Journal of Aging Research最新文献

Frail older people have an inherent risk of polypharmacy due to the need to treat multiple comorbidities, thus leading to various negative effects on their health due to the adverse actions from the drugs. This issue was discussed from a person-centered perspective, highlighting the category of frail older adults who are at a higher risk. Appropriate medication reconciliation in this population with useful prescribing tools (Beers and START/STOPP criteria) to minimize polypharmacy and to provide alternative prescriptive intervention could go alongside primary care to reduce the extent of frailty and polypharmacy. Reducing delayed referrals and extended hospitalization with electronic health record systems and using the signs of frailty from the Electronic Frailty Index (EFI) to predict polypharmacy for frail older persons are preventative approaches that proactively respond to frailty associated with the risk of polypharmacy.

Background: Recent advances in medicine have caused positive impact on the life expectancy of most countries, resulting in increased older adult population. Aging comes with a number of health challenges. This study investigated health conditions of older adults at admission and clinical outcomes in a regional referral hospital in southwestern Uganda.

Methods: A retrospective study reviewed clinical data of older adult patients admitted between January 2016 and December 2017. Demographic data, cause of admission, length, and outcomes of hospitalization are described.

Results: Up to 813 patient files were reviewed. The patients had been hospitalized to emergency, 371 (45.6%); medical, 355 (43.7%); surgical, 84 (10.3%); psychiatry, 2 (0.3%); and obstetrics and gynecology, 1 (0.1%) wards. The majority, 427 (52.5%), of the patients were females. Cancer was the most common reason for hospitalization, 130/889 (14.6%), followed by stroke, 94/889 (10.6%); heart failure, 76/889 (8.6%); chronic obstructive pulmonary disease, 56/889 (6.3%); pneumonia, 47/889 (5.3%); and head injury, 45/889 (5.1%), whilst 560 (68.9%) of the hospitalized patients were discharged, 197 (24.2%) died, 18 (2.2%) were referred for advanced care, and 38 (4.7%) escaped from the facility. The emergency ward had the highest deaths, 101 (51.3%), then medical, 56 (28.4%), and surgical, 39 (19.8%), wards. Mortality of those who died was admitted with stroke, 30 (15.2%), cancer, 21 (10.7%), head injury, 16 (8.1%), heart failure, 14 (7.1%), sepsis, 14 (7.1%), and renal disease, 12 (6.1%). On average, patients were admitted for 5 days (IQR: 3-8).

Conclusions: The high proportion of mortality in this group is worrying and requires further investigations.

The aim of this study was to describe the experiences of nursing students in fall prevention during clinical practice in the context of older home care clients. This was a qualitative focus group study of nursing students (n = 9) who had completed clinical practice in older clients' home care. The data were analysed using inductive content analysis. The nursing students described their experiences regarding falls and fall prevention in older clients' home care from two perspectives: evaluation of falls at older people's homes and fall prevention during home visits. Systematic evaluation of falls was based on physical examination and is the basis of fall prevention. However, evaluation of nutrition and adverse drug effects seemed to be ignored. In addition, fall prevention during home visits included concrete fall prevention in authentic client situations, confidential relationships with older clients, and evidence-based knowledge. From the perspective of fall prevention, there was a lack of comprehensive evaluation and understanding of the meaning of psychological factors, such as fear of falling. In order to be able to prevent falls in the older client population, students need more guidance regarding a comprehensive approach based on evaluation of falls. In addition, there is a need for continuous collaboration between education and home care services to develop educational approaches that interlink knowledge and skills in fall prevention.

This study aims to determine how demographics, socioeconomic characteristics, and lifestyle affect physical and cognitive health transitions among nonagenarians, whether these transitions follow the same patterns, and how each dimension affects the transitions of the other. We applied a multistate model for panel data to 2262 individuals over a 2-year follow-up period from the 1905 Danish Cohort survey. Within two years from baseline, the transition probability from good to bad physical health-ability to stand up from a chair-was higher than dying directly (29% vs. 25%), while this was not observed for cognition (24% vs. 27%) evaluated with Mini-Mental State Examination-a score lower than 24 indicates poor cognitive health. Probability of dying either from bad physical or cognitive health condition was 50%. Health transitions were associated with sex, education, living alone, body mass index, and physical activity. Physical and cognitive indicators were associated with deterioration of cognitive and physical status, respectively, and with survivorship from a bad health condition. We conclude that physical and cognitive health deteriorated differently among nonagenarians, even if they were related to similar sociodemographic and lifestyle characteristics and resulted dynamically related with each other.

Introduction: Sedentary behavior (SB) is highly prevalent among older adults, with more than 25% engaging in 6 hours or more of SB daily. SB has been associated with several cardiometabolic biomarkers in younger adults; however, there is a paucity of research in older populations. This study examined associations between patterns of SB and cardiometabolic biomarkers in community-dwelling adults aged 55 years and older.

Methods: Data were drawn from a convenience sample of 54 community-dwelling individuals (12 males, 42 females; mean age = 72.6 ± 6.8 years, range = 56-89 years). Cardiometabolic biomarkers assessed included systolic (SBP) and diastolic blood pressure (DBP), body mass index, waist circumference, and fasting blood glucose and cholesterol parameters. SB was assessed via accelerometry over a 7-day period, and measures included daily time in SB, number and length of sedentary bouts, the number and length of breaks between sedentary bouts, moderate-to-vigorous physical activity (MVPA), and light physical activity (LPA). Associations between the SB measures and each cardiometabolic risk factor were examined using separate stepwise multiple regression models, controlling for sex, MVPA, and accelerometer wear time. Isotemporal substitution models were used to examine the change in cardiometabolic outcomes when SB is replaced by an equal duration of either LPA or MVPA.

Results: Adjusted regression analyses showed that daily sedentary time was positively associated with DBP (β = 0.052, ∆R ² = 0.112, p = 0.022) and inversely associated with HDL cholesterol (β = -0.111, ∆R ² = 0.121, p = 0.039). Sedentary bout length was also associated with DBP and HDL cholesterol (β = 0.575, ∆R ² = 0.152, p = 0.007; β = -1.529, ∆R ² = 0.196, p = 0.007, respectively). Replacement of 10 minutes of SB a day with LPA was associated with improved DBP and HDL cholesterol (p ≤ 0.05). No other significant associations (p ≤ 0.05) were found.

Conclusion: Sitting for prolonged periods of time without interruption is unfavorably associated with DBP and HDL cholesterol. Prospective studies should identify causal relationships and observe specific changes in cardiometabolic profiles in older populations.

Physical activity and exercise have emerged as potential methods to improve brain health among older adults. However, there are currently no physical activity guidelines aimed at improving cognitive function, and the mechanisms underlying these cognitive benefits are poorly understood. The purpose of this narrative review is to present the current evidence regarding the effects of physical activity and exercise on cognition in older adults without cognitive impairment, identify potential mechanisms underlying these effects, and make recommendations for exercise prescription to enhance cognitive performance. The review begins with a summary of evidence of the effect of chronic physical activity and exercise on cognition. Attention then turns to four main biological mechanisms that appear to underlie exercise-induced cognitive improvement, including the upregulation of growth factors and neuroplasticity, inhibition of inflammatory biomarker production, improved vascular function, and hypothalamic-pituitary-adrenal axis regulation. The last section provides an overview of exercise parameters known to optimize cognition in older adults, such as exercise type, frequency, intensity, session duration, and exercise program duration.

Elderly care services are important to provide in response to the rapid growth of the elderly population. In developing countries like Indonesia, the speed of growth of the elderly population does not simultaneously occur, so the needs for care services vary. This study discusses the emergence of home care services in response to the increase in elderly population. By taking the case of community home care services in Sleman, this study found the pattern and process of the emergence of local initiatives in home care services. This study also revealed an important factor affecting the implementation of community home care services, that is, leadership.

Vitamin D is a neurosteroid hormone that regulates neurotransmitters and neurotrophins. It has anti-inflammatory, antioxidant, and neuroprotective properties. It increases neurotrophic factors such as nerve growth factor which further promotes brain health. Moreover, it is also helpful in the prevention of amyloid accumulation and promotes amyloid clearance. Emerging evidence suggests its role in the reduction of Alzheimer's disease hallmarks such as amyloid-beta and phosphorylated tau. Many preclinical studies have supported the hypothesis that vitamin D leads to attentional, behavioral problems and cognitive impairment. Cross-sectional studies have consistently found that vitamin D levels are significantly low in individuals with Alzheimer's disease and cognitive impairment compared to healthy adults. Longitudinal studies and meta-analysis have also exhibited an association of low vitamin D with cognitive impairment and Alzheimer's disease. Despite such evidence, the causal association cannot be sufficiently answered. In contrast to observational studies, findings from interventional studies have produced mixed results on the role of vitamin D supplementation in the prevention and treatment of cognitive impairment and dementia. The biggest issue of the existing RCTs is their small sample size, lack of consensus over the dose, and age of initiation of vitamin D supplements to prevent cognitive impairment. Therefore, there is a need for large double-blind randomized control trials to assess the benefits of vitamin D supplementation in the prevention and treatment of cognitive impairment.

Background/Purpose. Urinary incontinence (UI) is an important geriatric health problem, and it is linked to frailty syndrome. We had conducted a study to detect the prevalence and risk factors of UI and its effect on quality of life (QOL) among frail elderly females living in Cairo, Egypt. Methods. We carried out a cross-sectional study on 130 frail elderly females sixty years and older, attending Ain Shams Geriatrics Hospital, Cairo, Egypt. Each patient gave oral consent and then was subjected to history taking, full clinical examination, diagnosis of frailty (clinical frailty scale), assessment of UI by the Arabic version of International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF), assessment of QOL by using the Arabic version of Incontinence Impact Questionnaire Short Form (IIQ-7 SF), and complete urine analysis. Results. The prevalence of UI among the studied population was 80%. Mixed UI was the most prevalent type. UI was significantly associated with older age, functional impairment, multiparity, osteoarthritis, stroke, vaginal prolapse, and laxative use. All IIQ-7 subscales were higher (worse health-related QOL) for women with mixed UI. Conclusion. Urinary incontinence is prevalent in frail elderly females. Mixed UI, compared with other types, has a significant negative impact on all domains of quality of life.

The human aging is marked by several body changes, including in bone mineral density (BMD). Research shows that microRNAs are important modulators of bone metabolism. The present research aims to analyze the whole blood concentration of 10 selected microRNAs (miRs) and their association with absolute and relative scores of BMD in specific osseous site of Brazilian very-old adults. Forty noninstitutionalized and apparently healthy, very old (≥80 years) outpatients were eligible for research. Anthropometry, biochemistry, and densitometry measurements were performed along with coronary artery calcification (CAC) scores and tested across total circulating levels of microRNAs. As expected, the relative BMD scores for the lumbosacral region (L1 to S5) and for the femoral head and neck observed in the sample denote weakened bone architecture, compatible with prevalent osteopenia and osteoporosis. In this context, one single significant association was found, and negatively implicated the miR-34a-5p with both absolute (β = -0.36, P=0.001 for BMD) and relative (β = -0.43, P=0.001 for T-score) densitometry indexes of the femoral head (adjusted to sex and physical activity practice), but not with the other sites. No difference in total blood concentrations of the miRs was found according to CAC scores. Our findings indicate greater circulating levels for miR-34a-5p among very-old adults who display the lowest scores of BMD, being a finding consistent with a modest contribution of the miR (along with co-variables) to the mineralization of that site. Attesting clinical relevance of our findings demands forthcoming studies.