Aging and health research最新文献

Comprehensive Geriatric Assessment (CGA) is a process of care that involves a holistic, multidimensional, interdisciplinary assessment of an older individual and has been demonstrated to be the choice of management for frailty. By 2050, it is expected that 80 % of the aging population will be living in low and low-middle income countries (LMICs). The implementation of geriatric programs is scarce in LMICs. CGA based frailty clinics could help facilitate early screening for impairment in physical and psychological capacities among pre-frail and frail older individuals allowing for suggestions for targeted interventions. Creating a sound healthcare model which addresses issues of older adults living with frailty is the need of the hour, especially in LMICs. Establishing frailty clinics in low-middle income countries could thus help to create a sustainable age-friendly healthcare model for the vulnerable and poor aging population. It is now the time to act.

Background

Family-oriented mobility has become increasingly prevalent in recent years, leading to the emergence of a new demographic: older migrants. These individuals, who are often accompanied by their family members, relocate to another place of residence while retaining their household registration in their original location. The existing literature has largely neglected the social perspective on the mental health of this population group.

Methods

This study recruited participants from five communities in two cities and employed the Geriatric Social Network Scale, the Self-Rating Anxiety Scale, and the Geriatric Depression Scale to assess their mental health and social networks.

Results

Among the 317 qualified participants, 31.23 % reported experiencing anxiety and 15.77 % reported experiencing depression. The mean social network score was 3.83 ± 0.54 points. A negative correlation was observed between social network scores and both anxiety (r = −0.272, P < 0.001) and depression (r = −0.338, P < 0.001). Two distinct types of social networks were identified through latent profile analysis, with a low level of social support and a low-level social network being significantly correlated with depression (P < 0.001).

Conclusions

Mental health issues are prevalent among family-oriented older migrants. A medium-level social network was found to be negatively correlated with anxiety and depression. The presence of a low-level social network was found to be associated with depression. It is imperative to prioritize the mental health status of family-oriented older migrants. Collaboration between community nurses and social workers should be encouraged to aid in exploring more effective ways of promoting the mental health status and social networks of this population.

Background

Maintaining good nutritional status through a varied diet is key to healthy aging.

Methods

This cross-sectional study investigated the association between dietary variety based on the food frequency score (FFS, the score of the frequency of daily intake of 10 food groups, range 0–30) and nutrient intake based on a brief self-administered diet history questionnaire. Data from 130 older adults were analyzed. In addition, the association between FFS and estimated average requirement (EAR) deficiency in the Dietary Reference Intakes for Japanese was investigated.

Results

FFS significantly correlated with most of 29 nutrients investigated, except for carbohydrate and sodium, and inversely correlated with alcohol. FFS categorized into tertiles was significantly associated with many of 29 nutrients, except for carbohydrates, n-3 unsaturated fat, vitamin D, vitamin B12, sodium, and manganese, and inversely associated with alcohol. Multiple logistic regression analysis showed that a higher FFS significantly decreased the odds of EAR deficiencies of vitamin A, thiamine, vitamin C, calcium, magnesium, and zinc. The calculated cutoff values of FFS for EAR deficiencies were 17 for vitamin A, vitamin C, and calcium or 18 for thiamine, magnesium, and zinc.

Conclusion

Based on FFS, this study found that dietary variety was significantly associated with various nutrients and inversely associated with EAR deficiency rates among community-dwelling older adults. These results indicate that improving FFS may help maintain nutritional status, and the simple recommendation of a daily intake of 10 food groups may be useful for community-dwelling older adults.

Background

As people age the risk of dementia increases. Balance and strength deteriorate with ageing, but their associations with dementia are not clear. We aimed to determine relationships of balance and strength performance with incident dementia in the Health in Men Study (HIMS) cohort.

Methods

We used wave 4 of the HIMS as baseline for analyses (2011–2013), following 1261 men until December 2017 via data linkage to determine incident dementia. Balance was measured using a modified Balance Outcome Measure for Elder Rehabilitation (mBOOMER) Score and strength with the knee extension test. Cox proportional hazards regression was used, adjusting for sociodemographic and health data. Strength and balance scores were analysed non-linearly using restricted cubic splines.

Results

13.7% of men were diagnosed with dementia over a mean period of 4.7 (SD 1.5) years. Higher baseline mBOOMER scores were associated with a reduced risk of incident dementia, with greater changes in risk at higher mBOOMER scores (9 vs 8: HR 0.80, 95% CI 0.73–0.88; 12 vs 11: 0.49, 95% HR 0.36–0.68). Higher baseline lower limb strength was associated with a reduced risk of incident dementia, with greater changes occurring at lower scores, plateauing at around 25 kg (5 vs 4: HR 0.93, 95% CI 0.89–0.98; 25 vs 24: HR 0.99, 95% CI 0.95–1.03).

Conclusions

This study demonstrated a non-linear association of better performance in both strength and balance with reduced likelihood of incident dementia. These results raise the hypothesis that strategies to improve strength and balance could reduce the incidence of dementia in older men.

Background

Conventional approaches to frailty assessment rely on in-person evaluation by health professionals in medical settings. The COVID-19 pandemic drastically limited access to both primary care and face-to-face appointments, highlighting a need for novel and forward-thinking frailty screening methods to bridge this gap. Community-based seniors-serving organizations are well-positioned to implement remote frailty assessment, given its potential to enhance virtual services and referrals.

Methods

The Clinical Frailty Scale (CFS) was adapted and implemented as Virtual Frailty Screening (VFS), using the Plan-Do-Study-Act (PDSA) framework, in an inner-city organization for older adults. Participants participated in phone assessments by social workers (SWs); in-person visits included the CFS for comparative purposes. As a component of our larger quality improvement initiative, pilot data were analyzed descriptively alongside inferential methods consisting of Kendall's τ_b, Χ²-test of association, and Wilcoxon matched-pairs signed-rank test.

Results

Over 101 older adults were screened, with 79.21 % being assigned as very mild to moderately frail. VFS usage enabled crucial referrals for 70 older adults to receive long-term frailty-specific support and services in the community. Analysis found that the VFS performed similarly to the CFS, established by high convergent validity and alignment between both scales.

Conclusions

Findings support the implementation of remote frailty assessment by SWs in community-based seniors serving organizations. This integration bridges immediate service gaps, introducing a transformative approach to frailty assessment which has the potential for scalability. Success was attributed to a multidisciplinary approach with rapid PDSA changes in a nimble organization.

Background

To determine the test accuracy of four observations, three explorations and four short tests commonly used in psychiatric examinations to detect attention disorders related to delirium in older outpatients.

Method

We performed a test accuracy study among 86 older patients referred for cognitive screening to an outpatient clinic of a psychiatric institution. Eleven index tests were applied without knowledge of the reference standard. A geriatrician or psychiatrist blinded to the results of the index tests determined the reference diagnosis with DSM-IV-TR criteria. Observations were lack of adequate/ regular eye-contact, dozing off during conversation, dozing off when not stimulated, and losing the point of story. Explored was lack of concentration during activities, difficulty following conversation, and being easily distracted. Serial 7s, WORLD spelled backward, months of the year backward (MOTYB) and counting back from 20 to 0 were applied. Test accuracy was calculated for the single tests and combinations.

Results

Dozing off during conversation scored high specificity (97.9 %) as did dozing off when not stimulated (97.9 %), but both had low sensitivity (< 27.9 %). Test accuracy of the exploration questions was low. Serial 7s and WORLD spelled backwards had high sensitivity (92.7 %, respectively 80.5 %) but low specificity (< 51.1 % %). The best combination was MOTYB with WORLD spelled backward (sensitivity of 63.4 %, specificity of 77.8 %).

Conclusions

No single observation, exploration or short test of attention was found to have both high sensitivity and specificity. Probably, attention deficits in delirium are best detected with a combination of observations and short tests as part of a comprehensive psychiatric examination.

Benzodiazepines (BDZs) are psychotropic drugs that are often used to treat anxiety, including in older people. It is known that BDZs are sometimes prescribed inappropriately or used for longer than allowed by the guidelines. As a result, BDZs may be associated with tolerance symptoms, cognitive impairment, and confusion, especially when taken by geriatric patients. On the other hand, chronic anxiety is also known to be associated with cognitive decline in older age. This review analyzes the effects of inappropriate consumption of BDZs over a long period of time in older adults and proposes therapeutic alternatives to combat anxiety symptoms in the older adults.

Chronic health conditions such as cancer, diabetes, and heart disease are highly prevalent in the older adult population. Engaging in health behaviors can help prevent the onset of or better manage these conditions. To better understand how to increase older adult engagement in health behaviors, this rapid evidence review evaluated the relationship between health literacy and health behaviors in adults over the age of 65. The databases utilized for this review were PubMed (Medline), EBSCO (APA PsycInfo, Academic Search, and CINAHL Plus.) All six studies included demonstrated significant and positive associations between adequate health literacy and certain health behaviors including pap-smears, mammograms, physical activity, dietary variety, participation in medical checkups, patient participation in health care, hand hygiene practices, and diabetes self-management behaviors. Adequate health literacy was, however, associated with alcohol consumption in two studies. Knowing this, health professionals can utilize health literacy screening and interventions to promote health behaviors in older adults.

Background

Little is known about the caregiving time of different types of caregivers in Singapore or its monetary value. We quantified the caregiving time of primary informal, secondary informal, and migrant domestic worker (MDW) caregivers of older adults and estimated the monetary value of caregiving time of primary and secondary informal caregivers.

Methods

278 primary informal caregivers reported the time provided by themselves, secondary informal caregivers and MDW caregivers in a typical week helping their care-recipients, aged ≥75 years, with activities of daily living (ADLs), instrumental ADLs, healthcare and social care use, other needs, and supervision of MDW caregivers. We estimated monetary value using the proxy good method.

Results

On average, primary and secondary informal caregivers provided 33.0 (annual monetary value: S$15,959) and 8.4 (annual monetary value: S$4,062) caregiving hours/week. MDW caregivers provided even more – 42.0 h/week. Care-recipients received 60.5 h of care/week on average. Nationally, the monetary value of informal caregiving time for Singaporeans aged ≥75 years requiring human assistance was about S$1.28 billion.

Conclusion

This study highlights the substantial time commitment of informal and MDW caregivers. Our estimates of the monetary value of informal caregiving time can inform economic evaluations of care models for older adults and policies for supporting informal caregivers, particularly in societies that rely heavily on informal care.

Formaldehyde (FA) is a highly reactive molecule that is considered as a community concern due to the huge human exposure in industries, dissection unit in hospitals and academics. Furthermore, it is used in manufacturing paper and plywood, and preservation of biological specimens. FA is present normally in certain concentration in the brain and its metabolism plays a major role in methylation and demethylation of DNA, RNA and histones. However, excess concentration of FA reduces the cognitive function and causes dementia especially in aging brain. Recent studies investigated the link between excess exposure to FA and age-related cognitive impairment through NMDA-receptor dysregulation and other mechanisms including amyloid-β (Aβ) accumulation, alterations in alcohol dehydrogenase-5 (ALDH5) and Tau dysmetabolism and aggregation which serves as major causes of Alzheimer's disease (AD). Recent hypothesis agreed that when FA causes Aβ to accumulate in extracellular space, it prevents the medications that are dissolved in the interstitial fluid from permeating the injured cortical neurons and leads to neurons death. Although treatment of AD with phototherapy has been achieved before which involves the destruction of Aβ deposit; however, reducing the amount of exposure to FA and its derivatives remains a golden step in the prevention.