Journal of Aging Research最新文献

Background: With an expected increase in the prevalence of dementia, change in care policies and healthcare systems worldwide is needed. Rehabilitation is increasingly recognised as contributing to dementia care. Rehabilitation subscribes to person-centredness, and thus, evaluations of person-centredness in rehabilitation for people living with dementia are relevant in order for healthcare professionals to know how best to practice person-centredness.

Aim: The aim of this study was to identify methods of evaluating person-centeredness in rehabilitation for people living with dementia.

Materials and methods: Review of the literature using the search terms dementia, person-centredness, and rehabilitation or occupational therapy. Databases searched included: CINAHL, PubMed, Embase, PsycINFO, OTseeker, and SveMed+. The study included peer-reviewed articles from year 2000 to 2018 in Danish, English, Norwegian, or Swedish.

Results: Only one academic article met the inclusion criteria. In that article, person-centred practice was evaluated using observation and interview as well as analytical frameworks from person-centred care and occupational therapy.

Conclusion: Evaluations of person-centred practice in rehabilitation for people living with dementia in peer-reviewed literature are lacking. Evaluations are needed to identify effective strategies to pursue and uphold person-centred care. Given the dearth of research on evaluations of person-centredness in rehabilitation, this article included research in person-centred dementia care in the discussion, which potentially can inspire practice and research of rehabilitation for people living with dementia. To understand the complex nature of person-centredness, a variety of research methodologies of qualitative and quantitative characters are recommended for evaluations.

Subjective memory complaints (SMCs) and social capital were known to be related to self-rated health (SRH). Despite this, no studies have examined the potential interaction of SMC and social capital on SRH. Using data from a cross-sectional health survey of men and women aged 56 years and above (n = 6,421), we examined how SMCs and social capital explained SRH in a population of community-dwelling older adults in a semirural area in Malaysia. We also evaluated whether SRH's relationship with SMCs is moderated by social capital. The association of SMC and social capital with poor SRH was investigated using multivariable logistic regression. Social capital (OR = 0.86, 95% CI = 0.82-0.89), mild SMC (OR = 1.70, 95% CI = 1.50-1.94), and moderate SMC (OR = 1.90, 95% CI = 1.63-2.20) were found to be associated with poor SRH after adjustment for sociodemographic factors and depression in the initial regression model. SMC was found to have partial interaction effects with social capital which was included in the subsequent regression model. Unlike individuals with no SMC and mild SMC, those who reported moderate SMC did not show decreasing probabilities of poor SRH despite increasing levels of social capital. Nevertheless, this analysis suggests that social capital and SMC are independent predictors of poor SRH. Further research needs to be targeted at improving the understanding on how social capital and SMC moderate and interact with the perception of health in older adults.

Purpose: To describe the proportions of inadequate protein intake (IPI) per day and per meal and their association with functionality in middle to older aged Mexican adults.

Materials and methods: In a cross-sectional design, we evaluated the protein intake and functionality of instrumental activities of daily living (IADL) and activities of daily living (ADL) of 190 middle to older aged Mexican adults. IPI was considered as any protein intake: <1.2 g/kg/day, <30 g/meal, or <0.4 g/kg/meal. Functionality was organized into three groups: high, middle, and low scores. The first was set as the reference, and the other was considered as impaired functionality. With a multinomial logistic regression, we analyzed the association between IPI per day and per meal with impaired functionality.

Results: A high proportion of participants showed IPI per day. The meal with the highest proportion of IPI was dinner, followed by breakfast and lunch for both criteria. IPI at lunch was a significant risk factor for impaired functionality in ADL when assessed with the 30 g/meal criterion (low scores, OR 3.82 (95% CI, 1.15-12.65); middle scores, OR 2.40 [1.03-5.62]). For the 0.4 g/kg/meal criterion, IPI at dinner was a significant risk factor for IADL middle scores only (OR 7.64, [1.27-45.85]).

Conclusion: IPI per meal is high in middle to older aged Mexican adults, and at specific meals, it is a significant risk factor for impaired functionality in activities of daily living.

Background: Dysphagia is a predictor of mortality in Parkinson's disease (PD). Developing alternative methods to videofluoroscopy swallowing study (VFSS) for the evaluation of dysphagia is a public health necessity. The Swallowing Clinical Assessment Score in Parkinson's Disease (SCAS-PD) is an alternative and low-cost tool for diagnosis of dysphagia, but had not been properly validated in comparison to the gold-standard method. The objective of this study was to assess the validity and reliability of the SCAS-PD.

Methods: SCAS-PD was applied to 31 patients with PD, and VFSS was conducted concurrently. This clinical assessment uses different volumes and viscosities to identify signs of swallowing impairments. For validation purposes, the interclass correlation coefficient and the weighted kappa were calculated. The AUC of the ROC curve, sensitivity, and specificity values for detection of penetration/aspiration (PA) were assessed. Internal consistency was calculated by Cronbach's alpha.

Results: Fifty-one percent of patients were classified with dysphagia. SCAS-PD was differentiated between normal/functional deglutition and dysphagia with AUC 0.97, 95% CI 0.92-1.00, and an optimal cutoff at 19 (sensitivity 100% and specificity 87.5%). The internal consistency was α = 0.91 for the total score. The internal consistency of the SCAS-PD domains was oral phase (α = 0.73), pharyngeal phase (α = 0.86), and signs of PA (α = 0.95). The weighted kappa analysis demonstrated a high rate of concordance at 0.71 (p < 0.001) between SCAS-PD and VFSS.

Conclusions: SCAS-PD has been shown to have a good concordance with the VFSS. Considering this, SCAS-PD is highly applicable in clinical settings, since it is a simple and low-cost diagnostic tool for detecting dysphagia in PD patients.

Objectives: Obesity-related physiological changes can limit improvements of obese subjects after training. The aim was to investigate obesity, muscular strength, and physical function in community-dwelling nonsarcopenic old adults.

Methods: Nonsarcopenic subjects (N=229, 73.7 ± 5.7 years; 21% normal weight, 42% overweight, and 37% obese based on body mass index (BMI)) participated in a 12-week resistance exercise program. Leisure time physical activity (LTPA), body composition (dual-energy X-ray absorptiometry), quadriceps strength (maximum voluntary isometric contraction; absolute and relative to body weight), and physical function in terms of 6-minutes-walk-for-distance (6MWD) and timed up and go (TUG) were measured baseline and endpoint.

Results: At baseline, normal weight participants had lower absolute quadriceps strength (-43 ± 22 N, P=0.015) than obese, but better quadriceps strength relative to body weight (1.4 ± 0.7 N/kg, P < 0.001), 6MWD (53 ± 27 m, P < 0.001), and TUG (-1.4 ± 0.7 sec, P ≤ 0.001). LTPA was positively associated with 6MWD and TUG (both P < 0.05), but based on general linear models, differences in LTPA between BMI categories did not explain differences in 6MWD and TUG between BMI categories. During the program, dropout (11.9%) and attendance (85%) were similar between BMI groups. After the intervention, body composition and physical function significantly improved in all three BMI categories; however, normal weight participants lost more body fat (-1.53 ± 0.78%, P=0.014), gained more lean mass (0.70 ± 0.36 kg, P < 0.001) and relative quadriceps strength (0.31 ± 0.16 N/kg, P=0.017), and improved more on the 6MWD (24 ± 12 m, P < 0.001) but gained less grip strength (-2.4 ± 1.3 N/kg, P=0.020) compared to obese. There were no differences in TUG or absolute quadriceps strength changes between the BMI strata. Physical function at baseline as well as training success of overweight participants was located between the normal weight and obesity groups.

Conclusion: Nonsarcopenic obese community-dwelling old adults have lower physical function than their normal weight counterparts. This difference is not explained by lower LTPA. A 12-week resistance exercise program improves body composition and physical function in normal weight, overweight, and obese old adults; however, obese participants experience less favorable changes in body composition and physical function than normal weight individuals. This trial is registered with NCT01074879.

Aim: To determine morbidity and mortality in elderly patients following hip fracture surgery in Egypt and its correlates and to determine the utility of the POSSUM scale to predict morbidity and mortality among our population.

Methodology: We assessed postoperative morbidity and mortality following hip fracture surgery in a 6-month prospective observational study of 100 elderly patients who were undergoing surgical repair at the beginning of the study. The exclusion criteria included surgically unfit patients and patients refusing to participate in the study. The study was conducted in Ain Shams University Hospital, Ain Shams Specialized Hospital, and El-helal Hospital.

Results: The subjects were categorized as survivors and nonsurvivors according to the 6-month mortality, and the groups were compared statistically according to this classification. The observed 6-month mortality was 19.56%. POSSUM had high specificity for predicting 6-month survival (97.3%). A multivariate regression analysis revealed that postoperative admission to the intensive care unit and lack of ambulation were major risk factors associated with the 6-month mortality.

Conclusions: The POSSUM system had high specificity for predicting survivors (97.3%) but failed to predict mortality (sensitivity = 5.6%). The major risks for 6-month mortality are intensive care unit admission and lack of ambulation.

Introduction: Sarcopenia is defined as the progressive loss of skeletal muscle mass, associated with aging. A multidisciplinary approach has been increasingly prioritized in elderly care. A technique that has been widely used by the seniors is acupuncture.

Objectives: To analyse the effects of acupuncture in muscle strength and in inflammatory markers of older people with sarcopenia.

Methods: The sample was composed by 53 elderly people, aged over 60 years. Inclusion criteria were as follows: male and female seniors, sedentary and who were not under acupuncture treatment during the survey period. Assessment of body composition, handgrip strength, and functional test and IL-6, IL-10, and TNF-α cytokines analyses were performed. After verification of the physical examination, the subjects were divided into two groups (sarcopenic and nonsarcopenic). The first group was then randomized (by drawing lot) to be further divided into two subgroups: G1, composed of sarcopenic elderly people who received acupuncture intervention, and G2, composed of sarcopenic elderly people who did not receive intervention. The nonsarcopenic elderly people composed the group 3 (G3) and did not receive acupuncture intervention. ANOVA Split Plot was performed for intergroup comparison. For intragroup evaluation, ANOVA was conducted for repeated measures. For the delta values, ANCOVA was performed with the pretest as covariant. A p < 0.05 significance level was adopted.

Results: 26 older people concluded the collections. There was no statistically significant difference between the G1 group and the other ones regarding the assessed variables (muscle mass, muscle strength, functionality, and inflammatory markers).

Conclusion: The results allow us to infer that it is possible that the conducted intervention protocol has not produced any significant effects in the studied population. UTN number: RBR-8df2h4.

Purpose: In the present study, we aimed to investigate the effects of tomato powder (TP) on glucose and lipid metabolism, as well as oxidative stress and the NF-κB, mTOR, and Nrf2 pathways during the aging process in healthy rats.

Methods and results: Male Wistar rats were randomly assigned to four groups as follows: (i) Control group 1 (n=15, 3-week old): rats were fed standard diet for 7 weeks; (ii) TP group 1 (n=15, 3-week old): rats were fed standard diet supplemented with TP for 7 weeks; (iii) Control group 2 (n=15, 8-week old): rats were fed standard diet for 69 weeks; and (iv) TP group 2 (8-week old): rats were fed standard diet supplemented with TP for 69 weeks. TP supplementation significantly reduced the hyperglycemia, hypertriglyceridemia, and hypercholesterolemia and improved liver function and kidney function in 77-week old rats compared with the control animals (P < 0.05). In addition, TP significantly decreased the serum and liver MDA levels (P < 0.003 and P < 0.001, respectively) while increasing the activities of liver SOD (P < 0.001), CAT (P < 0.008), and GPx (P < 0.01) compared with the control groups in both 10-week-old and 77-week-old rats (P < 0.05). Age-related increases in phosphorylation of NF-κBp65, mTOR, 4E-BP1, and P70S6K were observed in livers of 77-week-old rats compared to those of 10-week-old rats (P < 0.001). TP supplementation decreased the expression of NF-κBp65 and activation of mTOR, 4E-BP1, and P70S6K in livers of 77-week-old rats compared to the control animals. Moreover, TP supplementation significantly elevated Nrf2 expression in livers of both 10-week-old and 77-week-old rats (P < 0.05).

Conclusion: TP ameliorates age-associated inflammation and oxidative stress through the inhibition of NF-κBp65, mTOR pathways, and Nrf2 activation may explain the observed improvement in glucose and lipid metabolism as well as the improved liver and kidney functions.

Despite increased rates of disease, disability, and social losses with aging, seniors consistently report higher levels of subjective well-being (SWB), a construct closely related to happiness, than younger adults. In this exploratory study, we utilized an available dataset to investigate how aspects of health commonly deteriorating with age, including sensory (i.e., vision and hearing) and cognitive status, relate to variability in self-described contributors to happiness. Community-dwelling seniors (n = 114) responded to a single-item prompt: "name things that make people happy." 1731 responses were categorized into 13 domains of SWB via structured content analysis. Sensory health and cognition were assessed by Snellen visual acuity, pure-tone audiometry, and in-person administration of the Brief Test of Adult Cognition by Telephone (BTACT) battery. A subset of eligible participants (n = 57) underwent functional magnetic resonance imaging (fMRI) to assess resting state functional connectivity (FC) within a previously described dopaminergic network associated with reward processing. SWB response patterns were relatively stable across gender, sensory status, and cognitive performance with few exceptions. For example, hearing-impaired participants listed fewer determinants of SWB (13.59 vs. 17.16; p < 0.001) and were less likely to name things in the "special events" category. Participants with a higher proportion of responses in the "accomplishments" domain (e.g., winning, getting good grades) demonstrated increased FC between the ventral tegmental area and nucleus accumbens, regions implicated in reward and motivated behavior. While the framework for determinants of happiness among seniors was largely stable across the factors assessed here, our findings suggest that subtle changes in this construct may be linked to sensory loss. The possibility that perceptions about determinants of happiness might relate to differences in intrinsic connectivity within reward-related brain networks also warrants further investigation.

Targeted screening for dementia among older adults in primary healthcare has potential benefits such as better clinical outcomes and the opportunity to access services. Cognitive screening can be followed up by further diagnostic assessment to determine a diagnosis of dementia. Unfortunately, the rates of accepting further diagnostic assessment following cognitive screening are low. The objective of this study was to explore the caregivers' decision-making process regarding uptake of diagnostic assessment following positive screening results. A qualitative design was employed, and interpretative phenomenological analysis was used to analyze the data. Three major themes in caregiver decision-making were identified: gathering information, protecting the patient, and balancing obligation and convenience in caregiving. These findings suggest that the decision-making process involved effort to process information through observations of the patient and that caregivers emphasized quality of life.