Ageing International最新文献

Objective: This study aims to examine the healthcare services received by adults aged 65 and over who visit the emergency department within 30 days of being discharged from their index admission, and it aims to establish a relationship between the healthcare services received and the revisits. Methods: Data were collected from the electronic records of 36,205 older patients who revisited the emergency department of a public training and research hospital. Patients were classified as “revisiting” if they returned to the ED within 30 days of discharge from their index visit. Descriptive statistics were used to summarize patient characteristics. Binary logistic regression assessed the impact of triage tag color, prior hospital visits, and outpatient clinic utilization on ED revisits. Results: Patients with a red triage tag were over six times more likely to be hospitalized than those with a yellow tag. Those who had visited the hospital within the previous 30 days were 37% more likely to return to the emergency department. Outpatient visits to internal medicine, cardiology, and pulmonology clinics increased revisit likelihood by 94%, 142%, and 244%, respectively. Conversely, patients receiving home healthcare were 65% less likely to revisit the emergency department. Conclusion: Outpatient service utilization are strongly associated with emergency department revisits among older adults. Enhancing access to primary care and improving coordination between specialists and family physicians may reduce unnecessary emergency department utilization. Policymakers should prioritize expanding primary care services and implementing remote follow-up systems to support continuity of care.

Canada’s growing immigrant population faces significant challenges in accessing primary healthcare services, particularly older adult immigrants from Arab countries. This study explores the experiences of Arab older adults and family caregivers in Ontario in navigating relationships with family physicians. We conducted a secondary analysis of data from a primary study that included interviews with 17 participants, comprising of caregivers and older adults. Findings revealed three central themes: the importance of community connections, person-centred care, and preferences for in-person over remote consultations. Participants emphasized the value of family physicians who shared cultural or linguistic backgrounds, which facilitated trust and access to care. However, care quality and attentiveness were equally praised among non-Arab physicians when cultural sensitivity and clear communication were demonstrated. Caregivers and older adults differed in their preferences for telehealth services, with older adults favoring in-person visits for their perceived thoroughness, while caregivers appreciated the convenience of remote appointments. The study highlights the role of relational care in building trust and addressing the unique needs of Arab older adults. It also underscores the importance of cultural humility among healthcare providers, fostering culturally safe environments regardless of shared ethnic or linguistic backgrounds. These findings offer insights for improving primary care practices and inform training for healthcare professionals in serving diverse immigrant populations effectively.

In recent decades, Islamic countries have undergone significant demographic shifts, with a noticeable increase in the proportion of older people. Religion, particularly Islam, plays a crucial role in helping older people overcome challenges such as loneliness, declining health, and the loss of loved ones. However, insufficient systematic reviews have been conducted on the literature on aged care from an Islamic perspective, illustrating that extensive studies in this field are required. Thus, the aim of the current paper was to bridge this gap by examining how Islamic beliefs and practices contribute to the physical and mental health of older people. Utilizing the Scopus, ScienceDirect, and PubMed databases, in addition to the gray literature, a systematic review of the literature was undertaken in August 2024. The inclusion criteria involved experimental, non-experimental, observational, and qualitative studies involving individuals aged 60 and above, with a focus on Islamic involvement. A narrative synthesis was conducted, and the quality of the studies was evaluated using the Joanna Briggs Institute checklists. The inclusion of 29 articles was supported by the methodological quality assessments. Four themes were identified: Islamic principles in care for older people; Islamic values and mental health; Islamic-based interventions and health outcomes; and spiritual needs and older people care. The integration of Islamic values into the care of older people offers a holistic approach that improves their physical and mental health. Future healthcare policies and guidelines should emphasize spiritual care as an essential element in care for older people to provide a more comprehensive and effective care approach.

The 25-Question Geriatric Locomotive Function Scale (GLFS-25) is an assessment tool developed by Japanese researchers to evaluate locomotive functions in older adults. The purpose of this study is to translate and culturally adapt the GLFS-25 for use in Turkey, then determine the scale’s reliability and validity in the Turkish context. A total of 264 older adults (124 males; mean age: 71.7 ± 6.2 years) participated in the study. To assess test–retest reliability, 248 participants (112 males; mean age: 71.8 ± 6.2 years) completed the GLFS-25 twice, with an interval of 3 to 14 days. Construct validity was evaluated using the Katz Index of Activities of Daily Living (ADL) and the Lawton Instrumental Activities of Daily Living Scale (IADL). Convergent validity was assessed on the Visual Analogue Scale (VAS) for pain and the Geriatric Depression Scale. The GLFS-25 Turkish showed excellent internal consistency with Cronbach’s alpha coefficient = 0.95 (95% CI = 0.95–0.96). Similarly, The GLFS-25 Turkish showed very high test-retest reliability with ICC = 0.96 (95% CI = 0.94–0.97). Correlations were good between GLFS-25 Turkish version and the Katz ADL (r = -0.62), Lawton IADL indices (r = -0.63), VAS-rest (r = -0.61), VAS-activity (r = -0.64), VAS-night (r = -0.63), and Geriatric Depression Scale (r = -0.67) (p = 0.001). We observed no ceiling and floor effects. The Turkish version of the GLFS-25 demonstrated good reliability and validity and can be effectively utilized to assess locomotive functions in Turkish-speaking older adults. This scale can be provides clinicians and researchers with a culturally adapted, psychometrically sound tool for evaluating mobility-related impairments in this population.

Computer-aided applications are currently on the rise, particularly in time-sensitive and highly accurate applications such as healthcare. The rate by which dementia cases have been significantly increasing despite clinical reports and psychometric tests being utilized by clinicians to diagnose it illustrates a health challenge and global concern about the techniques being used in the Global medical analysis of the condition. Therefore, with the help of machine learning (ML) algorithms, the aim of this study is to classify patients with dementia using various clinical parameters to help in quick and highly accurate diagnosis. Seven ML models: logistic regression, decision tree, random forest, support vector machine, gradient boosting, voting classifier and stacking classifier, were evaluated using several performance metrics to enhance the efficiency of dementia diagnosis. Interpretation of the model results was based on an explainable algorithm: SHapley Additive exPlanations (SHAP). All classifiers achieved high accuracy in categorising the dementia dataset where random forest, logistic regression and voting classifier achieved high accuracy (92%), high precision (98%), high recall (87% to 88%), high F1-score (92% to 93%) and high AUC (95%) which indicating the classifiers reliability in reducing false positive and false negative dementia cases. The used approach achieves more robustness and easy interpretability compared to other techniques applied in literature through the application of multiple ML techniques, a thorough cross-validation [The ensemble model had statistical significant difference when compared to the single model (AUC: 0.972 vs 0.924, p<0.05), but not with other ensemble models (AUC: 0.972 vs 0.966, p=0.55)], and SHAP analysis. The applied methodology can be used to facilitate the early detection of dementia, enable early treatment interventions, and SHAP-based interpretability can help increase transparency during this decision-making process, thereby increasing their integration into hospital operations. Such an approach can help neurologists and radiologists to effectively screen patients and prioritize further evaluations, which will ultimately lead to a minimization of diagnostic delays.

This study, based on the Donabedian’s model (JAMA, 260(12), 1743–1748, 1988), indentify professionals who spend the most time in care activities and proposes quality indicators for long-term care institutions in Portugal. The increasing complexity of long-term care in Portugal calls for an evaluation system tailored to the country’s clinical, social organizational context. Existing European indicators, developed for different settings, fail to fully capture national specificities. The indicators proposed in this study, incorporating care time, professional roles, and resident profiles, enable a more accurate assessment, support continuous improvement, and guide evidence-based public policies. Indicators were validated through literature review, Delphi consensus, and analysis of residents’ records using descriptive statistics and multiple linear and logistic regressions models (Stepwise and Forward). Structure, presence of an interdisciplinary team, an Individual Intervention Plan and case manager, Nursing Assistant hours and psychosocial care. Process: rate of dependency, use of anti-infective drugs, for the central nervous and cardiovascular systems, and prevalence of pressure ulcers. Outcome: rate of falls, deaths, hospitalizations, bedridden individuals, incontinence and incidence of pressure ulcers. This preliminary study based on Donabedian's model identifies structure, process and outcome indicators to evaluate long-term integrated care. The time spent caring for dependent users, especially in Long Duration and Maintenance Unit, reveals greater complexity. Despite the broad sample and interdisciplinary approach, methodological limitations require further research to validate and adapt the indicators to the portuguese context.

Provision of mental health services for older adults in sub-Saharan Africa needs to be organised and tailored to cater for unmet mental health needs of this population. This study sought to describe and compare the patterns of presentation of patients and trends in service utilization as the psychogeriatric service transitioned from a stand-alone to an interdisciplinary model over an 18-year period; identify factors associated with specific mental health disorders; and highlight the need for multidisciplinary geriatric care facilities. This study was conducted among patients attending the outpatient psychogeriatric clinic at the University College Hospital, Ibadan, Nigeria. A retrospective review of records of older persons who were first seen at the outpatient psychogeriatric clinic between January 2004 and December 2021 was performed. The mean age of the participants was 72.3(± 8.1) years. The commonest mental illness is dementia (42.4%) and 55.1% of the cohort had at least one medical comorbidity. The number of new referrals to the clinic grew steadily over the 18-year period with 88.2% of patients seen in the clinic in the last nine years in the interdisciplinary service compared to the standalone psychogeriatric service. Dementia is the primary reason for referrals to this facility, and frequent comorbidities underscore the necessity for an interdisciplinary geriatric health service.

Thailand has entered into a state of super-aging society, leading to a rapid increase in the prevalence of dementia. However, current research on dementia within the community remains scarce. Therefore, the aims of this study were to determine the prevalence of dementia and its associated factors in the community. A cross-sectional study was carried out on individuals registered as older adults at one primary care unit in Khon Kaen between February and May 2024. The participants were chosen using systematic random sampling, and dementia was identified using the Thai version of the Rowland Universal Dementia Assessment Scale (RUDAS), while potential risk factors were collected. The study included a total of 350 older adults. The prevalence of dementia was 31.1%. Among the participants with dementia, significant difficulties were observed in memory recall, visuoconstructional drawing, and judgement. The results of multivariate logistic regression analyses showed that advancing age (adjusted odds ratio [AOR] for age groups 70–79 years and over 80 years were 18.46 and 7.61, respectively), hearing impairment (AOR 5.01), subjective memory complaints (AOR 2.76), past or current alcohol use (AOR 2.83), daytime sleepiness (AOR 3.08), and partial dependence (AOR 15.16) were associated with dementia. Dementia is prevalent among Thai older adults in community setting and has shown an increase of the figure over the last decade. Several modifiable factors, including hearing impairment, subjective memory complaints, alcohol consumption, daytime sleepiness, and functional dependency, have been identified as potential pathways for dementia prevention and early detection facilitation.

Sleep problems are a frequent condition in older adults. Good mobility is a critical factor for maintaining health and well-being. The association between both variables is still poorly understood. The objective was to verify the association between sleep problems and mobility difficulties among community-dwelling older adults. This was a cross-sectional study, with 6,929 older adults (≥ 60 years), from the Brazilian Longitudinal Study of Aging (2019–2021). Exposure variables were sleep problems: insomnia (initial, intermediate, and final), poor sleep quality, and daytime sleepiness. Outcomes were mobility difficulties (yes/no): walking (100 m and 1 km), running 1 km, climbing one flight of stairs, and getting up from a chair. Multivariate logistic regression analyses were performed to investigate the associations. Older adults with insomnia (initial, intermediate, and final), poor sleep quality, and daytime sleepiness had between 1.80 (95%CI 1.34; 2.42) and 1.92 (95%CI 1.50; 2.45) greater odds of reporting difficulty in walking 100 m, 1.59 (95%CI 1.29; 1.95) and 1.75 (95%CI 1.41; 2.18) of reporting difficulty in walking 1 km, 1.63 (95%CI 1.28; 2.06) and 2.30 (95%CI 1.71; 3.10) of reporting difficulty in climbing one flight of stairs; 1.45 (95%CI 1.11; 1.90) and 1.79 (95%CI 1.32; 2.44) of reporting difficulty in getting up from a chair. Older adults with initial and final insomnia, and poor sleep quality had between 1.28 (95%CI 1.01; 1.62) and 2.09 (95%CI 1.46; 3.00) greater odds of reporting difficulty in running 1 km. These results reinforce the importance of periodically evaluating older adults’ sleep health in order to prevent their mobility difficulties.

Dietary Approaches to Stop Hypertension (DASH) are a recommended non-pharmacological dietary strategy for mitigating hypertension and averting its potential complications. In Zimbabwe the DASH interventions are available through a dietician in tertiary health care institutions. However, there are a number of barriers faced in accessing this service. This study explores the barriers to facility-based DASH among older adult patients in Gweru. In this qualitative study, twenty older adults with hypertension and their caregivers and eight healthcare workers provided information on their experiences with facility-based DASH. Barriers to facility-based DASH are - participant factors (financial challenges, limited family support, patient`s negative attitude, and fear); healthcare worker factors (limited knowledge due to absence of a formal curriculum on DASH and pressure of work) and system level barriers (unavailability of BP machines, unavailability of hypertension medication and distance to health facility). It is important to consider community-based DASH given the above barriers to the facility-based model.