Geriatrics最新文献

Non-melanoma skin cancers (NMSCs) are a significant cause of morbidity and mortality; their incidence is increasing most in older patients. NMSCs have traditionally been treated with surgical excision, curettage, Mohs micrographic surgery (MMS), and superficial radiotherapy (SRT). Image-guided SRT (IGSRT) is a treatment option for poor surgical candidates or patients with low- or high-risk, early-stage NMSC who prefer to avoid surgery. This large retrospective cohort study compared 2-, 4-, and 6-year freedom from recurrence in biopsy-proven NMSC lesions treated with IGSRT (n = 20,069 lesions) between patients aged < 65 years (n = 3158 lesions) and ≥65 years (n = 16,911 lesions). Overall freedom from recurrence rates were 99.68% at 2 years, 99.57% at 4 years, and 99.57% at 6 years. Rates did not differ significantly by age (p = 0.8) nor by sex among the two age groups (p > 0.9). There was a significant difference in recurrence among older patients when analyzed by stage (p = 0.032), but no difference by stage in younger patients (p = 0.7). For early-stage NMSCs, IGSRT is a clinically equivalent alternative to MMS and statistically significant in superiority to non-image-guided SRT. This study demonstrates that there is no significant effect of age on 2-, 4-, or 6-year freedom from recurrence in patients with IGSRT-treated NMSC.

Although many physical activity (PA) interventions for older adults have proven effective in controlled research settings, optimal implementation in real life remains challenging. This study identifies determinants perceived by stakeholders when implementing community-based PA interventions for older adults. We interviewed 31 stakeholders guided by the Consolidated Framework for Implementation Research (CFIR). Results showed that stakeholders are very specific about the role they can play in implementation, making collaboration between stakeholders crucial. Barriers and motivators were identified in the CFIR intervention characteristics domain (relative advantage, complexity and costs, evidence quality and strength, and adaptability and trialability), in the outer setting domain (cosmopolitism, patient needs, and external policy and incentives), in the inner setting domain (implementation climate, relative priority, compatibility and organizational incentives and rewards) and in the individual characteristics domain (knowledge and beliefs, and other personal attributes). An overarching theme was the stakeholders' emphasis on aiming for broad health goals in interventions, as they perceive PA as a means to reach these goals rather than an end in itself. Another overarching theme requiring attention in future implementation efforts is the need to tailor implementation efforts to the specific needs of older adults as the end users of the intervention.

The promotion of oral health in nursing care is essential for preventing oral diseases and maintaining health in elderly vulnerable populations. There is a need for standardized guidelines and education. The aim of this study was to collect data on the attitudes and hopes of caregivers regarding the implementation of the German Expert Nursing Standard "Promotion of Oral Health in Nursing" (GENS-POHN) and to evaluate their oral healthcare knowledge before implementation. A cross-sectional study was conducted in five different care settings in Germany. A self-administered questionnaire was used to collect data on the attitudes and hopes of nursing assistants regarding the GENS-POHN. Oral healthcare knowledge was evaluated before implementation. Most participants had a positive attitude towards the GENS-POHN and hoped that its implementation would lead to greater safety and competence in daily oral healthcare tasks. Few participants currently use screening or assessment instruments for oral care. There is a need for further education and training, as well as the development and implementation of standardized guidelines and tools for screening and assessment, in oral care. The GENS-POHN as an expert standard could be made accessible to an international audience by translating it into other respective national languages, thereby enhancing its usability for a wider range of users.

The objective of the present study was to analyze the psychometric properties of a life satisfaction scale in older Peruvian adults using an exploratory graph analysis (EGA) approach. A total of 407 older adults aged between 60 and 95 years (M = 69.5; SD = 6.7) from three comprehensive elderly care centers (CIAMs) in Lima, Peru, were recruited. A non-probabilistic convenience sampling was used. The Satisfaction with Life Scale (SWLS) was analyzed using EGA with the Gaussian GLASSO model to assess its dimensionality and structural consistency. The relationship with other variables was analyzed using scales such as the GAD-7 and PHQ-9. The network structure of the SWLS indicates a single dimension. Additionally, network loadings (nodes) were examined, showing high values (>0.35) for most items except item 1, which had a moderate loading (>0.25). Structural reliability showed that a single dimension was identified 100% of the time. The post hoc CFA considering the unidimensional network structure obtained through EGA showed satisfactory fit (χ2/df = 3.48, CFI = 0.96, TLI = 0.92, SRMR = 0.02, RMSEA = 0.07 [90% CI 0.05, 0.08]). Finally, internal consistency reliability was acceptable (ω = 0.92). The SWLS measure is robust and consistent. These findings are a valuable reference for advancing research on aging in Peru, as they provide a practical, valid, and reliable measure.

Aging is a natural, complex, and individual process that focuses on the progressive decay of the body and a decrease in cell function that begins in approximately the sixth decade of life and ends with death. Current scientific evidence shows that the aging process is mostly related to genetic load and varies because of the environment. Therefore, aging can be adjusted through the intervention of factors that control homeostasis in genetic, biochemical, and immunological processes, including those involving the gut microbiota. Indeed, the diversity of the gut microbiota decreases during aging, based on the presence of modifications in the hormonal, immunological, and operational processes of the gastrointestinal tract. These modifications lead to a state of dysbiosis. However, altering bacterial communities remains complicated due to the great diversity of factors that influence their modification. Alterations caused by the aging process are known to foster dysbiosis and correspond to conditions that determine the degree of frailty in senior citizens. Consequently, the microbial structure can be used as a biomarker for geriatric care in the promotion of healthy aging.

The global increase in dementia cases highlights the urgent need for effective treatment and care strategies. The aim of this study was to evaluate the effects of group reminiscence therapy on cognitive function, subjective well-being, and behavioral and psychological symptoms of dementia (BPSD) in older adults with moderate to severe dementia. A pre-post comparative design was used, with 49 participants receiving eight group reminiscence therapy sessions over 4 weeks. Baseline, one-week, and one-month postintervention assessments were conducted using the Hasegawa Dementia Scale-Revised (HDS-R), the Neuropsychiatric Inventory-Nursing Home Version (NPI-NH), and the Philadelphia Geriatric Center Morale Scale (PGC Morale Scale). The results showed no significant improvement in HDS-R scores, but significant improvements in PGC Morale Scale (p = 0.0417) and NPI-NH scores (p = 0.00226), indicating improved well-being and reduced BPSD. These findings suggest that group reminiscence therapy is effective in improving BPSD. Future research should focus on extending the duration of the intervention, including different populations, and combining group reminiscence therapy with other therapeutic approaches to fully determine its long-term benefits and mechanisms. Research on its cost-effectiveness and cultural applicability could further validate and improve the use of group reminiscence therapy in diverse care settings.

Age-related declines in the musculoskeletal system may place additional demands on the lumbar spine during everyday activities such as walking. This study aimed to investigate age-related differences in the functional demand (FD) of walking on the lumbar spine in older and younger adults. A motion analysis system with integrated force plates was used to acquire kinematic and kinetic data on 12 older (67.3 ± 6.0 years) and 12 younger (24.7 ± 3.1 years) healthy men during walking at a self-selected speed along a 10 m walkway. Isokinetic dynamometry was used to acquire the maximal joint moment capacity of the lumbar spine. The FD of the lumbar spine was calculated as the muscle moment during key phases of the gait cycle (GC) relative to the maximum moment capacity of the lumbar spine. The difference in FD between age groups was not significant (p = 0.07) and there were no significant differences between the young group (YG) and older group (OG) for any individual phase in the GC. Despite the lack of statistical significance, the results indicate that a practical difference may exist, as walking was approximately 20% more functionally demanding on the lumbar spine in the OG compared to the YG. Therefore, older adults may employ modified gait strategies to reduce mechanical load whilst walking to fall within the limits of their maximal force-producing capacity in the lumbar spine, which may have implications for injury risk.

The number of patients hospitalized with dementia is increasing, but one symptom, apathy, tends to be overlooked and unaddressed. Thus, this study determines how nurses certified in dementia nursing engage with older patients with dementia who exhibit apathy during hospitalization. A qualitative study using semi-structured interviews with 10 dementia care nurses in Japan was conducted. Through conventional content analysis, 10 categories were generated. They included (1) initiating patient engagement when their physiological or daily-life problems become more pronounced, (2) assessing and identifying the causes of decreased motivation from multiple perspectives, (3) assessing patients from multiple perspectives to determine the best way to start supporting them, (4) providing reassurance through basic dementia care, (5) incorporating pleasant stimuli into the hospital environment, (6) providing care based on patients' circumstances and abilities by collaborating with multiple professionals. Nurses initiate involvement with patients when their daily life problems become more pronounced. They conduct comprehensive assessments from multiple perspectives and collaborate with other professionals to ensure patient care and safety. They also extend their support to patients' families and maintain long-term involvement. Apathetic older patients benefit from basic nursing care practices and a patient-centered approach, which do not require specialization or additional costs and resources.

In the last decades, the scientific interest in ageing has increased due to the progressive ageing of the global population and due to the importance of guaranteeing the elder people and the next generations a good quality of life and biopsychological well-being. However, nowadays, there is not a common and accepted definition of ageing. This situation may refer to the complexity and relevance of the ageing topic and it means that the concept of ageing needs to be understood in a deeper way as a multidimensional and complex process that includes different elements distinctive. The main goal of this review is to explore the definitions and conceptual models of ageing according to a psychological point of view, through a biopsychosocial approach, that integrates biological, psychological, and social aspects with the main goal of a better understanding of the complexity of the process itself.

Methods: We conducted a review of the literature through PubMed, Scopus, Web of Science and Google Scholar databases, and we followed the PRISMA-ScR guidelines, analysing papers written in English between 2002 and 2023.

Results: The review showed different conceptual models of ageing, including Rowe and Kahn's successful ageing model, the World Health Organization's models, and others like the "Selection, Optimization and Compensation" Model. Also, the determinants and predictors of ageing have been analysed highlighting the individual variability and the multidimensional nature of ageing. The geographic diversity of the included studies allowed for the analysis of cultural, socioeconomic, and environmental differences in the conceptualisation of ageing.

Conclusions: The results emphasise the importance of targeted interventions and programs aimed at promoting well-being during ageing, considering the complexity and multidimensionality of the ageing process.

Owing to increasing super-aging societies, older adults will be encouraged to continue working. Although demand exists for older adults to continue working in Japanese society, the enabling factors have not been clarified. This study aimed to clarify (1) the life functions that affect the working status among younger-older adults who continue to work and those who do not via the Kihon Checklist (KCL) and (2) examine whether the number of areas of difficulties in daily functions of the KCL affected older adults' employment status. This cross-sectional study involved 5386 older men and women aged 65 years or older in one city in Japan. Employment status and the seven domains of the Kihon Checklist (KCL) were analyzed. The KCL items related to employment status were the physical (odds ratio = 2.46, p < 0.01), socialization (odds ratio = 1.95, p < 0.01), and mood domains (odds ratio = 1.29, p < 0.01). Furthermore, the odds ratio increased to 2.06 when three or more domains were applicable. To remain employed, one must be physically and mentally healthy. Furthermore, since the risk of non-employment increased when one KCL domain was applicable, a broader assessment of life functions is necessary.