Population ageing is a global occurrence. Unfortunately, the shortage of health professionals with geriatric competencies is a major factor restricting high-quality care for older people worldwide. Strengthening the knowledge and skills of the health workforce to better respond to the needs of older people is a major global priority. Geriatricians can play a pivotal role in reorienting care for older people towards an integrated and person-centred care system focused on functional ability, preventive strategies, and age-friendly services. The current scenario requires efforts to be directed towards establishing a standardised competency-based definition of a geriatrician to allow for an accurate estimation of the existing workforce with adequate training in geriatrics as crucial resources to facilitate the paradigm shift. This Personal View, supported by the International Association of Gerontology and Geriatrics and the European Geriatric Medicine Society, proposes a standardised definition of a geriatrician based on expected competencies and roles and a precise description of the essential features of geriatric medicine. By reducing ambiguities and offering a competency-based framework, the current standardisation approach is expected to facilitate better support, monitoring, and allocation of resources for improving care for older people worldwide.
{"title":"Defining the role and reach of a geriatrician","authors":"Matteo Cesari MD PhD , Jotheeswaran Amuthavalli Thiyagarajan PhD , Antonio Cherubini MD PhD , Prof Miguel Angel Acanfora MD , Prof Prasert Assantachai MD , Prof Mario Barbagallo MD PhD , Prof Mamadou Coume MD , Theresa Diaz MD , Nicholas Fuggle MD , Prof Sonia Ouali Hammami MD PhD , Prof Kenneth Madden MD MSc , Prof Radmila Matijevic MD PhD , Prof Jean-Pierre Michel MD , Prof Mirko Petrovic MD PhD , Prof Cornel Sieber MD PhD , Nicola Veronese MD , Prof Finbarr C Martin MD , Anshu Banerjee PhD , Prof John W Rowe MD","doi":"10.1016/j.lanhl.2024.100644","DOIUrl":"10.1016/j.lanhl.2024.100644","url":null,"abstract":"<div><div>Population ageing is a global occurrence. Unfortunately, the shortage of health professionals with geriatric competencies is a major factor restricting high-quality care for older people worldwide. Strengthening the knowledge and skills of the health workforce to better respond to the needs of older people is a major global priority. Geriatricians can play a pivotal role in reorienting care for older people towards an integrated and person-centred care system focused on functional ability, preventive strategies, and age-friendly services. The current scenario requires efforts to be directed towards establishing a standardised competency-based definition of a geriatrician to allow for an accurate estimation of the existing workforce with adequate training in geriatrics as crucial resources to facilitate the paradigm shift. This Personal View, supported by the International Association of Gerontology and Geriatrics and the European Geriatric Medicine Society, proposes a standardised definition of a geriatrician based on expected competencies and roles and a precise description of the essential features of geriatric medicine. By reducing ambiguities and offering a competency-based framework, the current standardisation approach is expected to facilitate better support, monitoring, and allocation of resources for improving care for older people worldwide.</div></div>","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"5 11","pages":"Article 100644"},"PeriodicalIF":13.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142393896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.lanhl.2024.100643
Prof Giovanni Guaraldi MD , Jovana Milic MD PhD , Eduardo Gnoatto Perondi MD , Ana Catarina Rodrigues Gonçalves MD , Prof Cristina Mussini MD , Marco Antonio de Avila Vitoria MD , Prof Matteo Cesari MD PhD
The Decade of Healthy Ageing (2021–30; the Decade), proclaimed by the UN in 2020, is a global initiative aimed at fostering collaborations to transform the world into a better place to live and grow older in. The Decade presents a positive vision of ageing, discarding the stereotypes of diseases and disabilities and promoting focus on capacities and abilities. This approach will help to foster a more inclusive world and, consequently, care systems, which value the dignity of each individual. Although the initiative represents a resource for the global population, the Decade also provides a unique opportunity for the large community of people living with HIV in terms of increased visibility and long-term solutions for their specific ageing-related health issues. This Personal View focuses on the relevance of the Decade in improving the lives of people in the HIV community, the rationale for a stronger engagement of people living with HIV in this initiative, and the potential to reduce global disparities between the HIV community and the general population and among different global regions.
{"title":"The UN Decade of Healthy Ageing (2021–30) for people living with HIV","authors":"Prof Giovanni Guaraldi MD , Jovana Milic MD PhD , Eduardo Gnoatto Perondi MD , Ana Catarina Rodrigues Gonçalves MD , Prof Cristina Mussini MD , Marco Antonio de Avila Vitoria MD , Prof Matteo Cesari MD PhD","doi":"10.1016/j.lanhl.2024.100643","DOIUrl":"10.1016/j.lanhl.2024.100643","url":null,"abstract":"<div><div>The Decade of Healthy Ageing (2021–30; the Decade), proclaimed by the UN in 2020, is a global initiative aimed at fostering collaborations to transform the world into a better place to live and grow older in. The Decade presents a positive vision of ageing, discarding the stereotypes of diseases and disabilities and promoting focus on capacities and abilities. This approach will help to foster a more inclusive world and, consequently, care systems, which value the dignity of each individual. Although the initiative represents a resource for the global population, the Decade also provides a unique opportunity for the large community of people living with HIV in terms of increased visibility and long-term solutions for their specific ageing-related health issues. This Personal View focuses on the relevance of the Decade in improving the lives of people in the HIV community, the rationale for a stronger engagement of people living with HIV in this initiative, and the potential to reduce global disparities between the HIV community and the general population and among different global regions.</div></div>","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"5 11","pages":"Article 100643"},"PeriodicalIF":13.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142393897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<div><h3>Background</h3><div>To minimise severe cases and deaths from COVID-19 among high-risk populations such as older adults (aged 60 years and older), it is crucial to monitor and update vaccination strategies. In this study, we aim to provide a global profile of the current COVID-19 vaccination programmes for older adults, including vaccination policies, coverage rates, and vaccine demand.</div></div><div><h3>Methods</h3><div>We used publicly available data on the COVID-19 vaccines used, vaccination schedules, indicated age groups, and age-specific country-level vaccine coverage, updated through to July 20, 2024. Data on vaccination policy were extracted from publicly available sources in the following priority: (1) official sources (ie, government websites, health department websites, and official reports); (2) resources integrated by institutions or organisations (ie, European Center for Disease Prevention and Control, Africa Center for Disease Prevention and Control, and COVAX); and (3) cross-validated news and media reports derived from government or health department sources. We estimated coverage gaps to achievement of two specific objectives: (1) immunising 100% of older adults with primary series and a booster dose, as per WHO’s goal; and (2) surpassing WHO’s goal by administering one extra booster dose to 80% of older adults or achieving 80% coverage of a 2023–24 series vaccine.</div></div><div><h3>Findings</h3><div>192 countries reported their use of COVID-19 vaccines for older people, of which 71 vaccine products have been used for older adults and 79 countries have deployed 22 vaccines containing components against variants of concern; 122 countries offered a second booster dose or a special booster dose, while others used only primary series or one booster dose. 96 countries prioritised older people for vaccination. Among countries with available data, the median proportion of individuals completing a primary series was 81% (IQR 58·3–92·0), for a first booster was 53% (14·1–81·7), for a second booster was 44·3% (13·5–69·7), and for a 2023–24 series vaccination was 23·6% (6·6–52·4), with large differences by region. Coverage of the second booster and the 2023–24 series was lower in individuals aged 60–70 years than in older age groups. To achieve the WHO target of 100% coverage for older populations with primary series and a booster dose, 1·01 doses per person are required, and to attain an 80% coverage for a second booster or 2023–24 series, surpassing WHO’s goal, 1·43 doses per person are required.</div></div><div><h3>Interpretation</h3><div>Progress of COVID-19 vaccination programmes for older adults is uneven across countries, emphasising an ongoing challenge to achieve vaccine equity for this high-risk age group. Therefore, it is essential to establish robust and timely vaccination surveillance systems, especially to facilitate data-driven policies that promote COVID-19 vaccination campaigns worldwide.</div></div><div><h3>Fu
{"title":"Global landscape of COVID-19 vaccination programmes for older adults: a descriptive study","authors":"Wen Zheng PhD , Jiayi Dong BSc , Zhiyuan Chen BSc , Xiaowei Deng PhD , Qianhui Wu PhD , Lance E Rodewald MD , Prof Hongjie Yu PhD","doi":"10.1016/j.lanhl.2024.100646","DOIUrl":"10.1016/j.lanhl.2024.100646","url":null,"abstract":"<div><h3>Background</h3><div>To minimise severe cases and deaths from COVID-19 among high-risk populations such as older adults (aged 60 years and older), it is crucial to monitor and update vaccination strategies. In this study, we aim to provide a global profile of the current COVID-19 vaccination programmes for older adults, including vaccination policies, coverage rates, and vaccine demand.</div></div><div><h3>Methods</h3><div>We used publicly available data on the COVID-19 vaccines used, vaccination schedules, indicated age groups, and age-specific country-level vaccine coverage, updated through to July 20, 2024. Data on vaccination policy were extracted from publicly available sources in the following priority: (1) official sources (ie, government websites, health department websites, and official reports); (2) resources integrated by institutions or organisations (ie, European Center for Disease Prevention and Control, Africa Center for Disease Prevention and Control, and COVAX); and (3) cross-validated news and media reports derived from government or health department sources. We estimated coverage gaps to achievement of two specific objectives: (1) immunising 100% of older adults with primary series and a booster dose, as per WHO’s goal; and (2) surpassing WHO’s goal by administering one extra booster dose to 80% of older adults or achieving 80% coverage of a 2023–24 series vaccine.</div></div><div><h3>Findings</h3><div>192 countries reported their use of COVID-19 vaccines for older people, of which 71 vaccine products have been used for older adults and 79 countries have deployed 22 vaccines containing components against variants of concern; 122 countries offered a second booster dose or a special booster dose, while others used only primary series or one booster dose. 96 countries prioritised older people for vaccination. Among countries with available data, the median proportion of individuals completing a primary series was 81% (IQR 58·3–92·0), for a first booster was 53% (14·1–81·7), for a second booster was 44·3% (13·5–69·7), and for a 2023–24 series vaccination was 23·6% (6·6–52·4), with large differences by region. Coverage of the second booster and the 2023–24 series was lower in individuals aged 60–70 years than in older age groups. To achieve the WHO target of 100% coverage for older populations with primary series and a booster dose, 1·01 doses per person are required, and to attain an 80% coverage for a second booster or 2023–24 series, surpassing WHO’s goal, 1·43 doses per person are required.</div></div><div><h3>Interpretation</h3><div>Progress of COVID-19 vaccination programmes for older adults is uneven across countries, emphasising an ongoing challenge to achieve vaccine equity for this high-risk age group. Therefore, it is essential to establish robust and timely vaccination surveillance systems, especially to facilitate data-driven policies that promote COVID-19 vaccination campaigns worldwide.</div></div><div><h3>Fu","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"5 11","pages":"Article 100646"},"PeriodicalIF":13.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.lanhl.2024.100653
Stephanie Denise M Sison , Dae Hyun Kim
{"title":"Rethinking emergency care for older adults living with frailty","authors":"Stephanie Denise M Sison , Dae Hyun Kim","doi":"10.1016/j.lanhl.2024.100653","DOIUrl":"10.1016/j.lanhl.2024.100653","url":null,"abstract":"","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"5 11","pages":"Article 100653"},"PeriodicalIF":13.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.lanhl.2024.07.008
Iracema Leroi MD , Prof Christopher J Armitage PhD , Elizabeth M Camacho PhD , Anna Pavlina Charalambous PhD , J P Connelly MSc , Prof Fofi Constantinidou PhD , Renaud David PhD , Prof Piers Dawes PhD , Prof Rachel A Elliott PhD , Mark Hann PhD , Alison Holden MSc , Emma Hooper MSc , Sean P Kennelly PhD , Evangelia Kontogianni MSc , Prof Brian A Lawlor MD , Julie Longobardi MSc , Luke Paterson MSc , Antonis M Politis PhD , Prof David Reeves PhD , Christine Schwimmer PhD , Eric Frison PhD
<div><h3>Background</h3><div>The effect of hearing and vision difficulties on the risk of developing dementia and worsening outcomes in people already living with dementia is well established. We evaluated the clinical impact of a hearing and vision rehabilitation and support programme on quality of life in people with mild-to-moderate dementia and concurrent sensory difficulties.</div></div><div><h3>Methods</h3><div>We conducted a parallel-group, multicentre, observer-blind, superiority randomised controlled trial in seven older adult clinics in five European countries (Cyprus, France, Greece, Ireland, and the UK). People with mild-to-moderate dementia with adult-acquired hearing difficulties, vision difficulties, or both were randomly assigned (1:1) along with their care partner to an 18-week home-basedsensory support intervention (SSI) of tailored hearing and vision rehabilitation and support, or to care as usual. Randomisation was blocked (block size of four, six, or eight) and stratified by country, with allocation assigned via a remote web-based system. The SSI included: full hearing assessment, vision assessment, or both; fitting of hearing aids, glasses, or other sensory aids; and home-based support from a sensory support therapist to assist adherence and uptake of sensory aids, foster social networking, and optimise the home sensory environment. Care as usual involved no additional intervention beyond services normally available to people with dementia at the respective sites. The primary outcome was health-related quality of life (Dementia Quality of Life Instrument [DEMQoL]) score at 36 weeks, reported as an adjusted mean difference. Analyses were done according to the intention-to-treat principle. This trial is registered with the ISRCTN Registry, ISRCTN17056211.</div></div><div><h3>Findings</h3><div>Between May 4, 2018, and May 6, 2021, 252 people with mild-to-moderate dementia were randomly assigned, of whom 251 (n=126 in the SSI group and n=125 in the care as usual group) were included in the analysis. The mean age of participants was 79·6 years (SD 5·8), and 132 (53%) were women. After a median follow-up time of 37·7 weeks (IQR 36·2–39·0), the mean DEMQoL score was 92·8 (SD 15·2) in the SSI group and 92·8 (14·0) in the care as usual group (adjusted difference 0·18, 95% CI –2·13 to 2·30, p=0·87). Among 114 adverse events reported for 56 (44%) participants in the SSI group, ten events in nine participants were related or possibly related to the intervention (medical device pain or discomfort n=6, ear pain n=1, scratch to the ear n=1, sore eye n=1, redness n=1; all of grade 1). Serious adverse events were reported for 25 (20%) participants in the SSI group and 16 (13%) in the care as usual group. Six (5%) participants in the SSI group and five (4%) in the care as usual group died. None of the serious adverse events or deaths were related to the study intervention or procedures.</div></div><div><h3>Interpretation</h3><div>This study s
{"title":"Hearing and vision rehabilitation for people with dementia in five European countries (SENSE-Cog): a randomised controlled trial","authors":"Iracema Leroi MD , Prof Christopher J Armitage PhD , Elizabeth M Camacho PhD , Anna Pavlina Charalambous PhD , J P Connelly MSc , Prof Fofi Constantinidou PhD , Renaud David PhD , Prof Piers Dawes PhD , Prof Rachel A Elliott PhD , Mark Hann PhD , Alison Holden MSc , Emma Hooper MSc , Sean P Kennelly PhD , Evangelia Kontogianni MSc , Prof Brian A Lawlor MD , Julie Longobardi MSc , Luke Paterson MSc , Antonis M Politis PhD , Prof David Reeves PhD , Christine Schwimmer PhD , Eric Frison PhD","doi":"10.1016/j.lanhl.2024.07.008","DOIUrl":"10.1016/j.lanhl.2024.07.008","url":null,"abstract":"<div><h3>Background</h3><div>The effect of hearing and vision difficulties on the risk of developing dementia and worsening outcomes in people already living with dementia is well established. We evaluated the clinical impact of a hearing and vision rehabilitation and support programme on quality of life in people with mild-to-moderate dementia and concurrent sensory difficulties.</div></div><div><h3>Methods</h3><div>We conducted a parallel-group, multicentre, observer-blind, superiority randomised controlled trial in seven older adult clinics in five European countries (Cyprus, France, Greece, Ireland, and the UK). People with mild-to-moderate dementia with adult-acquired hearing difficulties, vision difficulties, or both were randomly assigned (1:1) along with their care partner to an 18-week home-basedsensory support intervention (SSI) of tailored hearing and vision rehabilitation and support, or to care as usual. Randomisation was blocked (block size of four, six, or eight) and stratified by country, with allocation assigned via a remote web-based system. The SSI included: full hearing assessment, vision assessment, or both; fitting of hearing aids, glasses, or other sensory aids; and home-based support from a sensory support therapist to assist adherence and uptake of sensory aids, foster social networking, and optimise the home sensory environment. Care as usual involved no additional intervention beyond services normally available to people with dementia at the respective sites. The primary outcome was health-related quality of life (Dementia Quality of Life Instrument [DEMQoL]) score at 36 weeks, reported as an adjusted mean difference. Analyses were done according to the intention-to-treat principle. This trial is registered with the ISRCTN Registry, ISRCTN17056211.</div></div><div><h3>Findings</h3><div>Between May 4, 2018, and May 6, 2021, 252 people with mild-to-moderate dementia were randomly assigned, of whom 251 (n=126 in the SSI group and n=125 in the care as usual group) were included in the analysis. The mean age of participants was 79·6 years (SD 5·8), and 132 (53%) were women. After a median follow-up time of 37·7 weeks (IQR 36·2–39·0), the mean DEMQoL score was 92·8 (SD 15·2) in the SSI group and 92·8 (14·0) in the care as usual group (adjusted difference 0·18, 95% CI –2·13 to 2·30, p=0·87). Among 114 adverse events reported for 56 (44%) participants in the SSI group, ten events in nine participants were related or possibly related to the intervention (medical device pain or discomfort n=6, ear pain n=1, scratch to the ear n=1, sore eye n=1, redness n=1; all of grade 1). Serious adverse events were reported for 25 (20%) participants in the SSI group and 16 (13%) in the care as usual group. Six (5%) participants in the SSI group and five (4%) in the care as usual group died. None of the serious adverse events or deaths were related to the study intervention or procedures.</div></div><div><h3>Interpretation</h3><div>This study s","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"5 11","pages":"Article 100625"},"PeriodicalIF":13.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.lanhl.2024.100640
Danielle S Powell , Nicholas S Reed
{"title":"Sensory loss rehabilitation among people with dementia: a low-risk strategy to enhance quality of life","authors":"Danielle S Powell , Nicholas S Reed","doi":"10.1016/j.lanhl.2024.100640","DOIUrl":"10.1016/j.lanhl.2024.100640","url":null,"abstract":"","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"5 11","pages":"Article 100640"},"PeriodicalIF":13.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.lanhl.2024.08.007
Ruoyu Yin MPhil , Laura Martinengo PhD , Prof Helen Elizabeth Smith PhD , Mythily Subramaniam PhD , Konstadina Griva PhD , Lorainne Tudor Car PhD
This systematic review aimed to synthesise qualitative evidence on the views and experiences of older adults in using digital mental health interventions (DMHIs) for the prevention or self-management of mental disorders. We searched PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Web of Science, PsycINFO, and the first 100 results of Google Scholar for eligible studies and we included 37 papers reporting 35 studies in this Review. Most DMHIs were delivered using mobile apps (n=11), websites (n=6), and video-conferencing tools (n=6). The use of DMHIs in older adults was affected by negative perceptions about ageing and mental health, the digital divide (eg, insufficient digital literacy), personal factors (eg, motivation) and health status, interpersonal influences (eg, guidance and encouragement), intervention features (eg, pace and content), technology-related factors (eg, accessibility), and the perceived benefits and risks of using DMHIs. Future DMHIs for older adults should involve other stakeholders such as health-care professionals, provide content relevant to the needs of older people, be more accessible, and address concerns about privacy and confidentiality.
本系统性综述旨在综合老年人在使用数字心理健康干预措施（DMHIs）预防或自我管理精神障碍方面的观点和经验的定性证据。我们检索了 PubMed、Embase、Cumulative Index to Nursing and Allied Health Literature、Web of Science、PsycINFO 和 Google Scholar 的前 100 条结果，以查找符合条件的研究。大多数 DMHI 使用移动应用程序（11 篇）、网站（6 篇）和视频会议工具（6 篇）提供。影响老年人使用 DMHIs 的因素包括：对老龄化和心理健康的负面看法、数字鸿沟（如数字素养不足）、个人因素（如动机）和健康状况、人际影响（如指导和鼓励）、干预特点（如节奏和内容）、技术相关因素（如可及性）以及使用 DMHIs 的感知收益和风险。未来针对老年人的 DMHI 应让其他利益相关者（如医疗保健专业人员）参与进来，提供与老年人需求相关的内容，使其更易于使用，并解决隐私和保密问题。
{"title":"The views and experiences of older adults regarding digital mental health interventions: a systematic review of qualitative studies","authors":"Ruoyu Yin MPhil , Laura Martinengo PhD , Prof Helen Elizabeth Smith PhD , Mythily Subramaniam PhD , Konstadina Griva PhD , Lorainne Tudor Car PhD","doi":"10.1016/j.lanhl.2024.08.007","DOIUrl":"10.1016/j.lanhl.2024.08.007","url":null,"abstract":"<div><div>This systematic review aimed to synthesise qualitative evidence on the views and experiences of older adults in using digital mental health interventions (DMHIs) for the prevention or self-management of mental disorders. We searched PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Web of Science, PsycINFO, and the first 100 results of Google Scholar for eligible studies and we included 37 papers reporting 35 studies in this Review. Most DMHIs were delivered using mobile apps (n=11), websites (n=6), and video-conferencing tools (n=6). The use of DMHIs in older adults was affected by negative perceptions about ageing and mental health, the digital divide (eg, insufficient digital literacy), personal factors (eg, motivation) and health status, interpersonal influences (eg, guidance and encouragement), intervention features (eg, pace and content), technology-related factors (eg, accessibility), and the perceived benefits and risks of using DMHIs. Future DMHIs for older adults should involve other stakeholders such as health-care professionals, provide content relevant to the needs of older people, be more accessible, and address concerns about privacy and confidentiality.</div></div>","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"5 11","pages":"Article 100638"},"PeriodicalIF":13.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.lanhl.2024.100642
Aoife Leahy PhD , Louise Barry PhD , Gillian Corey MHSC , Aoife Whiston PhD , Helen Purtill PhD , Elaine Shanahan MD , Denys Shchetkovsky MB BCh , Damien Ryan MB BCh , Monica O’Loughlin RGN , Prof Margaret O'Connor MB BCh BAO , Rose Galvin PhD
Background
Multidisciplinary comprehensive geriatric assessment (CGA) improves outcomes in hospitalised older adults but there is limited evidence on its effectiveness in the emergency department. We aimed to assess the benefits of CGA in the emergency department for older adults living with frailty.
Methods
In this randomised controlled trial, we enrolled older adults (≥75 years) who presented to the emergency department with medical complaints at University Hospital Limerick (Limerick, Ireland). Participants screened positive for frailty on the Identification of Seniors at Risk screening tool (score ≥2). Patients requiring resuscitation as well as those with COVID-19, psychiatric, surgical, or trauma complaints were excluded. Participants were randomly allocated 1:1 to geriatrician-led multidisciplinary CGA and management or usual care. Outcome assessors were masked to treatment allocation. The primary efficacy outcome was time spent in the emergency department, defined as the time from registration on the computer database until time of discharge or admission to an inpatient ward in the intention-to-treat population. This study is registered with ClinicalTrials.gov, NCT04629690.
Findings
Between Nov 9, 2020, and May 13, 2021, we recruited 228 patients. 113 participants were included in the intervention group (mean age 82·4 years [SD 4·9]; 63 [56%] women; 113 [100%] White Irish) and 115 in the control group (83·1 [5·6]; 61 [53%]; 112 [97%]). Median time in the emergency department was 11·5 h (IQR 5–27) in the intervention group and 20 h (7–29) in the control group (median difference [Hodges–Lehmann estimator] 3·1 h [95% CI 0·6–7·5]; p=0·013). There were no adverse events related to the intervention.
Interpretation
Geriatrician-led multidisciplinary assessment of older adults living with frailty was associated with reduced time spent in the emergency department setting at index visit and lower rates of nursing home admission, greater increases in quality of life, and lower decreases in function at both 30 days and 180 days. Multicentre trials are needed to confirm the external validity of the findings. This study provides an evidence base for similar teams in an emergency department setting.
{"title":"Frailty screening with comprehensive geriatrician-led multidisciplinary assessment for older adults during emergency hospital attendance in Ireland (SOLAR): a randomised controlled trial","authors":"Aoife Leahy PhD , Louise Barry PhD , Gillian Corey MHSC , Aoife Whiston PhD , Helen Purtill PhD , Elaine Shanahan MD , Denys Shchetkovsky MB BCh , Damien Ryan MB BCh , Monica O’Loughlin RGN , Prof Margaret O'Connor MB BCh BAO , Rose Galvin PhD","doi":"10.1016/j.lanhl.2024.100642","DOIUrl":"10.1016/j.lanhl.2024.100642","url":null,"abstract":"<div><h3>Background</h3><div>Multidisciplinary comprehensive geriatric assessment (CGA) improves outcomes in hospitalised older adults but there is limited evidence on its effectiveness in the emergency department. We aimed to assess the benefits of CGA in the emergency department for older adults living with frailty.</div></div><div><h3>Methods</h3><div>In this randomised controlled trial, we enrolled older adults (≥75 years) who presented to the emergency department with medical complaints at University Hospital Limerick (Limerick, Ireland). Participants screened positive for frailty on the Identification of Seniors at Risk screening tool (score ≥2). Patients requiring resuscitation as well as those with COVID-19, psychiatric, surgical, or trauma complaints were excluded. Participants were randomly allocated 1:1 to geriatrician-led multidisciplinary CGA and management or usual care. Outcome assessors were masked to treatment allocation. The primary efficacy outcome was time spent in the emergency department, defined as the time from registration on the computer database until time of discharge or admission to an inpatient ward in the intention-to-treat population. This study is registered with <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>, <span><span>NCT04629690</span><svg><path></path></svg></span>.</div></div><div><h3>Findings</h3><div>Between Nov 9, 2020, and May 13, 2021, we recruited 228 patients. 113 participants were included in the intervention group (mean age 82·4 years [SD 4·9]; 63 [56%] women; 113 [100%] White Irish) and 115 in the control group (83·1 [5·6]; 61 [53%]; 112 [97%]). Median time in the emergency department was 11·5 h (IQR 5–27) in the intervention group and 20 h (7–29) in the control group (median difference [Hodges–Lehmann estimator] 3·1 h [95% CI 0·6–7·5]; p=0·013). There were no adverse events related to the intervention.</div></div><div><h3>Interpretation</h3><div>Geriatrician-led multidisciplinary assessment of older adults living with frailty was associated with reduced time spent in the emergency department setting at index visit and lower rates of nursing home admission, greater increases in quality of life, and lower decreases in function at both 30 days and 180 days. Multicentre trials are needed to confirm the external validity of the findings. This study provides an evidence base for similar teams in an emergency department setting.</div></div><div><h3>Funding</h3><div>Health Research Board (ILP-HSR-2017–014).</div></div>","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"5 11","pages":"Article 100642"},"PeriodicalIF":13.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.lanhl.2024.100641
Yau-Hua Yu
{"title":"Oral health: integral component of overall health and important determinant of ageing","authors":"Yau-Hua Yu","doi":"10.1016/j.lanhl.2024.100641","DOIUrl":"10.1016/j.lanhl.2024.100641","url":null,"abstract":"","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"5 11","pages":"Article 100641"},"PeriodicalIF":13.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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