a smaller mean difference from fat% (−5.2 vs −7.6 for BAI vs BMI and fat%, respectively, p < .01) indicating better agreement. In men, however, BMI was in better agreement with fat% (r of .6 vs .7 for BAI vs BMI and fat%, respectively, p < .01) with a smaller mean difference from fat% (−3.0 vs −2.2 for BAI vs BMI and fat%, respectively, p < .01). Finally, BAI did not accurately predict fat% in people with a fat% below 15%. BAI provides valid estimation of body adiposity in an older adult population; however, BMI may be a better index for older men. Finally, BAI is not accurate in people with extremely low or high body fat percentages. PMID:24158764

Interdisciplinary Collaboration in Medication-Related Falls Prevention in Older Adults.

PubMed

Huang, Lisa; Turner, Jazmin; Brandt, Nicole J

2018-04-01

The older adult population continues to steadily increase. Largely attributed to longer life spans and aging of the Baby Boomer generation, continued growth of this population is expected to affect a multitude of challenging public health concerns. Specifically, falls in older adults are prevalent but overlooked concerns. Health care providers are well-positioned to provide valuable interventions in this aspect. An interdisciplinary, team-based approach of health care providers is required to maximize falls prevention through patient-centered and collaborative care. The current article highlights the implications of inappropriate medication use and the need to improve care coordination to tackle this public health issue affecting older adults. [Journal of Gerontological Nursing, 44(4), 11-15.]. Copyright 2018, SLACK Incorporated.

Mindfulness-Based Interventions for Older Adults: A Review of the Effects on Physical and Emotional Well-being

PubMed Central

Geiger, Paul J.; Boggero, Ian A.; Brake, C. Alex; Caldera, Carolina A.; Combs, Hannah L.; Peters, Jessica R.; Baer, Ruth A.

2015-01-01

This comprehensive review examined the effects of mindfulness-based interventions on the physical and emotional wellbeing of older adults, a rapidly growing segment of the general population. Search procedures yielded 15 treatment outcome studies meeting inclusion criteria. Support was found for the feasibility and acceptability of mindfulness-based interventions with older adults. Physical and emotional wellbeing outcome variables offered mixed support for the use of mindfulness-based interventions with older adults. Potential explanations of mixed findings may include methodological flaws, study limitations, and inconsistent modifications of protocols. These are discussed in detail and future avenues of research are discussed, emphasizing the need to incorporate geriatric populations into future mindfulness-based empirical research. PMID:27200109

Depression, disability and functional status among community-dwelling older adults in South Africa: evidence from the first South African National Income Dynamics Study.

PubMed

Tomita, Andrew; Burns, Jonathan K

2013-12-01

This study examined the relationship between depression and functional status among a community-dwelling older population of 65 years and older in South Africa. Data from the first wave of the South African National Income Dynamics Study were used, this being the first longitudinal panel survey of a nationally representative sample of households. The study focused on the data for resident adults 65 years and older (n = 1,429). Depression was assessed using the 10-item version of the Center for Epidemiologic Studies Depression Scale. Functional status, pertaining to both difficulty and dependence in activities of daily living (ADL), instrumental activities of daily living (IADL), and physical functioning and mobility (PFM), were assessed using 11 items. Functional challenges were generally higher in the older age group. There was a significant association between depression and functional dependence in ADL (adjusted OR = 2.57 [CI: 1.03-6.41]), IADL (adjusted OR = 2.76 [CI: 1.89-4.04]), and PFM (adjusted OR = 1.66 [CI: 1.18-2.33]), but the relationship between depression and functional status, particularly PFM, appeared weaker in older age. The relationship between depression symptoms and function is complex. Functional characteristics between older and younger old populations are diverse, and caution is indicated against overgeneralizing the challenges related to depression and function among this target population. Copyright © 2013 John Wiley & Sons, Ltd.

Family Violence Among Older Adult Patients Consulting in Primary Care Clinics: Results From the ESA (Enquête sur la santé des aînés) Services Study on Mental Health and Aging

PubMed Central

Préville, Michel; Mechakra-Tahiri, Samia Djemaa; Vasiliadis, Helen-Maria; Mathieu, Véronique; Quesnel, Louise; Gontijo-Guerra, Samantha; Lamoureux-Lamarche, Catherine; Berbiche, Djamal

2014-01-01

Objective To document the reliability and construct validity of the Family Violence Scale (FVS) in the older adult population aged 65 years and older. Method: Data came from a cross-sectional survey, the Enquête sur la santé des aînés et l’utilisation des services de santé (ESA Services Study), conducted in 2011–2013 using a probabilistic sample of older adults waiting for medical services in primary care clinics (n = 1765). Family violence was defined as a latent variable, coming from a spouse and from children. Results: A model with 2 indicators of violence; that is, psychological and financial violence, and physical violence, adequately fitted the observed data. The reliability of the FVS was 0.95. According to our results, 16% of older adults reported experiencing some form of family violence in the past 12 months of their interview, and 3% reported a high level of family violence (FVS > 0.36). Our results showed that the victim’s sex was not associated with the degree of violence (β = 0.02). However, the victim’s age was associated with family violence (β = −0.12). Older adults, aged 75 years and older, reported less violence than those aged between 65 and 74 years. Conclusion: Our results lead us to conclude that family violence against older adults is common and warrants greater public health and political attention. General practitioners could play an active role in the detection of violence among older adults. PMID:25161067

The Role of Support Services in Promoting Social Inclusion for the Disadvantaged Urban-dwelling Elderly

PubMed Central

Nguyen, Vicky P.K.H.; Sarkari, Feroz; MacNeil, Kate; Cowan, Laura; Rankin, Joyce

2013-01-01

Background Disadvantaged older adults living in non-family situations in Toronto are more likely than older adults living in family situations to have less economic security, less social support, and less choice in housing. Older adults who live in poverty and are precariously housed are more likely to be chronically ill, to live with multiple illnesses, to have poor nutrition, high stress and loneliness, all of which are strongly associated with the determinant of health social exclusion. The aim of this study is to: 1) evaluate the level of social disadvantage and exclusion experienced by low-income older adults 65 years of age and older living alone or in non-family situations; 2) assess the level of dependency on government and community services (support services) to maintain a reasonable standard of living (minimize effects of social exclusion); and 3) identify consequences of social exclusion not addressed by current available services. Methods Fifteen male older adult members of the Good Neighbours’ Club in downtown Toronto were interviewed. Semi-structured questionnaires assessed barriers to, utility of, and perceived impact of support services available to disadvantaged older adults living in the central core of southeast Toronto. Results Support services for income, housing, food security, social support, and health care do mitigate the effects of social exclusion in the study participants. Data gathered from interviews identified factors that counter the efforts by support services to increase social inclusion in this population. Conclusions Support services reduce social isolation experienced by these older adults. Evidence of the detrimental impact of low financial literacy suggests a need to design and implement training programs to build the older adults’ capacity to manage their own finances effectively, and resist falling victim to financial fraud. PMID:24278093

Comprehension deficits among older patients in a quick diagnostic unit

PubMed Central

Hvidt, Lisa Nebelin; Hvidt, Kristian Nebelin; Madsen, Kim; Schmidt, Thomas A

2014-01-01

Background Higher prevalence of multiple illnesses and cognitive impairment among older patients pose a risk of comprehension difficulties, potentially leading to medication errors. Therefore, the objective of this study was to investigate comprehension of discharge instructions among older patients admitted to a Quick Diagnostic Unit (QDU). Methods One hundred and two patients discharged from the QDU answered a questionnaire covering understanding of their hospitalization and discharge plan. Patients’ ability to recall discharge instructions and awareness of comprehension deficits, ie, ability to identify the misconceived information, were evaluated by comparing the questionnaires with the discharge letters. The population was divided into an older group (age ≥65 years) and a younger group. Results The older group (n=40) was less able to recall correct medication instructions when compared to the younger group (54% versus 78%, respectively; P=0.02). In multiple logistic regression analysis, correct recall of medication instructions was 4.2 times higher for the younger group compared to the older group (odds ratio 4.2, 95% confidence interval 1.5–11.9, P=0.007) when adjusted for sex and education. The older patients were less aware of their own comprehension deficits, and in respect to medication instructions awareness decreased 6.1% for each additional year of age (odds ratio 0.939, 95% confidence interval 0.904–0.98, P=0.001) when adjusted for sex and education. Conclusion Older patients were less able to recall correct medication instructions and less aware of their comprehension deficits after discharge from a QDU. The findings of the present study emphasize the importance of thorough communication and follow-up when treating older patients. PMID:24790423

Coming of age: health-care challenges of an ageing population in Israel.

PubMed

Dwolatzky, Tzvi; Brodsky, Jenny; Azaiza, Faisal; Clarfield, A Mark; Jacobs, Jeremy M; Litwin, Howard

2017-06-24

Although Israel is still young in years, with relatively high birth rates and older people (individuals aged 65 years or older) constituting only about 11% of its population, the absolute number of older people is growing rapidly. Life expectancy is high, and increasing numbers of people are living to advanced old age (older than 85 years). A wide spectrum of geriatric care is provided within a universal system providing health services to all citizens. Community and institutional care is available, and many innovative programmes are being developed. The unique demographic characteristics of the ageing society in Israel reflect cultural and multiethnic diversity, in addition to a high rate of immigration of older people. To meet the growing challenges, address disparities, and search for innovation will require planning and development of adequate services at the highest level. Copyright © 2017 Elsevier Ltd. All rights reserved.

Challenges for the Aging Family in the People's Republic of China.

PubMed

Phillips, David R; Feng, Zhixin

2015-09-01

The People's Republic of China has the largest population of older persons of any country in the world. It is a nation that has experienced enormous economic, social, and demographic changes over the past three and a half decades. Traditionally, the family was the main social support for older persons; this changed somewhat under early socialism, but in recent years, the importance of family support has been reasserted. However, over this time, the family's ability to support its older members has been considerably altered and arguably weakened. This article reviews four key issues (population change, the hukou system, economic reform, general features surrounding modernization) that have gradually changed families' capacity to provide support for older members. Research foci and public policy directions are considered under which the state might take some responsibilities from the family, support capacity to care, and improve the quality and quantity of support for older citizens.

Canine Outreach Promoting Engagement: The Effect of Meaningful Activities on Students' Attitudes Toward Cognitively Impaired Older Adults.

PubMed

Yordy, B Morgan; Pope, W Stuart; Wang, Chih-Hsuan

2018-06-14

Animal-assisted activities (AAAs) show promise in providing emotional and social benefits to older adults and may be used as a tool to promote therapeutic communication between students and cognitively impaired older adults. The purpose was to develop a program incorporating AAAs to enhance social engagement of cognitively impaired older adults in a community respite program and in turn enhance student comfort when caring for this vulnerable population. The Dementia Attitudes Scale, a validated tool, was used to measure students' attitudes before and after AAA intervention. Data were analyzed using repeated-measures analysis of variance. Students were significantly more comfortable and demonstrated a gain in knowledge after AAAs were included in the community clinical experience. Incorporating AAAs into student community/service-learning clinical experience improved communication between students and cognitively impaired older adults, improving students' attitudes when caring for this population.

Rethinking Hospital-Associated Deconditioning: Proposed Paradigm Shift

PubMed Central

Mangione, Kathleen K.; Stevens-Lapsley, Jennifer E.

2015-01-01

Physical therapists often treat older adults with marked deficits in physical function secondary to an acute hospitalization. These deficits are often collectively defined as hospital-associated deconditioning (HAD). However, there is a paucity of evidence that objectively demonstrates the efficacy of physical therapy for older adults with HAD. Older adults with HAD represent a highly variable and complex population and thus may be difficult to study and develop effective interventions for using our current rehabilitation strategies. This perspective article outlines an innovative framework to operationalize and treat older adults with HAD. This framework may help therapists apply emerging exercise strategies to this population and facilitate additional research to support the total value of physical therapy for older adults in postacute care settings—with value measured not only by improvements in physical performance but perhaps also by reduced rates of disability development, rehospitalization, and institutionalization. PMID:25908526

Nutritional Care Considerations of Older Americans

PubMed Central

Greene, Joncier

1979-01-01

The US Census Bureau's 1977 projection of the nation's population aged 65 and older by the year 2000 was 31.8 million. This paper addresses the projection that in the future a higher proportion of the population in the United States will be older persons. It is obvious that older Americans are living longer with an increased incidence of diseases such as diabetes, hypertension, cardiac problems, and obesity, requiring medical and nutritional care. This paper discusses commitment to provide quality services in terms of prescribing appropriate and functional therapeutic diets to meet the needs of older Americans. Two mechanisms are discussed that are effective tools for calculating diabetic diet prescriptions and weight reduction diets based on energy level and energy needs. Also discussed are the provision of assistance to meet the social support needs of old people such as food stamps, Meals-on-Wheels, and homemaker's service. PMID:490673

Suicidal behavior in the older patient with schizophrenia

PubMed Central

Kasckow, John; Montross, Lori; Prunty, Laurie; Fox, Lauren; Zisook, Sidney

2011-01-01

Little is known about treating elderly suicidal patients with schizophrenia. The purpose of this article is to review the literature dealing with this population and to discuss what is required to advance this field. Most available studies from middle-aged and older individuals suggest that risk factors include hopelessness, lower quality of life, past traumatic events, depressive symptoms, lifetime suicidal ideation and past attempts; it is not clear whether these findings are generalizable to geriatric populations. Although little treatment research has been performed in older suicidal patients with schizophrenia, an integrated psychosocial and pharmacologic approach is recommended. In addition, one recent study augmented antipsychotic treatment with an SSRI (i.e., citalopram) in a sample of middle-aged and older individuals with schizophrenia with subsyndromal depression; in that study, serotonin selective reuptake inhibitor augmentation reduced depressive symptoms and suicidal ideation. More research is required to better understand suicidal behavior in older patients with schizophrenia. PMID:22028735

New signs and signals make roads safer for older drivers : research spotlight.

DOT National Transportation Integrated Search

2015-09-01

The aging of Michigans population has resulted in an increase in the : number of older drivers involved in traffic collisions. The number of : drivers age 65 and older involved in crashes in Michigan increased by : 2.4% from 2004 to 2013, even as ...

Anticipatory guidance provision related to driving safety/cessation for older drivers : a rural-urban comparison.

DOT National Transportation Integrated Search

2014-12-01

Older drivers are overrepresented in motor vehicle crash fatalities. As the U.S. population continues to : age, this problem will grow. Health care providers (HCPs) are in a position to provide their older patients : with education which may prevent ...

Physical and leisure activity in older community-dwelling canadians who use wheelchairs: a population study.

PubMed

Best, Krista L; Miller, William C

2011-04-13

Background. Physical and leisure activities are proven health promotion modalities and have not been examined in older wheelchair users. Main Objectives. Examine physical and leisure activity in older wheelchair users and explore associations between wheelchair use and participation in physical and leisure activity, and wheelchair use, physical and leisure activity, and perceived health. Methods. 8301 Canadians ≥60 years of age were selected from the Canadian Community Health Survey. Sociodemographic, health-related, mobility-related, and physical and leisure activity variables were analysed using logistic regression to determine, the likelihood of participation in physical and leisure activity, and whether participation in physical and leisure activities mediates the relationship between wheelchair use and perceived health. Results. 8.3% and 41.3% older wheelchair users were physically and leisurely active. Wheelchair use was a risk factor for reduced participation in physical (OR = 44.71) and leisure activity (OR = 10.83). Wheelchair use was a risk factor for poor perceived health (OR = 10.56) and physical and leisure activity negatively mediated the relationship between wheelchair user and perceived health. Conclusion. There is a need for the development of suitable physical and leisure activity interventions for older wheelchair users. Participation in such interventions may have associations with health benefits.

Physical and Leisure Activity in Older Community-Dwelling Canadians Who Use Wheelchairs: A Population Study

PubMed Central

Best, Krista L.; Miller, William C.

2011-01-01

Background. Physical and leisure activities are proven health promotion modalities and have not been examined in older wheelchair users. Main Objectives. Examine physical and leisure activity in older wheelchair users and explore associations between wheelchair use and participation in physical and leisure activity, and wheelchair use, physical and leisure activity, and perceived health. Methods. 8301 Canadians ≥60 years of age were selected from the Canadian Community Health Survey. Sociodemographic, health-related, mobility-related, and physical and leisure activity variables were analysed using logistic regression to determine, the likelihood of participation in physical and leisure activity, and whether participation in physical and leisure activities mediates the relationship between wheelchair use and perceived health. Results. 8.3% and 41.3% older wheelchair users were physically and leisurely active. Wheelchair use was a risk factor for reduced participation in physical (OR = 44.71) and leisure activity (OR = 10.83). Wheelchair use was a risk factor for poor perceived health (OR = 10.56) and physical and leisure activity negatively mediated the relationship between wheelchair user and perceived health. Conclusion. There is a need for the development of suitable physical and leisure activity interventions for older wheelchair users. Participation in such interventions may have associations with health benefits. PMID:21584226

[A novel method for targeting and characterizing healthy older people].

PubMed

Carrasco, Marcela; Martínez, Gabriel; Foradori, Arnaldo; Hoyl, Trinidad; Valenzuela, Eduardo; Quiroga, Teresa; Gac, Homero; Ihle, Sofia; Marin, Pedro Paulo

2010-09-01

there is no established definition of healthy aging in clinical practice, although it is a World Health Organization goal. to develop a clinical protocol to identify healthy older people living in the community and study their clinical, laboratory and functional characteristics. healthy people aged 60 years or older, were invited to participate in the study, by newspapers and radio, if they selfperceived as healthy, lived in the community, were functionally independent and had low disease burden. Potential participants were initially screened by telephone, and those who met the inclusion criteria were included. They had a comprehensive geriatric assessment which included clinical, anthropometric, laboratory and functional assessments. of 384 people who answered the call, 83 subjects aged 60 to 98 years (57% women) met the inclusion criteria of healthy older people. Seventy eight percent did not consume any medication, 100% were able to perform physical activities that required at least three metabolic equivalents (Mets). Basic laboratory showed that approximately 90% of subjects had normal values, using standard benchmarks established for an adult population. the protocol used in this work was able to identify healthy older people with low disease burden and good functionality. It also validated history and comprehensive geriatric assessment as reliable instruments to identify these subjects.

Risk and Protective Factors Associated with Health-Related Quality of Life Among Older Gay and Bisexual Men Living With HIV Disease

PubMed Central

Emlet, Charles A.

2013-01-01

Purpose: To identify risk and protective factors associated with mental and physical health-related quality of life, after controlling for key background characteristics, in a population of older gay and bisexual men living with HIV disease. Previous research examining quality of life among persons living with HIV rarely includes older adults. Design and Methods: Survey responses from 226 gay and bisexual men aged 50 and older, and living with HIV disease, which were part of the Caring and Aging with Pride study, were analyzed using multivariate linear regression models. Results: Findings reveal that comorbidity, limitations in activities, and victimization are significant risk factors for decreased physical and mental health-related quality of life. Stigma and HIV progression did not contribute to the overall outcome variables in multivariate models. Social support and self-efficacy serve as protective factors although social support was only significant with mental health-related quality of life. Implications: Comorbidity, functional limitations, and lifetime victimization are risks to quality of life among older gay and bisexual men with HIV disease. Self-efficacy and social support represent intrapersonal and interpersonal resources that can be enhanced through interventions to improve health-related quality of life. PMID:23355449

The Lifestyle Interventions and Independence for Elders Study: design and methods.

PubMed

Fielding, Roger A; Rejeski, W Jack; Blair, Steven; Church, Tim; Espeland, Mark A; Gill, Thomas M; Guralnik, Jack M; Hsu, Fang-Chi; Katula, Jeffrey; King, Abby C; Kritchevsky, Stephen B; McDermott, Mary M; Miller, Michael E; Nayfield, Susan; Newman, Anne B; Williamson, Jeff D; Bonds, Denise; Romashkan, Sergei; Hadley, Evan; Pahor, Marco

2011-11-01

As the number of older adults in the United States rises, maintaining functional independence among older Americans has emerged as a major clinical and public health priority. Older people who lose mobility are less likely to remain in the community; demonstrate higher rates of morbidity, mortality, and hospitalizations; and experience a poorer quality of life. Several studies have shown that regular physical activity improves functional limitations and intermediate functional outcomes, but definitive evidence showing that major mobility disability can be prevented is lacking. A Phase 3 randomized controlled trial is needed to fill this evidence gap. The Lifestyle Interventions and Independence for Elders (LIFE) Study is a Phase 3 multicenter randomized controlled trial designed to compare a supervised moderate-intensity physical activity program with a successful aging health education program in 1,600 sedentary older persons followed for an average of 2.7 years. LIFE's primary outcome is major mobility disability, defined as the inability to walk 400 m. Secondary outcomes include cognitive function, serious fall injuries, persistent mobility disability, the combined outcome of major mobility disability or death, disability in activities of daily living, and cost-effectiveness. Results of this study are expected to have important public health implications for the large and growing population of older sedentary men and women.

The Influence of Pain Severity and Interference on Satisfaction with Pain Management among Middle-Aged and Older Adults

PubMed Central

Krok-Schoen, Jessica L.; O'Connor, Melissa L.; Brooks, Amber K.

2016-01-01

Background. Health outcomes are often contingent on how effective the individual is able to manage existent illness-related symptoms. This is all the more relevant among chronic pain patients. Objective. This study aimed to identify indicators of pain treatment satisfaction among middle-aged and older adults (N = 150) receiving outpatient treatment from a comprehensive cancer center. Methods. Patients were surveyed on questions assessing pain treatment satisfaction, pain severity, and additional social characteristics. Results. Descriptive data showed that middle-aged adults reported more pain locations, greater pain severity, and less satisfaction with pain treatment. A multivariate model was specified, showing older adults being more satisfied with their pain treatment. For the middle-aged adults, treatment satisfaction was generally lower with greater pain severity. This counters that for the older adults, where treatment satisfaction remained consistent despite increased levels of pain severity. Conclusion. These findings address an important issue regarding how pain is experienced across the life course. This suggests that general assumptions cannot be made about the health outcomes of older adults. Beyond the descriptive definitions of pain, there remains the need to develop models that account for determinants that may account for the pain experience among a diverse adult population. PMID:28100956

Cooking for One or Two: Applying Participatory Action Research to improve community-dwelling older adults' health and well-being.

PubMed

Chojenta, Catherine; Mingay, Edwina; Gresham, Ellie; Byles, Julie

2018-04-01

This paper describes the process of the redevelopment and expansion of Cooking for One or Two, a community-based nutrition education program for older adults. This project took place in a large regional city in NSW Australia from September 2011 to September 2013. Previous Cooking for One or Two participants and Hunter Medical Research Institute Research Register members were recruited for focus groups (n = 37), recipe testing (n = 19) and telephone interviews (n = 55) to aid in the development and expansion of the program. Participant's experiences and preferences informed the development of a supplementary cookbook and add-on education modules. Through a variety of methods, the research team sought ongoing feedback on the content and direction of the program. Content experts also reviewed the health promotion information for appropriateness. Utilising the Participatory Action Research process resulted in an expanded set of materials for Cooking for One or Two that can enable older people to engage in peer-to-peer education and to take care of their nutritional and social health. The process is a valuable example of the success of ongoing collaboration between researchers and program developers with the target population. SO WHAT?: While the research team developed evidence-based content for the expanded program, the key to success was the continued engagement with the target population. This engagement fostered a sense of ownership over the program by participants and has led to continued support by the target population. © 2018 Australian Health Promotion Association.

Disparity in Dental Attendance Among Older Adult Populations: A Comparative Analysis Across Selected European Countries and the United States

PubMed Central

Manski, Richard; Moeller, John; Chen, Haiyan; Widström, Eeva; Listl, Stefan

2015-01-01

Background The current study addresses the extent to which diversity in dental attendance across population subgroups exists within and between the United States and selected European countries. Method The analyses relied on 2006/2007 data from the Survey of Health, Ageing, and Retirement in Europe (SHARE) and 2004–2006 data from of the Health and Retirement Study (HRS) in the United States for respondents aged 51 years and older. Logistic regression models were estimated to identify impacts of dental care coverage and oral as well as general health status on dental care use. Results We were unable to discern significant differences in dental attendance across population subgroups in countries with and without social health insurance, between the USA and European countries, and between European countries classified by social welfare regime. Patterns of diverse dental use were found, but they did not appear predominately in countries classified by welfare state regime or by presence or absence of social health insurance. Conclusions Findings of this study suggest that income and education have stronger and more persistent correlation with dental use than the correlation between dental insurance and dental use across European countries. We conclude that (1) higher overall rates of coverage in most European countries, compared to relatively lower rates in the USA, contribute to this finding and that (2) policies targeted to improving the income of older persons and their awareness of the importance of oral health care in both Europe and the USA can contribute to improving the use of dental services. PMID:26465093

Coexisting Frailty, Cognitive Impairment, and Heart Failure: Implications for Clinical Care

PubMed Central

Butts, Brittany; Gary, Rebecca

2015-01-01

Objective To review some of the proposed pathways that increase frailty risk in older persons with heart failure and to discuss tools that may be used to assess for changes in physical and cognitive functioning in this population in order to assist with appropriate and timely intervention. Methods Review of the literature. Results Heart failure is the only cardiovascular disease that is increasing by epidemic proportions, largely due to an aging society and therapeutic advances in disease management. Because heart failure is largely a cardiogeriatric syndrome, age-related syndromes such as frailty and cognitive impairment are common in heart failure patients. Compared with age-matched counterparts, older adults with heart failure 4 to 6 times more likely to be frail or cognitively impaired. The reason for the high prevalence of frailty and cognitive impairment in this population is not well known but may likely reflect the synergistic effects of heart failure and aging, which may heighten vulnerability to stressors and accelerate loss of physiologic reserve. Despite the high prevalence of frailty and cognitive impairment in the heart failure population, these conditions are not routinely screened for in clinical practice settings and guidelines on optimal assessment strategies are lacking. Conclusion Persons with heart failure are at an increased risk for frailty, which may worsen symptoms, impair self-management, and lead to worse heart failure outcomes. Early detection of frailty and cognitive impairment may be an opportunity for intervention and a key strategy for improving clinical outcomes in older adults with heart failure. PMID:26594103

Inappropriate prescribing in a large community-dwelling older population: a focus on prevalence and how it relates to patient and physician characteristics.

PubMed

Amos, T B; Keith, S W; Del Canale, S; Orsi, P; Maggio, M; Baccarini, S; Gonzi, G; Liu, M; Maio, V

2015-02-01

The prescription of potentially inappropriate medications (PIMs) for older adults is a well-known population health concern. Updated country-specific estimates of inappropriate prescribing in older adults using germane explicit criteria are needed to facilitate physician-tailored quality improvement strategies. Therefore, we sought to determine the prevalence of PIMs for older adults in Emilia-Romagna, Italy, using the updated Maio criteria. We also evaluated patient and general practitioner (GP) characteristics related to inappropriate prescribing. Older adults (≥ 65) in 2012 were evaluated in a one-year retrospective study using administrative health care data. The 2011 Maio criteria includes 25 medications reimbursed by the Italian National Formulary, in the following categories in terms of severity: 16 medications that 'should always be avoided,' 3 that are 'rarely appropriate,' and 6 that have 'some indications although they are often misused.' To evaluate the extent of associations between patient and GP related characteristics, we used generalized estimating equations with an exchangeable covariance design to fit robust logistic regression models. A total of 865,354 older adults were in the cohort and 28% had at least one PIM. Of the entire cohort, 8%, 10%, and 14% of individuals were prescribed at least one medication that 'should always be avoided,' is 'rarely appropriate,' and has 'some indications but are often misused,' respectively. Older patients (≥ 75) and females were more likely to be exposed to PIMs. 2,923 GPs were identified in the region, each having prescribed at least one PIM, of which older GPs (≥ 56), male GPs, and solo practice GPs were more likely to prescribe PIMs to their older patients. The high prevalence of PIM exposure among older adults is a substantial issue in the region. Knowing how patient and GP characteristics relate to PIMs exposure may improve the design and targeting of initiatives for improving prescribing safety in this population. © 2014 John Wiley & Sons Ltd.

Household characteristics for older adults and study background from SAGE Ghana Wave 1.

PubMed

Biritwum, Richard B; Mensah, George; Minicuci, Nadia; Yawson, Alfred E; Naidoo, Nirmala; Chatterji, Somnath; Kowal, Paul

2013-06-11

Globally, the population aged 60 years and older is projected to reach 22% by 2050. In sub-Saharan Africa, this figure is projected to exceed 8%, while in Ghana, the older adult population will reach 12% by 2050. The living arrangements and household characteristics are fundamental determinants of the health and well-being of this population, data sources about which are increasingly available. The World Health Organization's Study on global AGEing and adult health (SAGE) Wave 1 was conducted in China, Ghana, India, Russian Federation, Mexico, and South Africa between 2007 and 2010. SAGE Ghana Wave 1 was implemented in 2007/08 using face-to-face interviews in a nationally representative sample of persons aged 50-plus, along with a smaller cohort aged 18-49 years for comparison purposes. Household information included a household roster including questions about health insurance coverage for all household members, household and sociodemographic characteristics, status of the dwelling, and economic situation. Re-interviews were done in a random 10% of the sample and proxy interviews done where necessary. Verbal autopsies were conducted for deaths occurring in older adult household members in the 24 months prior to interview. The total household population was 27,270 from 5,178 households. The overall household response rate was 86% and household cooperation rate was 98%. Thirty-four percent of household members were under 15 years of age while 8.3% were aged 65-plus years. Households with more than 11 members were more common in rural areas (57.2%) and in the highest income quintile (30.6%). Household members with no formal education formed 24.7% of the sample, with Northern and Upper East regions reaching more than 50%. Only 26.8% of the household members had insurance coverage. Households with hard floors ranged from 25.7% in Upper West to 97.7% in Ashanti region. Overall, 84.9% of the households had access to improved sources of drinking water, with the lowest at 29.6% in the Volta region. The overall rate of access to improved sanitation was just 14.9%. The findings show significant regional differences, with the three Northern Regions having worse education, income, and sanitation levels, compared to Southern and Central Regions of the country. Household characteristics and intra-household dynamics have been shown to influence health and health-seeking behaviors across a number of contexts and countries, and play a fundamental role in the well-being of older Ghanaians. SAGE Ghana is part of a multi-country study using standardized questionnaires and tested methodologies to provide household level data required to inform policy on the growing population of older adults in Ghana. With the good response rates and measures instituted to assure quality of data, this article demonstrates the high quality data and research methods of SAGE.

Relationship between Diagnostic Criteria, Depressive Equivalents and Diagnosis of Depression among Older Adults with Intellectual Disability

ERIC Educational Resources Information Center

Langlois, L.; Martin, L.

2008-01-01

Background: Depression is more common among persons with an intellectual disability (ID) than the general population, and may be expected to increase with age just as in the general population. However, little is known about depression among older adults with ID. The literature has questioned the use of standard diagnostic criteria for depression…

34 CFR 367.32 - How does the Secretary reallot funds under section 752(j)(4) of the Act?

Code of Federal Regulations, 2013 CFR

2013-07-01

... States, as determined by the Secretary, whose population of older individuals who are blind has a... populations in other States of older individuals who are blind. (b) The amounts referred to in paragraph (a... year only. (Approved by the Office of Management and Budget under control number 1820-0018) (Authority...

34 CFR 367.32 - How does the Secretary reallot funds under section 752(j)(4) of the Act?

Code of Federal Regulations, 2014 CFR

2014-07-01

... States, as determined by the Secretary, whose population of older individuals who are blind has a... populations in other States of older individuals who are blind. (b) The amounts referred to in paragraph (a... year only. (Approved by the Office of Management and Budget under control number 1820-0018) (Authority...

An Investigation of the Most Influential Factors Predicting Nursing Students' Knowledge and Attitude toward Older Persons

ERIC Educational Resources Information Center

Little, Elaine B.

2017-01-01

The aging population with complex health needs is growing. Nursing programs are challenged to educate student nurses competent and willing to meet this specific population's needs. Research on ageism supports the presence of aging bias. Possible negative attitudes towards older persons by nursing students is a concern for nurse educators. Nursing…

Long-Term Adjustment after Surviving Open Heart Surgery: The Effect of Using Prayer for Coping Replicated in a Prospective Design

ERIC Educational Resources Information Center

Ai, A. L.; Ladd, K. L.; Peterson, C.; Cook, C. A.; Shearer, M.; Koenig, H. G.

2010-01-01

Purpose: Despite the growing evidence for effects of religious factors on cardiac health in general populations, findings are not always consistent in sicker and older populations. We previously demonstrated that short-term negative outcomes (depression and anxiety) among older adults following open heart surgery are partially alleviated when…

Aging in the United States: An Education Module.

ERIC Educational Resources Information Center

Population Reference Bureau, Inc., Washington, DC.

The elderly are projected to make up a quarter of the U.S. population by the year 2025. This teaching kit introduces students to the major issues surrounding the growth of the elderly population. Young people whom older citizens are counting on for care and support are, for the most part, unaware of the impact that this burgeoning older population…

Outcomes of Surgery for Stress Urinary Incontinence in the Older Woman

PubMed Central

Ellington, David R.; Erekson, Elisabeth A.; Richter, Holly E.

2015-01-01

Synopsis As population demographics continue to evolve, specifics on age-related outcomes of stress urinary incontinence interventions will be critical to patient counseling and management planning. Understanding medical factors unique to older woman and their lower urinary tract condition will allow caregivers to optimize surgical outcomes, both physical and functional, and minimize complications within this population. PMID:26476111

HIV/AIDS Interventions in an Aging U.S. Population

ERIC Educational Resources Information Center

Jacobson, Stephanie A.

2011-01-01

According to the Centers for Disease Control and Prevention (CDC), 25 percent of people living with HIV in the United States in 2006 were age 50 and older. HIV prevention for people over 50 is an important health concern, especially as the U.S. population grows older. Scholarly research has identified the need for HIV/AIDS interventions in the…

Children in an aging society.

PubMed

Uhlenberg, Peter

2009-06-01

This article explores ways in which population aging in the United States between 2010 and 2030 might impact the well-being of children, with a distinction made between advantaged and disadvantaged children. A variety of economic and demographic statistics are used to describe the changing age structure of the population and changing public spending on older people and children. Data from the 1985 General Social Survey and Wave 2 of the National Survey of Families and Households are also used to examine connections between older people and children. In recent decades, there has been a graying of the federal budget, and programs for children have received a declining proportion of domestic spending. These trends will be exaggerated between 2010 and 2030 unless structural changes occur. Grandparents may provide increasing resources for their grandchildren. Age segregation results in relatively few older people being directly involved with children not related to them by kinship. The implications of population aging for children are relevant primarily for disadvantaged children. Disadvantaged children have grandparents with fewest resources and are most in need of public spending. As costs of supporting the older population increase, intentional social changes will be needed to prevent growing inequality among children.

The Kimberley Assessment of Depression of Older Indigenous Australians: Prevalence of Depressive Disorders, Risk Factors and Validation of the KICA-dep Scale

PubMed Central

Almeida, Osvaldo P.; Flicker, Leon; Fenner, Stephen; Smith, Kate; Hyde, Zoe; Atkinson, David; Skeaf, Linda; Malay, Roslyn; LoGiudice, Dina

2014-01-01

Objective This study aimed to develop a culturally acceptable and valid scale to assess depressive symptoms in older Indigenous Australians, to determine the prevalence of depressive disorders in the older Kimberley community, and to investigate the sociodemographic, lifestyle and clinical factors associated with depression in this population. Methods Cross-sectional survey of adults aged 45 years or over from six remote Indigenous communities in the Kimberley and 30% of those living in Derby, Western Australia. The 11 linguistic and culturally sensitive items of the Kimberley Indigenous Cognitive Assessment of Depression (KICA-dep) scale were derived from the signs and symptoms required to establish the diagnosis of a depressive episode according to the DSM-IV-TR and ICD-10 criteria, and their frequency was rated on a 4-point scale ranging from ‘never’ to ‘all the time’ (range of scores: 0 to 33). The diagnosis of depressive disorder was established after a face-to-face assessment with a consultant psychiatrist. Other measures included sociodemographic and lifestyle factors, and clinical history. Results The study included 250 participants aged 46 to 89 years (mean±SD = 60.9±10.7), of whom 143 (57.2%) were women. The internal reliability of the KICA-dep was 0.88 and the cut-point 7/8 (non-case/case) was associated with 78% sensitivity and 82% specificity for the diagnosis of a depressive disorder. The point-prevalence of a depressive disorder in this population was 7.7%; 4.0% for men and 10.4% for women. Heart problems were associated with increased odds of depression (odds ratio = 3.3, 95% confidence interval = 1.2,8.8). Conclusions The KICA-dep has robust psychometric properties and can be used with confidence as a screening tool for depression among older Indigenous Australians. Depressive disorders are common in this population, possibly because of increased stressors and health morbidities. PMID:24740098

Nurses’ Practice Environment and Their Job Satisfaction: A Study on Nurses Caring for Older Adults in Shanghai

PubMed Central

Wang, Ying; Dong, Weizhen; Mauk, Kristen; Li, Peiying; Wan, Jin; Yang, Guang; Fang, Lyuying; Huan, Wan; Chen, Chun; Hao, Mo

2015-01-01

Aim To examine the job satisfaction of nurses who are caring for older adults in healthcare settings in Shanghai, and to explore the underlying factors in order to explain and predict nurses’ job satisfaction. Background China has the largest elderly population in the world, and its population is aging rapidly. Studies on job satisfaction of nurses providing care for the elderly in China can help to identify problem areas and develop strategies for the improvement of nurses’ working conditions. However, to date, this subject matter has not been thoroughly studied in the Chinese context. Previous studies in other countries show that many factors impact nurses’ job satisfaction, with the practice environment being a critical factor. There is a serious nursing shortage in China, especially in the big cities such as Shanghai. Given the increasing care demand of the aging population, learning about the job satisfaction level among nurses who are caring for older adults can provide essential information to help attract and retain nurses in this specialty area. Methods A cross-sectional survey was conducted among 444 nurses in 22 elderly care institutions in Shanghai. The Chinese version of the Index of Work Satisfaction (IWS) and the Nursing Practice Environment Scale were instruments used. Inferential statistical tests used to analyze the data included Spearman correlation analysis, one-way analysis of variance, and hierarchical regression tests. Results The average overall IWS (part B) score was 135.21 ± 19.34. Personality, job and organizational characteristics were found to be the most influential factors, and the practice environment was identified as having the strongest impact on job satisfaction (Beta = 0.494). Conclusion Job satisfaction level among nurses who are caring for older adults in Shanghai is moderate, but the data suggest that this could be greatly increased if the nursing practice environment was improved. PMID:26380980

High prevalence of risk factors in elderly patients using drugs associated with acquired torsades de pointes chronically in Colombia

PubMed Central

Moreno‐Gutiérrez, Paula Andrea; Gaviria‐Mendoza, Andrés; Cañón, Mauricio Montoya

2016-01-01

Aims Medication is one of the main causes of long QT syndrome (LQTS) and torsades de pointes (TdP), and the older adult population is at particularly high risk. The aim of the present study was to describe the prescription patterns of drugs with a risk of TdP in the Colombian older adult population. Methods Patients older than 65 years who received medication with a risk of TdP during three consecutive months were selected. The medication was obtained and classified according to the QT Drug List from Crediblemeds.org. The data were analysed using SPSS‐22. Results A total of 55 932 patients were chronically receiving QT‐prolonging drugs; 61.9% (n = 34 ,632) were women and the mean age of the sample was 75.6 years. Drugs with a conditional risk were consumed by 95.2% of patients, 5.3% received drugs with a known risk and 2.9% received drugs with a possible risk. Two or more QT‐prolonging drugs were consumed by 10.3% of the patients (n = 5786). Most of the sample (96.8%, n = 54 170) had at least one additional risk factor for LQTS, with a mean of 3.1 ± 0.9 risk factors. Patients receiving QT‐prolonging drugs for psychiatric and neurological disease were at a higher risk of major polypharmacy [odds ratio (OR) 3.0; 95% confidence interval (CI) 2.80, 3.22) and of receiving high doses of QT‐prolonging drugs (OR 3.8; 95% CI 3.52, 4.05). Conclusions The widespread use of medication that causes TdP and the high prevalence of additional risks in the older adult population raise the need for accurate prediction of risk and constant patient monitoring. Patients taking psychiatric drugs are at a higher risk of TdP. PMID:27060989

Factors Influencing Decision Making for Carotid Endarterectomy versus Stenting in the Very Elderly

PubMed Central

Heo, Sung Hyuk; Bushnell, Cheryl D.

2017-01-01

As the population ages worldwide, the number of elderly patients with carotid stenosis is also increasing. There have been many large clinical trials comparing carotid endarterectomy (CAE) versus stenting, but the inclusion criteria (i.e., symptomatic or asymptomatic), stenting methods (i.e., protection device), and primary end point (i.e., the definition of myocardial infarction and follow-up period) were different between trials. Therefore, the interpretation of those results is difficult and requires attention. When it comes to age, the patients older than 80 years were excluded or stratified to a high risk group in previous landmark trials. However, a recent guideline recommended that endarterectomy may be associated with lower stroke risk compared with carotid artery stenting in patients older than 70 years with symptomatic carotid disease. The annual risk of stroke in individuals with asymptomatic carotid stenosis is about 1–3% but the risk is about 4–12% with symptomatic stenosis without carotid intervention. Although the outcome of CAE is better than that of carotid stenting in patients older than 70 years, the perioperative risk is higher in older patients. Therefore, it is important to classify high risk patients and consider underlying disability and life expectancy of very elderly patients before deciding whether to undergo a carotid intervention. In addition, we should also consider that the stroke rate with intensive medical treatment is unknown and is currently being investigated in randomized controlled trials. Intensive medical treatment includes high intensity statins, diabetes and blood pressure control, and aggressive antiplatelet treatment. The aim of this review is to report the factors that may be responsible for the variability in the treatment of carotid stenosis, particularly in the elderly population. This will allow the readers to integrate the current available evidence to individualize the treatment of carotid stenosis in this challenging population. PMID:28603515

The Prevalence, Correlates, Detection and Control of Diabetes among Older People in Low and Middle Income Countries. A 10/66 Dementia Research Group Population-Based Survey

PubMed Central

Salas, Aquiles; Acosta, Daisy; Ferri, Cleusa P.; Guerra, Mariella; Huang, Yueqin; Jacob, K. S.; Jimenez-Velazquez, Ivonne Z.; Llibre Rodriguez, Juan J.; Sosa, Ana L.; Uwakwe, Richard; Williams, Joseph D.; Jotheeswaran, A. T.; Liu, Zhaorui; Lopez Medina, A. M.; Salinas-Contreras, Rosa Maria; Prince, Martin J.

2016-01-01

Background Little is known of the epidemiology of diabetes among older people in low and middle income countries. We aimed to study and compare prevalence, social patterning, correlates, detection, treatment and control of diabetes among older people in Latin America, India, China and Nigeria. Methods Cross-sectional surveys in 13 catchment area sites in nine countries. Diagnosed diabetes was assessed in all sites through self-reported diagnosis. Undiagnosed diabetes was assessed in seven Latin American sites through fasting blood samples (glucose > = 7mmol/L). Results Total diabetes prevalence in catchment sites in Cuba (prevalence 24.2%, SMR 116), Puerto Rico (43.4%, 197), and urban (27.0%, 125), and rural Mexico (23.7%, 111) already exceeds that in the USA, while that in Venezuela (20.9%, 100) is similar. Diagnosed diabetes prevalence varied very widely, between low prevalences in sites in rural China (0.9%), rural India (6.6%) and Nigeria (6.0%). and 32.1% in Puerto Rico, explained mainly by access to health services. Treatment coverage varied substantially between sites. Diabetes control (40 to 61% of those diagnosed) was modest in the Latin American sites where this was studied. Diabetes was independently associated with less education, but more assets. Hypertension, central obesity and hypertriglyceridaemia, but not hypercholesterolaemia were consistently associated with total diabetes. Conclusions Diabetes prevalence is already high in most sites. Identifying undiagnosed cases is essential to quantify population burden, particularly in least developed settings where diagnosis is uncommon. Metabolic risk factors and associated lifestyles may play an important part in aetiology, but this requires confirmation with longitudinal data. Given the high prevalence among older people, more population research is indicated to quantify the impact of diabetes, and to monitor the effect of prevention and health system strengthening on prevalence, treatment and control. PMID:26913752

Diabetes management. Analysis of the American Diabetes Association's clinical practice recommendations.

PubMed

Strano-Paul, L; Phanumas, D

2000-04-01

Type 2 diabetes generally develops in persons older than age 45 and comprises more than 90% of the estimated 15 million diabetes cases identified in the United States. Due to the burgeoning population of older Americans and the increased prevalence of obesity and sedentariness, type 2 diabetes is nearing epidemic proportions. Tight glycemic control combined with good diet and regular exercise can reduce the incidence of complications associated with unchecked disease. To help physicians and patients achieve such objectives, the American Diabetes Association publishes clinical practice recommendations that propose the most effective methods for screening, diagnosis, and disease management. The position statements presenting the standard of care for treatment of diabetes are reviewed and critiqued from an evidence-based medicine perspective.

The social determinants of substance abuse in African American baby boomers: effects of family, media images, and environment.

PubMed

Pope, Robert C; Wallhagen, Margaret; Davis, Harvey

2010-07-01

Grounded theory methodology was used to explore the social processes involved in the use of illicit drugs in older African Americans as an underpinning to the development of approaches to nursing care and treatment. Interviews were conducted with six older African American substance users who were currently in drug treatment programs. Responses to the questions were recorded, transcribed, and analyzed using constant comparative methods. Three core themes emerged: (a) family, (b) media images, and (c) environment. The core issues of substance abuse, such as the environment and larger societal forces, cannot be addressed by one discipline and mandate that clinicians move to an interdisciplinary approach to achieve a plan of care for this growing population.

Disseminating a clinically effective physical activity program to preserve mobility in a community setting for older adults

USDA-ARS?s Scientific Manuscript database

Background: As the population of older adults continues to increase, the dissemination of strategies to maintain independence of older persons is of critical public health importance. Recent large-scale clinical trial evidence has definitively shown intervention of moderate-intensity physical activi...

The New Majority: Impact of Older Students upon the University Today.

ERIC Educational Resources Information Center

Stern, Milton R.

1992-01-01

A discussion of the impact of an older college student population on European higher education looks at the organization of continuing education, part-time education, professional continuing education, distance learning, retirement programs for older adults, continuing education funding, staffing for no-credit education, centralized vs.…

Marketing to Older American Consumers.

ERIC Educational Resources Information Center

Mertz, Barbara; Stephens, Nancy

1986-01-01

Examined older adults as a potential market for American businesses. Data indicate that in terms of size and income, senior citizens comprise a substantial buying group. Their buying styles, product and service needs, and shopping behavior vary from younger adults and within the older adult population. Strategies for successful marketing are…

Understanding Older People’s Readiness for Receiving Telehealth: Mixed-Method Study

PubMed Central

2018-01-01

Background The Dutch Ministry of Health has formulated ambitious goals concerning the use of telehealth, leading to subsequent changes compared with the current health care situation, in which 93% of care is delivered face-to-face. Since most care is delivered to older people, the prospect of telehealth raises the question of whether this population is ready for this new way of receiving care. To study this, we created a theoretical framework consisting of 6 factors associated with older people’s intention to use technology. Objective The objective of this study was to understand community-dwelling older people’s readiness for receiving telehealth by studying their intention to use videoconferencing and capacities for using digital technology in daily life as indicators. Methods A mixed-method triangulation design was used. First, a cross-sectional survey study was performed to investigate older people’s intention to use videoconferencing, by testing our theoretical framework with a multilevel path analysis (phase 1). Second, for deeper understanding of older people’s actual use of digital technology, qualitative observations of older people executing technological tasks (eg, on a computer, cell phone) were conducted at their homes (phase 2). Results In phase 1, a total of 256 people aged 65 years or older participated in the survey study (50.0% male; median age, 70 years; Q1-Q3: 67-76). Using a significance level of .05, we found seven significant associations regarding older people’s perception of videoconferencing. Older people’s (1) intention to use videoconferencing was predicted by their performance expectancy (odds ratio [OR] 1.26, 95% CI 1.13-1.39), effort expectancy (OR 1.23, 95% CI 1.07-1.39), and perceived privacy and security (OR 1.30, 95% CI 1.17-1.43); (2) their performance expectancy was predicted by their effort expectancy (OR 1.38, 95% CI 1.24-1.52); and (3) their effort expectancy was predicted by their self-efficacy (OR 1.55, 95% CI 1.42-1.68). In phase 2, a total of 6 men and 9 women aged between 65 and 87 years participated in the qualitative observation study. Of the primary themes, 5 themes were identified that could provide greater understanding of older people’s capacities and incapacities in using digital technology: (1) “self-efficacy and digital literacy,” (2) “obstacles to using technology,” (3) “prior experience and frequency of use,” (4) “sources of support and facilitating conditions,” and (5) “performance expectancy.” These 5 themes recurred in all 15 observations. Conclusions Performance expectancy, effort expectancy, and perceived privacy and security are direct predictors of older people’s intention to use videoconferencing. Self-efficacy appeared to play a role in both older people’s intention to use, as well as their actual use of technology. The path analysis revealed that self-efficacy was significantly associated with older people’s effort expectancy. Furthermore, self-efficacy and digital literacy appeared to play a major role in older people’s capacities to make use of digital technology. PMID:29625950

Evacuating People and Their Pets: Older Floridians' Need for and Proximity to Pet-Friendly Shelters.

PubMed

Douglas, Rachel; Kocatepe, Ayberk; Barrett, Anne E; Ozguven, Eren Erman; Gumber, Clayton

2017-10-04

Pets influence evacuation decisions, but little is known about pet-friendly emergency shelters' availability or older adults' need for them. Our study addresses this issue, focusing on the most densely populated area of Florida (Miami-Dade)-the state with the oldest population and greatest hurricane susceptibility. We use Geographic Information Systems (GIS)-based methodology to identify the shortest paths to pet-friendly shelters, based on distance and congested and uncongested travel times-taking into account the older population's spatial distribution. Logistic regression models using the 2013 American Housing Survey's Disaster Planning Module examine anticipated shelter use as a function of pet ownership and requiring pet evacuation assistance. Thirty-four percent of older adults in the Miami-Dade area have pets-35% of whom report needing pet evacuation assistance. However, GIS accessibility measures show that travel time factors are likely to impede older adults' use of the area's few pet-friendly shelters. Logistic regression results reveal that pet owners are less likely to report anticipating shelter use; however, the opposite holds for pet owners reporting they would need help evacuating their pets-they anticipate using shelters. High pet shelter need coupled with low availability exacerbates older adults' heightened vulnerability during Florida's hurricane season. © The Author 2017. 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.

Bridging community and prison for older adults: invoking human rights and elder and intergenerational family justice.

PubMed

Maschi, Tina; Viola, Deborah; T Harrison, Mary; Harrison, William; Koskinen, Lindsay; Bellusa, Stephanie

2014-01-01

Older adults in prison present a significant health and human rights challenge for the criminal justice system. To date, there is no known study that provides a comprehensive examination or portrait of older persons in prison. The purpose of this paper is to understand individual, family, system, and community vulnerabilities that can complicate successful community reintegration for these individuals. This study provides a cross-sectional, descriptive analysis of biopsychosocial, spiritual, and prison use characteristics associated with a sample of 677 older prisoners, aged 50+, in a state-wide prison system. Results indicate the extent of diversity within this population based on demographic, clinical, social, legal profiles, prison service use patterns, and professional and personal contacts. Due to the diversity within this population, an interdisciplinary approach is needed to address the complex social and health care needs of an aging prison population and to plan for their reentry. Practical implications - These findings suggest the need for holistic prevention, assessment, and interventions to interrupt the social-structural disparities that foster and support pathways to incarceration and recidivism. The human rights implications for the current treatment of older adults in prison include providing in-prison treatment that promotes safety, well-being, reconciliation, and seamless bridges between prison and community for older adults and their families. The True Grit Program is presented as an example of a humanistic and holistic approach of such an approach.

Nutritional assessment of elderly patients on dialysis: pitfalls and potentials for practice.

PubMed

Rodrigues, Juliana; Cuppari, Lilian; Campbell, Katrina L; Avesani, Carla Maria

2017-11-01

The chronic kidney disease (CKD) population is aging. Currently a high percentage of patients treated on dialysis are older than 65 years. As patients get older, several conditions contribute to the development of malnutrition, namely protein energy wasting (PEW), which may be compounded by nutritional disturbances associated with CKD and from the dialysis procedure. Therefore, elderly patients on dialysis are vulnerable to the development of PEW and awareness of the identification and subsequent management of nutritional status is of importance. In clinical practice, the nutritional assessment of patients on dialysis usually includes methods to assess PEW, such as the subjective global assessment, the malnutrition inflammation score, and anthropometric and laboratory parameters. Studies investigating measures of nutritional status specifically tailored to the elderly on dialysis are scarce. Therefore, the same methods and cutoffs used for the general adult population on dialysis are applied to the elderly. Considering this scenario, the aim of this review is to discuss specific considerations for nutritional assessment of elderly patients on dialysis addressing specific shortcomings on the interpretation of markers, in addition to providing clinical practice guidance to assess the nutritional status of elderly patients on dialysis. © The Author 2017. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

Cortical bone histomorphology of known‐age skeletons from the Kirsten collection, Stellenbosch university, South Africa

PubMed Central

Heinrich, Jarred; Beresheim, Amy; Alblas, Mandi

2016-01-01

ABSTRACT Objectives Normal human bone tissue changes predictably as adults get older, but substantial variability in pattern and pace remains unexplained. Information is needed regarding the characteristics of histological variables across diverse human populations. Methods Undecalcified thin sections from mid‐thoracic ribs of 213 skeletons (138 M, 75 F, 17–82 years, mean age 48 years), are used to explore the efficacy of an established age‐at‐death estimation method and methodological approach (Cho et al.: J Forensic Sci 47 (2002) 12‐18) and expand on it. The ribs are an age‐balanced sample taken from skeletonized cadavers collected from 1967 to 1999 in South Africa, each with recorded sex, age, cause of death and government‐defined population group (129 “Colored,” 49 “Black,” 35 “White”). Results The Ethnicity Unknown equation performs better than those developed for European‐Americans and African‐Americans, in terms of accuracy and bias. A new equation based solely on the study sample does not improve accuracy. Osteon population densities (OPD) show predicted values, yet secondary osteon areas (On.Ar) are smaller than expected for non‐Black subgroups. Relative cortical area (Ct.Ar/Tt.Ar) is low among non‐Whites. Conclusions Results from this highly diverse sample show that population‐specific equations do not increase estimate precision. While within the published range of error for the method (±24.44 years), results demonstrate a systematic under‐aging of young adults and over‐aging of older adults. The regression approach is inappropriate. The field needs fresh approaches to statistical treatment and to factors behind cortical bone remodeling. Am J Phys Anthropol 160:137–147, 2016. © 2016 The Authors American Journal of Physical Anthropology Published by Wiley Periodicals, Inc. PMID:26865244

How many steps/day are enough? For older adults and special populations

PubMed Central

2011-01-01

Older adults and special populations (living with disability and/or chronic illness that may limit mobility and/or physical endurance) can benefit from practicing a more physically active lifestyle, typically by increasing ambulatory activity. Step counting devices (accelerometers and pedometers) offer an opportunity to monitor daily ambulatory activity; however, an appropriate translation of public health guidelines in terms of steps/day is unknown. Therefore this review was conducted to translate public health recommendations in terms of steps/day. Normative data indicates that 1) healthy older adults average 2,000-9,000 steps/day, and 2) special populations average 1,200-8,800 steps/day. Pedometer-based interventions in older adults and special populations elicit a weighted increase of approximately 775 steps/day (or an effect size of 0.26) and 2,215 steps/day (or an effect size of 0.67), respectively. There is no evidence to inform a moderate intensity cadence (i.e., steps/minute) in older adults at this time. However, using the adult cadence of 100 steps/minute to demark the lower end of an absolutely-defined moderate intensity (i.e., 3 METs), and multiplying this by 30 minutes produces a reasonable heuristic (i.e., guiding) value of 3,000 steps. However, this cadence may be unattainable in some frail/diseased populations. Regardless, to truly translate public health guidelines, these steps should be taken over and above activities performed in the course of daily living, be of at least moderate intensity accumulated in minimally 10 minute bouts, and add up to at least 150 minutes over the week. Considering a daily background of 5,000 steps/day (which may actually be too high for some older adults and/or special populations), a computed translation approximates 8,000 steps on days that include a target of achieving 30 minutes of moderate-to-vigorous physical activity (MVPA), and approximately 7,100 steps/day if averaged over a week. Measured directly and including these background activities, the evidence suggests that 30 minutes of daily MVPA accumulated in addition to habitual daily activities in healthy older adults is equivalent to taking approximately 7,000-10,000 steps/day. Those living with disability and/or chronic illness (that limits mobility and or/physical endurance) display lower levels of background daily activity, and this will affect whole-day estimates of recommended physical activity. PMID:21798044

Feasibility study of an attention training application for older adults.

PubMed

Hill, Nikki L; Mogle, Jacqueline; Colancecco, Elise; Dick, Robert; Hannan, John; Lin, Feng Vankee

2015-09-01

Technology-based attention training has demonstrated promise in its potential to improve cognitive functioning in older people. Developing mobile applications, with older users specifically in mind, may support future dissemination of these interventions and integration into daily life. The purpose of this pilot study was to test the feasibility of an Attention Training Application (ATA) for community-dwelling older adults using mobile technology. A descriptive, mixed-methods design was used to capture older adults' feedback on the usability and acceptability of the ATA. A convenience sample of older adults (n = 9) from two independent living facilities participated in a 2-hour training and practice session with the ATA. Participants were given personally tailored instructions for using the mobile device and the ATA specifically. Following a practice session, participants provided ratings on multiple components of the ATA and completed an audio-recorded, semi-structured interview to provide detailed descriptions of their experience and perceptions. An iterative process of content analysis was used to characterise the open-ended responses. Participants rated the ATA favourably overall on several 0-10 scales including likeability [8.5 (1.6)], interest [8.8 (2.3)] and satisfaction [8.2 (1.9)]. The qualitative analyses revealed several issues relevant to the feasibility of the ATA among older people including the importance of the technological background of the user, limiting negative feedback, challenges with the touch screen interface, personal preferences for challenge, extending the practice period and the difficulty of the dual-task condition. The use of the ATA is feasible in the older adult population. Future development should specifically consider personal characteristics as well as preferences to maximise usability and acceptability among older people. Older adults enjoyed the ATA. This opens doors to user-friendly technological interventions that may be effective in assisting older adults maintain and possibly even improve their cognitive function. © 2015 John Wiley & Sons Ltd.

Unusual trend in the prevalence of trisomy 13 in mothers aged 35 and older: A population based study of national congenital anomaly data.

PubMed

Nair, Deepa Balachandran; Tucker, David; Hughes, Rhian; Greenacre, Judith; Morgan, Margery

2015-07-01

Trisomy 13 is one of the three autosomal trisomies compatible with viability. It is associated with structural anomalies, learning disability and poor survival. Advanced maternal age is the most frequently suggested risk factor. This is a population based register study to investigate the temporal trends of trisomy 13. Chromosomal trisomies were reviewed by the Welsh Congenital Anomaly Register using data from 1998-2012. All pregnancy outcomes were included. Prevalence rates and trends for all cases and for cases with mothers aged below 35 years and those aged 35 years and older were plotted for trisomy 13, 18 and 21. Possible risk factors contributing to the trend in older mothers were compared in the early and late period of the study. There were 124 cases of trisomy 13 over the 15 year period with 55 mothers aged 35 years and older. Overall prevalence was 2.5 per 10,000 total births. A significant declining trend in the prevalence of trisomy 13 in mothers aged 35 and older (χ(2) trend = 4.98, p=0.026) was noted. Rates for younger mothers were lower and remained stable. Prevalence of trisomy 18 and 21 in older mothers remained stable. The unexpected declining trend in trisomy 13 in older mothers could not be explained by the risk factors examined in this study. There have been no other reports of trends in the prevalence of trisomy 13 in older mothers in recent years. There is further need for surveillance of trends in future and in other populations. © 2015 Wiley Periodicals, Inc.

Ten-year fatal and non-fatal myocardial infarction incidence in elderly populations in Spain: the EPICARDIAN cohort study

PubMed Central

Gabriel, Rafael; Alonso, Margarita; Reviriego, Blanca; Muñiz, Javier; Vega, Saturio; López, Isidro; Novella, Blanca; Suárez, Carmen; Rodríguez-Salvanés, Francisco

2009-01-01

Background In Spain, more than 85% of coronary heart disease deaths occur in adults older than 65 years. However, coronary heart disease incidence and mortality in the Spanish elderly have been poorly described. The aim of this study is to estimate the ten-year incidence and mortality rates of myocardial infarction in a population-based large cohort of Spanish elders. Methods A population-based cohort of 3729 people older than 64 years old, free of previous myocardial infarction, was established in 1995 in three geographical areas of Spain. Any case of fatal and non-fatal myocardial infarction was investigated until December 2004 using the "cold pursuit method", previously used and validated by the the WHO-MONICA project. Results Men showed a significantly (p < 0.001) higher cumulative incidence of myocardial infarction (7.2%; 95%CI: 5.94-8.54) than women (3.8%; 95%CI: 3.06-4.74). Although cumulative incidence increased with age (p < 0.05), gender-differences tended to narrow. Adjusted incidence rates were higher in men (957 per 100 000 person-years) than in women (546 per 100 000 person-years) (p < 0.001) and increased with age (p < 0.001). The increase was progressive in women but not in men. Adjusted mortality rates were also higher in men than in women (p < 0.001), being three times higher in the age group of ≥ 85 years old than in the age group of 65-74 years old (p < 0.001). Conclusion Incidence of fatal and non-fatal myocardial infarction is high in the Spanish elderly population. Men show higher rates than women, but gender differences diminish with age. PMID:19778417

Validity of body composition assessment methods for older men with cardiac disease.

PubMed

Young, H; Porcari, J; Terry, L; Brice, G

1998-01-01

This study was designed to determine which of several body composition assessment methods was most accurate for patients with cardiac disease for the purpose of outcome measurement. Six body composition assessment methods were administered to each of 24 men with cardiac disease. Methods included circumference measurement, skinfold measurement, near-infrared interactance via the Futrex-5000, bioelectrical impedance via the BioAnalogics ElectroLipoGraph and Tanita TBF-150, and hydrostatic weighing, the criterion measure. A repeated measures analysis of variance indicated no significant (P > .05) difference between circumference and skinfold measurements compared to hydrostatic weighing. Near-infrared interactance presented the best standard error of estimates (3.5%) and the best correlation (r = .84) with hydrostatic weighing; however, the constant error was 3.76%. Bioelectrical impedance measured by the ElectroLipoGraph and TBF-150 instruments significantly underestimated percent body fat by 8.81% and 4.8%, respectively. In this study of middle-aged to older men with cardiac disease, the best method for determining body fat was circumferences. This technique was accurate, easy to administer, inexpensive, and had a lower error potential than the other techniques. Skinfold measurements were also closely related to hydrostatic weighing, but should be performed only by experienced practitioners because there is a greater potential for tester error in certain patients. In the future, near-infrared interactance measurements may be a viable technique for body composition assessment in patients with cardiac disease. However, algorithms specific to the population of patients with cardiac disease being tested must be developed before this technique can be routinely recommended for body composition assessment. Bioelectrical impedance assessment by either method is not recommended for patients with cardiac disease, as it consistently underestimated percent body fat when compared to hydrostatic weighing in this population.

Telehealth Cognitive Behavior Therapy for Co-Occurring Insomnia and Depression Symptoms in Older Adults

PubMed Central

Lichstein, Kenneth L.; Scogin, Forrest; Thomas, S. Justin; DiNapoli, Elizabeth A.; Dillon, Haley R.; McFadden, Anna

2015-01-01

Objective Telehealth has proven effective with a wide range of disorders, but there is a paucity of data on the use of telehealth using cognitive-behavior therapy (CBT) with late-life insomnia and depression. This pilot study was designed to examine the feasibility and effectiveness of using telehealth to treat older adults with comorbid insomnia and depression living in rural Alabama. Method Five patients received 10 sessions of CBT for insomnia and depression. Patients were engaged in treatment via Skype from their primary care physician’s office. Assessments were conducted at baseline, posttreatment, and 2-month follow-up. Results Patients exhibited clinically significant improvement in both insomnia (sleep diaries and Insomnia Severity Index) and depression (Hamilton Rating Scale for Depression) at posttreatment, and these gains were well maintained at 2-month follow-up. Conclusions These preliminary data suggest that telehealth may be an effective means of providing treatment to older adults, including underserved populations. PMID:24014056

Evaluating the SF-36 Health Survey (Version 2) in Older Vietnamese Americans

PubMed Central

Ngo-Metzger, Quyen; Sorkin, Dara H.; Mangione, Carol M.; Gandek, Barbara; Hays, Ron D.

2014-01-01

Objectives The SF-36® Health Survey (Version 2; SF-36) was evaluated among older Vietnamese Americans to determine whether underlying dimensions of physical and mental health were similar to those of other groups in the United States. Method Field testing of participants from senior centers. Results The study provided support for the reliability and validity of the SF-36. Structural equation modeling provided confirmation of physical and mental health factors. However, the factor loadings for the SF-36 scales were more consistent with previous results from Asian countries than the typical pattern observed in the United States. Discussion As the older populations in the United States become more diverse, it is important to have standardized health-related quality of life measures. However, the conceptualization of physical and mental health and associations among different scales may be different for Asian immigrants than for other groups. Thus, the interpretation of the SF-36 scores needs to account for cultural differences. PMID:18381886

Executive function is independently associated with performances of balance and mobility in community-dwelling older adults after mild stroke: implications for falls prevention

PubMed Central

Liu-Ambrose, Teresa; Pang, Marco; Eng, Janice J

2015-01-01

Background Stroke survivors have a high incidence of falls. Impaired executive-controlled processes are frequent in stroke survivors and are associated with falls in this population. Better understanding of the independent association between executive-controlled processes and physiological fall risk (i.e. performances of balance and mobility) could enhance future interventions that aim to prevent falls and to promote an independent lifestyle among stroke survivors. Methods Cross-sectional analysis of 63 adults who suffered a mild stroke >1 year prior to the study, aged > or =50 years. Results Cognitive flexibility was independently associated with performances of balance and mobility in community-dwelling older adults after mild stroke, after accounting for age, quadriceps strength of the paretic side and current physical activity level. Conclusions Clinicians may need to consider cognitive function when assessing and treating impaired balance and mobility in community-dwelling older adults after mild stroke. PMID:17143004

Community-based Adapted Tango Dancing for Individuals with Parkinson's Disease and Older Adults

PubMed Central

Hackney, Madeleine E.; McKee, Kathleen

2014-01-01

Adapted tango dancing improves mobility and balance in older adults and additional populations with balance impairments. It is composed of very simple step elements. Adapted tango involves movement initiation and cessation, multi-directional perturbations, varied speeds and rhythms. Focus on foot placement, whole body coordination, and attention to partner, path of movement, and aesthetics likely underlie adapted tango’s demonstrated efficacy for improving mobility and balance. In this paper, we describe the methodology to disseminate the adapted tango teaching methods to dance instructor trainees and to implement the adapted tango by the trainees in the community for older adults and individuals with Parkinson’s Disease (PD). Efficacy in improving mobility (measured with the Timed Up and Go, Tandem stance, Berg Balance Scale, Gait Speed and 30 sec chair stand), safety and fidelity of the program is maximized through targeted instructor and volunteer training and a structured detailed syllabus outlining class practices and progression. PMID:25548831

Aging on the Street: Homeless Older Adults in America.

PubMed

Sorrell, Jeanne M

2016-09-01

Older adults are at greater risk for homelessness today than at any time in recent history. Approximately one half of homeless individuals in America are older than 50, which has created serious challenges for how cities, governments, and health care providers care for homeless populations. Systems established in the 1980s to help care for homeless individuals were not designed to address problems of aging. It is critical that nurses and all health professionals have a better understanding of the unique needs and concerns of homeless older adults. Nurses can be an important part of the solution, not only through direct patient care but by advocating for improvements in care for this vulnerable population. [Journal of Psychosocial Nursing and Mental Health Services, 54(9), 25-29.]. Copyright 2016, SLACK Incorporated.

Audiologic Management of Older Adults With Hearing Loss and Compromised Cognitive/Psychoacoustic Auditory Processing Capabilities

PubMed Central

Kricos, Patricia B.

2006-01-01

The number and proportion of older adults in the United States population is increasing, and more clinical audiologists will be called upon to deliver hearing care to the approximately 35% to 50% of them who experience hearing difficulties. In recent years, the characteristics and sources of receptive communication difficulties in older individuals have been investigated by hearing scientists, cognitive psychologists, and audiologists. It is becoming increasingly apparent that cognitive compromises and psychoacoustic auditory processing disorders associated with aging may contribute to communication difficulties in this population. This paper presents an overview of best practices, based on our current knowledge base, for clinical management of older individuals with limitations in cognitive or psychoacoustic auditory processing capabilities, or both, that accompany aging. PMID:16528428

Characteristics of Refractive Errors in a Population of Adults in the Central Region of Poland.

PubMed

Nowak, Michal S; Jurowski, Piotr; Grzybowski, Andrzej; Smigielski, Janusz

2018-01-08

Background : To investigate the distribution of refractive errors and their characteristics in older adults from a Polish population. Methods : The study design was a cross-sectional study. A total of 1107 men and women were interviewed and underwent detailed ophthalmic examinations, 998 subjects underwent refraction. Myopia was defined as spherical equivalent (SER) refraction ≤-0.5 dioptres (D) and hyperopia was defined as SER ≥+0.5 dioptres (D). Results : Among those who were refracted the distribution of myopia and hyperopia was 24.1% (95% CI 21.4-26.7) and 37.5% (95% CI 34.5-40.5), respectively. Myopia decreased from 28.7% in subjects aged 35-59 years to 19.3% in those aged 60 years or older and hyperopia increased from 21.8% at 35-59 years of age to 53.3% in subjects aged ≥60 years. Multiple regression analysis showed decreasing age (OR 0.98, 95% CI 0.96-1.00), female gender (OR 1.87, 95% CI 1.18-2.95) and presence of cataract (OR 2.40, 95% CI 1.24-4.63) were independent risk factors associated with myopia. Conclusions : The distribution of refractive errors found in our study is similar to those reported in other Caucasian populations and differs from Asian populations. Myopia was positively associated with younger age, female gender and presence of cataract.

Treatment of Muscle-Invasive Bladder Cancer in Older Patients.

PubMed

Skinner, Eila C

2016-01-01

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

Onset Time of Inhibition of Return is a Promising Index for Assessing Cognitive Functions in Older Adults.

PubMed

Li, Tingni; Wang, Lei; Huang, Wanyi; Zhen, Yanfen; Zhong, Chupeng; Qu, Zhe; Ding, Yulong

2018-06-06

Developing efficient tools for assessing general cognitive functions in older adults is essential. Previous studies found that inhibition of return (IOR) occurred later in the older adults than in the younger (e.g., Castel, Chasteen, Scialfa, & Pratt, 2003). However, little is known about the relationship between the onset time of IOR (IOR-OT) and cognitive functions in the aging population. The present study examined this issue and investigated the potential of using IOR-OT as an index of cognitive functioning in older adults. In two studies, the IOR-OT of healthy younger and older adults was measured by a modified Posner peripheral cueing task, and cognitive functions of the older adults were evaluated with the Addenbrooke's Cognitive Examination Revised (ACE-R). Both studies showed a significant correlation (r = ~0.5) between IOR-OT and cognitive functions as assessed by ACE-R in older individuals: later IOR-OT was accompanied by a lower ACE-R score. To our knowledge, the present studies are the first to discover a relatively strong correlation between IOR-OT and cognitive functions in older adults. These findings provide new evidence supporting the inhibition deficit theory of aging and lay the foundation of using IOR-OT as an objective measure of cognitive functions in the aging population.

Glycemic targets and medication limitations for type 2 diabetes mellitus in the older adult.

PubMed

Thompson, Angela M; Linnebur, Sunny A; Vande Griend, Joseph P; Saseen, Joseph J

2014-02-01

To review the optimal management of type 2 diabetes mellitus (T2DM) in the older adult. A PubMed search was completed to identify publications in the English language from 1947 to 2013 using combinations of the search terms: geriatrics, aged, diabetes mellitus, and type 2 diabetes mellitus. References of articles were also reviewed for inclusion if not identified in the PubMed search. Original studies, clinical reviews, and guidelines were identified and evaluated for clinical relevance. Although the number of older adults with T2DM is growing, evidence for the treatment of T2DM in this population is lacking. Barriers such as polypharmacy, comorbid conditions, economic limitations, cognitive impairment, and increased risk of hypoglycemia may limit optimal glycemic control in older adults. Several organizations provide recommendations for glycemic targets and recommend using standard glycemic goals in most healthy older adults. However, less stringent goals are necessary in certain older populations such as those patients with limited life expectancy and severe hypoglycemia. In general, glycemic goals should be individualized in older patients. Age-related pharmacokinetic and pharmacodynamic changes, comorbid conditions, adverse drug reactions, ease of medication administration, and cost of medications necessitate the need to individualize pharmacologic therapy. Glycemic targets and medication use for T2DM should be individualized in older adults.

Disability Transitions and Health Expectancies among Adults 45 Years and Older in Malawi: A Cohort-Based Model

PubMed Central

Payne, Collin F.; Mkandawire, James; Kohler, Hans-Peter

2013-01-01

Background Falling fertility and increasing life expectancy contribute to a growing elderly population in sub-Saharan Africa (SSA); by 2060, persons aged 45 y and older are projected to be 25% of SSA's population, up from 10% in 2010. Aging in SSA is associated with unique challenges because of poverty and inadequate social supports. However, despite its importance for understanding the consequences of population aging, the evidence about the prevalence of disabilities and functional limitations due to poor physical health among older adults in SSA continues to be very limited. Methods and Findings Participants came from 2006, 2008, and 2010 waves of the Malawi Longitudinal Survey of Families and Health, a study of the rural population in Malawi. We investigate how poor physical health results in functional limitations that limit the day-to-day activities of individuals in domains relevant to this subsistence-agriculture context. These disabilities were parameterized based on questions from the SF-12 questionnaire about limitations in daily living activities. We estimated age-specific patterns of functional limitations and the transitions over time between different disability states using a discrete-time hazard model. The estimated transition rates were then used to calculate the first (to our knowledge) microdata-based health expectancies calculated for SSA. The risks of experiencing functional limitations due to poor physical health are high in this population, and the onset of disabilities happens early in life. Our analyses show that 45-y-old women can expect to spend 58% (95% CI, 55%–64%) of their remaining 28 y of life (95% CI, 25.7–33.5) with functional limitations; 45-y-old men can expect to live 41% (95% CI, 35%–46%) of their remaining 25.4 y (95% CI, 23.3–28.8) with such limitations. Disabilities related to functional limitations are shown to have a substantial negative effect on individuals' labor activities, and are negatively related to subjective well-being. Conclusions Individuals in this population experience a lengthy struggle with disabling conditions in adulthood, with high probabilities of remitting and relapsing between states of functional limitation. Given the strong association of disabilities with work efforts and subjective well-being, this research suggests that current national health policies and international donor-funded health programs in SSA inadequately target the physical health of mature and older adults. Please see later in the article for the Editors' Summary PMID:23667343

Age and sex differences of risk factors of activity limitations in Japanese older adults.

PubMed

Monma, Takafumi; Takeda, Fumi; Noguchi, Haruko; Tamiya, Nanako

2016-06-01

The objective of the present study was to verify how socioeconomic and physical/mental health status would be associated with activity limitations by age and sex among older adults, using nationally representative cross-sectional data in Japan. The present study focused on 8373 older adults aged 65 years or older extracted from the Comprehensive Survey of Living Conditions conducted in 2007 by the Japanese Ministry of Health, Labor and Welfare. Univariate and multiple logistic regression analyses and population-attributable risk were applied to validate the relationships of socioeconomic and physical/mental health status with activity limitations among the total population, and by age groups (young-old or old-old) and sex. Mental health showed the highest odds ratio and population-attributable risk in the total population. In addition, low back pain was associated with activity limitations regardless of age and sex. Other musculoskeletal diseases, such as arthropathy and osteoporosis, were related to activity limitations for women, regardless of age, whereas cardiovascular diseases, including angina pectoris/myocardial infarction and cerebral stroke, were associated with activity limitations for men in any age group. There were no statistically significant correlations between socioeconomic status and activity limitations in any groups. Mental health was the most important factor of activity limitations in Japanese older adults. Furthermore, low back pain regardless of age and sex, other musculoskeletal diseases only for women and cardiovascular diseases mainly for men could also be significant risk factors to activity limitations. Therefore, preventive approaches of activity limitations considering sex differences are important for older adults in Japan. Geriatr Gerontol Int 2015; ●●: ●●-●●. © 2015 Japan Geriatrics Society.