Gerontology and Geriatric Medicine最新文献

Introduction: In the current study, we construct growth charts of body surface area (BSA) for adults using the quantile regression (QR) approach and growth charts of different Gaussian Percentiles (Z-scores) against age. Methods: A cross-sectional data consisting of 3,473 individuals aged 5 or more, both males and females were taken from Multan city. Quantile regression (QR) was used to construct BSA growth charts. Growth charts for different Z-scores were also constructed. Results: For our data set, the mean BSA is 0.48750. The BSA percentiles show a trending higher after the age of 5 until the age of 22, then decrease between age 22 and 35, and then finally increase after age 35. The Z-score curve increases slightly after age 5 and then proceeds higher until age 22. After age 22 and before 35 it plateaus and then increases slightly after age 35. Conclusion: Since the use of empirical BSA percentiles and Z-scores with grouped age provides a discrete approximation for the population percentiles and Z-scores, it is more accurate to use continuous BSA percentile and Z-score, curves against given ages while using quantile regression and Z-score approach. Furthermore, this approach can also be adopted to construct many other growth charts for physiological and medical sciences.

Accurate measurement of vital signs are important at skilled nursing facilities (SNF). Recent technological advancements now enable automated vital sign measurements. This overcomes the limitations of traditional manual vital sign measurement, which is time-consuming and error-prone. We present a novel case where continuous vital sign measurement was used to detect meaningful vital sign changes that led to early detection of a COVID-19 outbreak at a SNF. Residents were continuously monitored for changes to baseline respiratory rate and heart rate and with a Probability of Change (POC). Variations in baseline respiratory rate and heart rate occurred in 66% and 42%, respectively, of COVID-19 positive individuals; 83% of participants had statistically significant variations in either vital sign. Clinical investigations are typically triggered by vital signs outside normal ranges. We present a novel methodology to detect subtle vital sign changes that can lead to earlier diagnosis, treatment, and recovery from infections, like COVID-19.

Objective: To explore the perceptions of nursing home (NH) clinicians regarding factors underpinning known increases in psychotropic prescribing over the COVID-19 pandemic. Methods: Three iterative online surveys were fielded to Virginia NH prescribing clinicians (11/2021-6/2022) to assess their perspectives regarding factors driving pandemic increases in NH psychotropic use. Existing literature and emerging survey data informed survey content. Sampling was for convenience and achieved through crowdsourcing, leveraging collaborations with Virginia NH clinician professional organizations. Results: A total of 89 surveys were collected. Clinicians noted simultaneous surging of dementia symptoms with decreased availability of non-pharmacologic measures to remedy them, leading to increased prescribing of all psychotropics. Staff shortages and turnover, isolation from family and community, and personal protective equipment protocols were identified as key pandemic factors contributing to this mismatch. Conclusions: Virginia NH clinicians explicitly linked increased NH psychotropic prescribing to known pandemic phenomena, associations previously hypothesized, but not, to our knowledge, directly confirmed.

Background: Despite the key role family caregivers play in the US healthcare system, they are not systematically identified and tracked, limiting our knowledge about this important group. Objective: Our objective was to identify caregiver characteristics and barriers to service delivery in a primarily rural state. Methods: As part of a quality improvement project, a cross-sectional online survey was fielded in clinical and community settings. Participants included 85 self-identified adult caregivers of another adult with an illness, condition, or disability from within a US state healthcare network. Descriptive analyses were conducted, and inferential statistics were used to compare urban versus rural respondents and older versus younger respondents. Results: Caregivers were responsible for a wide range of care activities and particularly older caregivers spent a significant amount of time providing care. Older caregivers also reported significantly lower levels of burden compared to younger caregivers, yet both groups had clinically high levels on average. Caregivers reported receiving helpful emotional support, but needed more tangible support and were limited by availability and cost. Conclusions: There is a need to fund comprehensive caregiver programing and address caregivers' own social and physical health needs to reduce caregiver burden.

Background: The ethical challenges faced by physicians when patients or their families refuse medical interventions are particularly complex in geriatric care. This manuscript explores the delicate balance between professional recommendations and patient autonomy, focusing on the nuanced decisions surrounding enteral nutrition in older patients. Methods: Two case studies are presented: a 99-year-old woman with a history of hypertension, diabetes, and coronary heart disease, and an 82-year-old man with Alzheimer's disease. Both cases involve the recommendation of a nasogastric tube for enteral nutrition, and the subsequent patient and family responses to this intervention. Results: In the first case, the patient and her family initially refused the tube due to personal beliefs and financial concerns, leading to a focus on psychological support and symptom management. The patient eventually agreed to the tube, but tragically passed away shortly after. In contrast, the second case resulted in the patient's family agreeing to the tube after a thorough discussion, leading to a successful recovery and the patient's ability to eat orally 6 months later. Conclusions: The cases underscore the importance of patient-centered care, clear communication, and empathy in geriatric medicine. They highlight the need for healthcare providers to respect patient autonomy, be aware of their own biases, and engage in open dialogue with patients and families. The manuscript advocates for a nuanced approach to medical ethics, where the patient's journey is guided with respect and care, honoring their wishes while striving for the best possible outcomes.

Among older adults, depression is a common, morbid, and costly disorder. Older adults with depression are overwhelmingly treated by primary care providers with poor rates of remission and treatment response, despite attempts to improve care delivery through behavioral health integration and care management models. Given one in 10 older adults in primary care settings meet criteria for depression, there is a pressing need to improve the efficacy of depression treatment among affected individuals. Measurement-based care (i.e., the incorporation of systematic measurement of patient outcomes into treatment) for depressed older adults in primary care has had poor uptake, which at least partly underlies the limited efficacy of depression treatments. In this perspective, we discuss the proposal that ecological momentary assessment (EMA) may increase uptake of measurement-based care for depression in primary care, enhance the quality of clinical depression data, and lead to improvements in treatment efficacy without adding to providers' burden. We describe key issues related to EMA implementation and application in routine settings for depressed older adults, along with potential pitfalls and future research directions.

This study analyzes the self-perception of mental health of socially vulnerable elderly people during the COVID-19 crisis in Brazil. Conducted across all state capitals from February 2021 to October 2023, it included 366 participants living in various conditions such as camps, street situations, slums, and communities. The average age was 66.7 years, with a majority being male (59.0%), of Black or Brown race/color (62.3%), and earning below one minimum wage (36.6%). Findings revealed that older adults in street situations, experiencing psychological manifestations like sleep disturbances due to the pandemic, tended to assess their mental health more negatively. In contrast, older men of white race/color without such manifestations, and those practicing strategies like physical activity or relaxation, were less likely to perceive their mental health as poor. Addressing housing, implementing health strategies, and recognizing sample and regional complexities are crucial interventions for older adults in street situations.

Family and kinship care is a common way of caring for older adults, particularly in rural Ethiopia, where institutional care arrangements are nonexistent. Moreover, the majority of studies on family caregivers of older adults were conducted in western cultures, which makes it difficult to understand family caregivers in the Ethiopian context. This study aims at exploring the experience of family caregivers for older adults in a co-residential setting. Specifically, it focuses on answering caregiving challenges and available social supports for family caregivers in a co-residential living arrangement. This study used a qualitative research method employing phenomenology to understand the lived experience of family caregivers for older adults in rural northwestern Ethiopia. Data were collected through a semi-structured interview with eight purposefully selected family caregivers of rural older adults. Regarding family caregivers's challenges and available social supports, four themes emerged from the collected data. These are economic challenges, the incongruence of older adult needs and caregiving capacity, work-caregiving conflict, work-social life conflict, and the presence of social support from different individuals and community-based institutions. In addition to strengthening caregiver support environments, it's critical to develop the capacity of family caregivers through training, economic support, and the integration of family caregivers with health extension workers.

Group activities and connection with nature are associated with improved well-being for older adults. This quasi-experiment tests the effectiveness of RASCALs, an innovative program of group activities using nature-focused livestream broadcasts. Assisted living residents in the experimental group (n = 16) lived in buildings that received RASCALs programming twice a week for 3 months. Compared to residents in the comparison group (n = 17) who received regular group activity programming, they experienced significant positive change in the Positive Relations with Others domain of well-being (β = .873, p = .008). Combining nature-focused livestream broadcasts with groups activities for older adults in assisted living communities may be an innovative and effective way to overcome barriers to accessing nature and improve residents' well-being.