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The association between loneliness and frailty among community-dwelling older adults in five European countries: a longitudinal study 五个欧洲国家居住在社区的老年人孤独与虚弱之间的关系:纵向研究
IF 6.7 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-10-10 DOI: 10.1093/ageing/afae210
Lizhen Ye, Esmee Bally, Sophie A Korenhof, Irene Fierloos, Tamara Alhambra Borrás, Gary Clough, Hein Raat, Amy van Grieken
Background Loneliness is described as the subjective experience of unfulfilled personal and social needs, with emotional and social domains. Frailty is a state of vulnerability to stressors, which is often characterised by impairment in the physical, psychological and/or social domain. Objective This study aims to examine the bidirectional association between loneliness and frailty across the different domains. Methods The study included 1735 older adults from the Urban Health Centres Europe project. Loneliness was assessed using the six-item De Jong Gierveld Loneliness Scale. Frailty was assessed by the Tilburg Frailty Indicator. Multivariate linear regression and cross-lagged panel models were used to explore the associations between the social and emotional loneliness dimensions and overall, physical, psychological and social frailty. Results A bidirectional association existed between overall loneliness and overall frailty (loneliness to frailty: β = 0.09, 95% CI: 0.03, 0.15; frailty to loneliness: β = 0.05, 95% CI: 0.004, 0.10). Higher levels of overall loneliness at baseline were associated with higher levels of psychological frailty at follow-up (β = 0.05, 95% CI: 0.00, 0.10). The reverse association was not significant. A bidirectional association existed between overall loneliness and social frailty (loneliness to social frailty: β = 0.05, 95% CI: 0.01, 0.10; social frailty to loneliness: β = 0.05, 95% CI: 0.00, 0.09). Conclusion This study confirms the importance of addressing loneliness among older adults. Interventions that increase social support, exercise engagement and promote healthy behaviours may be effective in reducing the risk of frailty among older adults and simultaneously preventing loneliness.
背景 孤独被描述为个人和社会需求得不到满足的主观体验,涉及情感和社会领域。虚弱是一种易受压力影响的状态,通常表现为身体、心理和/或社交方面的损伤。目的 本研究旨在探讨孤独与虚弱之间在不同领域的双向联系。方法 研究对象包括来自欧洲城市健康中心项目的 1735 名老年人。孤独感采用六项目 De Jong Gierveld 孤独感量表进行评估。年老体弱采用蒂尔堡年老体弱指标进行评估。采用多变量线性回归和交叉滞后面板模型来探讨社交孤独和情感孤独维度与总体、身体、心理和社会脆弱性之间的关联。结果 总体孤独感与总体虚弱之间存在双向联系(孤独感与虚弱:β = 0.09,95% CI:0.03,0.15;虚弱与孤独感:β = 0.05,95% CI:0.004,0.10)。基线时总体孤独程度较高与随访时心理虚弱程度较高相关(β = 0.05,95% CI:0.00,0.10)。反向关联并不显著。总体孤独感与社交脆弱之间存在双向关联(孤独感导致社交脆弱:β = 0.05,95% CI:0.01,0.10;社交脆弱导致孤独感:β = 0.05,95% CI:0.00,0.09)。结论 本研究证实了解决老年人孤独问题的重要性。增加社会支持、锻炼参与和促进健康行为的干预措施可有效降低老年人体弱的风险,同时预防孤独。
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引用次数: 0
Real-world mobility recovery after hip fracture: secondary analyses of digital mobility outcomes from four randomized controlled trials. 髋部骨折后真实世界的行动能力恢复:对四项随机对照试验的数字行动能力结果进行二次分析。
IF 6 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-10-01 DOI: 10.1093/ageing/afae234
Monika Engdal, Kristin Taraldsen, Carl-Philipp Jansen, Raphael Simon Peter, Beatrix Vereijken, Clemens Becker, Jorunn Laegdheim Helbostad, Jochen Klenk

Background: The main focus of rehabilitation following hip fracture is to regain mobility.

Objectives: To estimate the progression of real-world mobility the first year after hip fracture using digital mobility outcomes.

Design: An exploratory, prospective cohort study with pooled data from four previously conducted clinical trials.

Setting and subjects: We combined data from the Trondheim Hip Fracture Trial and Eva-Hip Trial in Trondheim, Norway, and the PROFinD 1 and PROFinD 2 trials in Stuttgart and Heidelberg, Germany, resulting in a sample of 717 hip fracture patients aged ≥65 years.

Methods: Each of the trials assessed mobility using body-fixed sensors (activPAL) at three time points, collectively providing observations across the entire first year post-surgery. The following 24-h DMOs were calculated: total walking duration (minutes), maximum number of steps within a walking bout, and number of sit-to-stand-to-walk transfers. Continuous 1-year progression of the median, the 25th percentile, and the 75th percentile were estimated using quantile regression models with splines.

Results: The dataset contained 5909 observation days. The median daily total walking duration increased until 36 weeks post-surgery reaching 40 min; daily maximum number of steps within a walking bout increased during the first eight weeks and then stabilized at less than 100 steps; daily sit-to-stand-to-walk transfers reached a plateau after 6 weeks with less than 40 transfers.

Conclusions: The three DMOs progressed differently and attained plateau levels at varying times during the first year after hip fracture, indicating that these Digital Mobility Outcomes provide complementary information about different aspects of mobility recovery.

背景:髋部骨折后康复的主要重点是恢复活动能力:利用数字移动能力结果,估计髋部骨折后第一年实际移动能力的进展情况:设计:一项探索性、前瞻性队列研究,汇集了之前进行的四项临床试验的数据:我们合并了来自挪威特隆赫姆的特隆赫姆髋部骨折试验和 Eva-Hip 试验,以及德国斯图加特和海德堡的 PROFinD 1 和 PROFinD 2 试验的数据,得到了 717 名年龄≥65 岁的髋部骨折患者样本:每项试验都在三个时间点使用固定在身体上的传感器(activPAL)对活动能力进行评估,从而对术后第一年的活动能力进行观察。计算了以下 24 小时 DMOs:总步行时间(分钟)、一次步行的最大步数以及从坐到站再到步行的转移次数。使用带样条的量子回归模型估算了中位数、第 25 百分位数和第 75 百分位数的 1 年连续进展情况:数据集包含 5909 个观察日。每日总步行时间的中位数在术后36周之前一直在增加,达到40分钟;每日步行的最大步数在前8周增加,然后稳定在100步以下;每日从坐到站再到步行的转移在6周后达到高峰,转移次数少于40次:结论:在髋部骨折后的第一年中,三种数字移动能力指标的进展情况各不相同,并在不同时间达到了高原水平,这表明这些数字移动能力指标提供了有关移动能力恢复不同方面的互补信息。
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引用次数: 0
Intersection between person-centred practice and Montessori for dementia and ageing in residential aged care. 以人为本的实践与蒙台梭利在老年护理院痴呆症和老龄化问题上的交集。
IF 6 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-10-01 DOI: 10.1093/ageing/afae217
Marta Woolford, Lauren Bruce, Daniella Rigoni, Hannah Gulline, Phillipa Horsman, Ann MacRae, Danielle Berkovic, Niluksha Morawaka, Silvia Alberti, Helen Skouteris, Darshini Ayton

Background: Internationally, person-centred care (PCC) is embedded in the language of regulations and mandated to be practised in residential aged care (RAC). Despite this, PCC has not been fully adopted in RAC in Australia and internationally, and concerns about the quality of care persist. Over the past 2 decades, Montessori for dementia and ageing has been introduced in RAC to support and inform a cultural change towards PCC. This study aimed to examine the intersection between the goals and approaches of Montessori and PCC in RAC.

Methods: This qualitative descriptive study reports on a secondary analysis of qualitative data from focus groups (FGs) and interviews with residents, family-members, staff, and volunteers from eight RAC homes in Victoria, Australia. Sixteen FGs and 36 interviews were conducted. A qualitative deductive approach using researcher-developed Montessori for dementia and ageing framework for data analysis was applied.

Results: Findings provide support for the intersection between PCC and Montessori with participants' descriptions of PCC aligning with many of the goals and approaches of Montessori. Participants most commonly described Montessori approaches of engagement in daily tasks with purposeful roles and promoting cognitive abilities through multi-sensory stimulation. Least frequently-described approaches included focusing on residents' strengths/abilities, maintaining function, using familiar objects, and guided repetition.

Conclusions: Findings have important implications for practice to use Montessori as a vehicle that supports and upskills the workforce to deliver care that is person-centred. Future research must examine the resources required to support the implementation and sustainability of Montessori as a vehicle for PCC.

背景:在国际上,"以人为本的护理"(PCC)已被纳入法规语言中,并被强制要求在养老院护理(RAC)中实施。尽管如此,"以人为本的护理 "并未在澳大利亚和国际上的养老院中得到全面采用,人们对护理质量的担忧依然存在。在过去的二十年里,蒙台梭利痴呆症和老龄化教育已被引入澳大利亚养老院和护理中心,以支持和引导养老院和护理中心的文化变革。本研究旨在探讨蒙台梭利的目标和方法与康复咨询中心的照护中心之间的交叉点:本定性描述性研究报告对来自澳大利亚维多利亚州八所康复中心的居民、家庭成员、工作人员和志愿者的焦点小组(FGs)和访谈的定性数据进行了二次分析。共进行了 16 次焦点小组讨论和 36 次访谈。采用定性演绎法,使用研究人员开发的蒙特梭利痴呆与老龄化框架进行数据分析:结果:研究结果支持了老年陪伴中心与蒙特梭利之间的交叉,参与者对老年陪伴中心的描述与蒙特梭利的许多目标和方法一致。学员们最常描述的蒙台梭利方法是:有目的性地参与日常任务,通过多种感官刺激提高认知能力。最少描述的方法包括关注住院者的力量/能力、保持功能、使用熟悉的物品以及引导重复:研究结果对利用蒙特梭利作为支持和提高工作人员技能的工具,以提供以人为本的护理具有重要的实践意义。未来的研究必须对支持蒙台梭利作为以人为本的护理的载体的实施和可持续性所需的资源进行审查。
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引用次数: 0
The temporal sequence and reciprocal relationships of frailty, social isolation and loneliness in older adults across 21 years. 跨越 21 年的老年人虚弱、社会孤立和孤独的时间顺序和相互关系。
IF 6 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-10-01 DOI: 10.1093/ageing/afae215
Fereshteh Mehrabi, Mary Louise Pomeroy, Thomas K M Cudjoe, Emerald Jenkins, Elsa Dent, Emiel O Hoogendijk

Background: It is unclear whether social isolation and loneliness may precede frailty status or whether frailty may precipitate social isolation and loneliness. We investigated the reciprocal and temporal sequence of social isolation, loneliness, and frailty among older adults across 21 years.

Methods: We used seven waves of the Longitudinal Aging Study Amsterdam from 2302 Dutch older adults (M = 72.6 years, SD = 8.6, 52.1% female) ages 55 or older. Using random intercept cross-lagged panel models, we investigated between- and within-person associations of social isolation and loneliness with frailty. Frailty was measured using the Frailty Index. Loneliness was measured using the 11-item De Jong Gierveld Loneliness Scale. Social isolation was measured using a multi-domain 6-item scale.

Results: Social isolation and loneliness were weakly correlated across waves. At the between-person level, individuals with higher levels of frailty tended to have higher levels of social isolation but not loneliness. At the within-person level, the cross-lagged paths indicated that earlier frailty status predicted future social isolation and loneliness over time. However, prior social isolation was not associated with subsequent frailty except at time point 5 (T5). Loneliness at specific time points (T1, T4 and T6) predicted greater frailty at later time points (T2, T5 and T7). The results also supported reciprocal and contemporaneous relations between social isolation, loneliness and frailty.

Conclusions: Social isolation and loneliness are potential outcomes of frailty. Public health policies and health practitioners should prioritise interventions targeting social connection among older adults with pre-frailty or frailty.

背景:目前还不清楚社会隔离和孤独感是否会先于体弱状态,或者体弱是否会导致社会隔离和孤独感。我们调查了 21 年间老年人社交孤立、孤独和虚弱的相互关系和时间顺序:我们使用了阿姆斯特丹纵向老龄化研究的 7 个波次,研究对象为 2302 名 55 岁或 55 岁以上的荷兰老年人(M = 72.6 岁,SD = 8.6,52.1% 为女性)。我们使用随机截距交叉滞后面板模型,研究了社会隔离和孤独与虚弱之间的人际关系和人内关系。虚弱程度用虚弱指数来衡量。孤独感采用 11 项 De Jong Gierveld 孤独感量表进行测量。社会隔离度采用多领域 6 项量表进行测量:结果:社会隔离和孤独感在不同波次中的相关性较弱。在人与人之间,虚弱程度较高的人往往具有较高的社会孤立感,但孤独感并不高。在人与人之间的层面上,交叉滞后路径表明,早先的虚弱状况会随着时间的推移预测未来的社会孤立感和孤独感。然而,除了在时间点 5(T5)外,之前的社会隔离与之后的虚弱状态无关。特定时间点(T1、T4 和 T6)的孤独感预示着后期时间点(T2、T5 和 T7)更大的虚弱感。研究结果还证明,社会隔离、孤独感和虚弱之间存在互为因果的同期关系:结论:社会隔离和孤独是体弱的潜在后果。公共卫生政策和卫生从业人员应优先考虑针对虚弱前期或虚弱老年人的社会联系进行干预。
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引用次数: 0
Social isolation, loneliness and low dietary micronutrient intake amongst older people in England. 英格兰老年人的社会隔离、孤独感和膳食微量营养素摄入量低。
IF 6 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-10-01 DOI: 10.1093/ageing/afae223
Andrew Steptoe, Hoi Lam Fong, Camille Lassale

Background: Social isolation and loneliness are associated with increased risk of adverse health outcomes at older ages. This study evaluated whether isolation and loneliness are related to inadequate intake of micronutrients in the diet.

Methods: We tested associations between social isolation and loneliness and dietary micronutrient intake 2 years later in 3713 men and women (mean age 68.26, standard deviation 7.81 years) who completed two online 24-h dietary recalls. Associations of isolation and loneliness with intake of nine minerals and vitamins that fell below national recommendations were tested using logistic regressions, adjusting for age, gender, ethnicity, education, marital status, smoking and physical activity and total energy intake.

Results: The prevalence of low dietary intake varied markedly across micronutrients. Social isolation (1-point increase in a score ranging 0-5) was associated with increased odds (adjusted for covariates) of low intake of magnesium [odds ratio (OR) 1.153, 95% confidence interval (CI) 1.037-1.282, P = .009], potassium (OR 1.201, 95% CI 1.087-1.327, P < .001), vitamin B6 (OR 1.263, 95% CI 1.110-1.438, P < .001), folate (OR 1.211, 95% CI 1.093-1.341, P < .001) and vitamin C (OR 1.238, 95% CI 1.098-1.394, P < .001). These associations remained unchanged when food insecurity and impaired activities of daily living were taken into account. By contrast, loneliness was not related to the inadequate intake of any micronutrient.

Conclusions: Low intake of micronutrients increases risk of age-related health problems. Attention to the dietary quality of older people with limited social contacts and little involvement in community activities might enhance health outcomes.

背景:社会隔离和孤独与老年人不良健康后果风险的增加有关。本研究评估了孤立和孤独是否与饮食中微量营养素摄入不足有关:我们测试了 3713 名男性和女性(平均年龄 68.26 岁,标准偏差 7.81 岁)2 年后的社会隔离和孤独感与膳食中微量营养素摄入量之间的关系,这些男性和女性完成了两次在线 24 小时膳食回顾。在对年龄、性别、种族、教育程度、婚姻状况、吸烟、体力活动和总能量摄入进行调整后,采用逻辑回归法检验了孤立和孤独与九种矿物质和维生素摄入量低于国家推荐值之间的关系:结果:不同微量营养素的膳食摄入量偏低率差异显著。社会隔离(在 0-5 分之间增加 1 分)与镁(几率比(OR)1.153,95% 置信区间(CI)1.037-1.282,P = .009)、钾(OR 1.201,95% 置信区间(CI)1.087-1.327,P = .009)摄入量低的几率增加(经协变量调整)有关:微量营养素摄入量低会增加与年龄有关的健康问题的风险。关注社会交往有限、很少参与社区活动的老年人的饮食质量可能会改善他们的健康状况。
{"title":"Social isolation, loneliness and low dietary micronutrient intake amongst older people in England.","authors":"Andrew Steptoe, Hoi Lam Fong, Camille Lassale","doi":"10.1093/ageing/afae223","DOIUrl":"https://doi.org/10.1093/ageing/afae223","url":null,"abstract":"<p><strong>Background: </strong>Social isolation and loneliness are associated with increased risk of adverse health outcomes at older ages. This study evaluated whether isolation and loneliness are related to inadequate intake of micronutrients in the diet.</p><p><strong>Methods: </strong>We tested associations between social isolation and loneliness and dietary micronutrient intake 2 years later in 3713 men and women (mean age 68.26, standard deviation 7.81 years) who completed two online 24-h dietary recalls. Associations of isolation and loneliness with intake of nine minerals and vitamins that fell below national recommendations were tested using logistic regressions, adjusting for age, gender, ethnicity, education, marital status, smoking and physical activity and total energy intake.</p><p><strong>Results: </strong>The prevalence of low dietary intake varied markedly across micronutrients. Social isolation (1-point increase in a score ranging 0-5) was associated with increased odds (adjusted for covariates) of low intake of magnesium [odds ratio (OR) 1.153, 95% confidence interval (CI) 1.037-1.282, P = .009], potassium (OR 1.201, 95% CI 1.087-1.327, P < .001), vitamin B6 (OR 1.263, 95% CI 1.110-1.438, P < .001), folate (OR 1.211, 95% CI 1.093-1.341, P < .001) and vitamin C (OR 1.238, 95% CI 1.098-1.394, P < .001). These associations remained unchanged when food insecurity and impaired activities of daily living were taken into account. By contrast, loneliness was not related to the inadequate intake of any micronutrient.</p><p><strong>Conclusions: </strong>Low intake of micronutrients increases risk of age-related health problems. Attention to the dietary quality of older people with limited social contacts and little involvement in community activities might enhance health outcomes.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":null,"pages":null},"PeriodicalIF":6.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11479707/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Comparative efficacy of various exercise types and doses for depression in older adults: a systematic review of paired, network and dose-response meta-analyses. 各种运动类型和剂量对老年人抑郁症的疗效比较:配对、网络和剂量反应荟萃分析的系统回顾。
IF 6 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-10-01 DOI: 10.1093/ageing/afae211
Shudong Tian, Zhide Liang, Mengmeng Tian, Fanghui Qiu, Yingdanni Yu, Hong Mou, Yan Gao

Objectives: We assessed the effects of different exercise modalities and doses on depression levels in older adults.

Methods: Systematic searches of the PubMed, Web of Science, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Scopus databases were conducted from the start of database construction until December 2023. Studies were included if they were randomised controlled trials (RCTs) of exercise interventions in older adults. Pairwise, network and dose-network meta-analyses were conducted using random-effects models for the outcome of depression in older adults.

Results: A total of 80 RCTs with 5536 participants were included in this study. Network meta-analyses showed that resistance exercise [standardized mean difference (SMD) = - 0.68, 95% confidence interval (CI): - 0.90, - 0.46] and mind-body exercise (MBE; SMD = - 0.54, 95% CI: - 0.72, - 0.37) were the most effective forms of exercise for improving depression in older adults, followed by aerobic exercise (SMD = - 0.31, 95% CI: - 0.50, - 0.13) and mixed exercise (SMD = - 0.23, 95% CI: - 44, - 0.01). In addition, a U-shaped dose-response relationship was found between overall exercise dose and depression levels in older adults, and a significant response was seen after 390 metabolic equivalent (MET)-min/week.

Conclusions: Our study determined the effectiveness of different exercises in improving levels of older adults and found that resistance exercise and MBE were more effective adjunctive treatments. By providing the most effective treatments, older adults can reap the benefits of improving depression in older adults at doses lower than the World Health Organization guidelines.

目的:我们评估了不同运动方式和剂量对老年人抑郁水平的影响:我们评估了不同运动方式和剂量对老年人抑郁水平的影响:从数据库建立之初到 2023 年 12 月,我们对 PubMed、Web of Science、Embase、PsycINFO、Cumulative Index to Nursing and Allied Health Literature (CINAHL) 和 Scopus 数据库进行了系统检索。纳入的研究必须是针对老年人运动干预的随机对照试验(RCT)。采用随机效应模型对老年人抑郁症结果进行配对分析、网络分析和剂量网络荟萃分析:结果:本研究共纳入了 80 项研究性试验,共有 5536 名参与者。网络荟萃分析表明,阻力运动[标准化平均差(SMD)= - 0.68,95% 置信区间(CI):- 0.90, - 0.46]和身心锻炼(MBE;SMD = - 0.54,95% CI:- 0.72, - 0.37)是最有效的抑郁治疗方式。37)是改善老年人抑郁最有效的运动形式,其次是有氧运动(SMD = - 0.31,95% CI:- 0.50,- 0.13)和混合运动(SMD = - 0.23,95% CI:- 44,- 0.01)。此外,研究还发现,老年人的总体运动剂量与抑郁水平之间存在U型剂量-反应关系,在代谢当量(MET)-分钟/周达到390后,抑郁水平会出现显著反应:我们的研究确定了不同运动对改善老年人抑郁水平的有效性,并发现阻力运动和 MBE 是更有效的辅助治疗方法。通过提供最有效的治疗方法,老年人可以以低于世界卫生组织指南的剂量获得改善老年人抑郁症的益处。
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引用次数: 0
New horizons in systems engineering and thinking to improve health and social care for older people. 系统工程和思维的新视野,以改善老年人的健康和社会护理。
IF 6 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-10-01 DOI: 10.1093/ageing/afae238
Navneet Aujla, Tricia Tooman, Stella Arakelyan, Tim Kerby, Louise Hartley, Amy O'Donnell, Bruce Guthrie, Ian Underwood, Julie A Jacko, Atul Anand

Existing models for the safe, timely and effective delivery of health and social care are challenged by an ageing population. Services and care pathways are often optimised for single-disease management, while many older people are presenting with multiple long-term conditions and frailty. Systems engineering describes a holistic, interdisciplinary approach to change that is focused on people, system understanding, design and risk management. These principles are the basis of many established quality improvement (QI) tools in health and social care, but implementation has often been limited to single services or condition areas. Newer engineering techniques may help reshape more complex systems. Systems thinking is an essential component of this mindset to understand the underlying relationships and characteristics of a working system. It promotes the use of tools that map, measure and interrogate the dynamics of complex systems. In this New Horizons piece, we describe the evolution of systems approaches while noting the challenges of small-scale QI efforts that fail to address whole-system problems. The opportunities for novel soft-systems approaches are described, along with a recent update to the Systems Engineering Initiative for Patient Safety model, which includes human-centred design. Systems modelling and simulation techniques harness routine data to understand the functioning of complex health and social care systems. These tools could support better-informed system change by allowing comparison of simulated approaches before implementation, but better effectiveness evidence is required. Modern systems engineering and systems thinking techniques have potential to inform the redesign of services appropriate for the complex needs of older people.

安全、及时、有效地提供医疗和社会护理服务的现有模式受到了人口老龄化的挑战。服务和护理路径往往是针对单一疾病管理而优化的,而许多老年人却患有多种长期疾病,身体虚弱。系统工程描述了一种以人为本、系统理解、设计和风险管理的跨学科整体变革方法。这些原则是医疗和社会护理领域许多成熟的质量改进(QI)工具的基础,但其实施往往局限于单一的服务或条件领域。新的工程技术可以帮助重塑更复杂的系统。系统思维是这一思维方式的重要组成部分,它可以理解一个工作系统的内在关系和特征。它提倡使用各种工具来绘制、测量和分析复杂系统的动态。在这篇 "新视野 "文章中,我们介绍了系统方法的演变过程,同时指出了小规模质量改进工作所面临的挑战,即无法解决整个系统的问题。文章介绍了新型软系统方法的机遇,以及最近对患者安全系统工程倡议模型的更新,其中包括以人为本的设计。系统建模和模拟技术利用常规数据来了解复杂的医疗和社会护理系统的运作。这些工具可以在实施前对模拟方法进行比较,从而支持更明智的系统变革,但还需要更好的有效性证据。现代系统工程和系统思维技术有可能为重新设计适合老年人复杂需求的服务提供信息。
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引用次数: 0
Effects of exercise referral schemes enhanced with behavioural self-management strategies on functional capacity and self-reported disability in community-dwelling older adults. Secondary results from the SITLESS multi-country, three-armed randomized controlled trial. 通过行为自我管理策略加强运动转介计划对社区老年人功能能力和自我报告残疾的影响。SITLESS 多国三臂随机对照试验的二次结果。
IF 6 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-10-01 DOI: 10.1093/ageing/afae225
Pia Ø Olsen, Mark A Tully, Borja Del Pozo Cruz, Maria Giné-Garriga, Laura Coll-Planas, Marta Roqué, Dietrich Rothenbacher, Dhayana Dallmeier, Oriol Sansano-Nadal, Nicole E Blackburn, Jason J Wilson, Mathias Skjødt, Paolo Caserotti

Background: Exercise referral schemes (ERS) are an effective strategy for increasing physical activity (PA) in older adults. Behavioural self-management strategies (SMS) may augment the maintenance of PA and associated benefits in this population, resulting in preservation of the functional capacity and prevention of disability over the long-term.

Aim: The primary aim was to investigate the long-term (22-months) effects of ERS enhanced with SMS on functional capacity assessed by the Short Physical Performance Battery (SPPB) compared to ERS (primary comparison) and a control condition (CTRL).Secondarily, between-group effects after 4 and 16 months on the SPPB and self-reported disability outcomes were investigated.

Methods: 1360 physically inactive community-dwelling older adults ≥65 years from four European countries were randomized into (i) 16 weeks ERS enhanced with SMS (ERS-SMS), (ii) ERS alone and (iii) CTRL. In addition to SPPB, self-reported function and disability were assessed by the short-form late life function and disability index and with a six-item activity of daily living questionnaire.

Results: No long-term effects were found for the SPPB-score in ERS-SMS vs ERS (0.21 point, 95% CI [-0.04, 0.46]). Significant group × time effects were observed for the SPPB-score after 4 months in favour of ERS-SMS over CTRL (0.51 point, 95% CI [0.29, 0.73]) and ERS (0.46 point, 95% CI [0.24, 0.68]).

Conclusion: The study did demonstrate differences, in favour of ERS + SMS, but on SPPB these were small, and not sustained over time. The additional effect of SMS was inconsistent and uncertain.

背景:运动转介计划(ERS)是增加老年人体育锻炼(PA)的有效策略。目的:本研究的主要目的是调查通过行为自我管理策略(SMS)加强的运动转介计划与运动转介计划(主要对比)和对照条件(CTRL)相比,对通过短期体能测试(SPPB)评估的功能能力的长期(22个月)影响。方法:来自四个欧洲国家的 1360 名年龄≥ 65 岁、不爱运动的社区老年人被随机分配到(i) 16 周的 ERS 增强型 SMS(ERS-SMS)、(ii) ERS 单项和(iii) CTRL。除 SPPB 外,还通过短式晚年功能和残疾指数以及六项日常生活活动调查问卷对自我报告的功能和残疾情况进行了评估:ERS-SMS与ERS相比,SPPB得分没有发现长期效应(0.21分,95% CI [-0.04,0.46])。在 4 个月后的 SPPB 评分方面,ERS-SMS 比 CTRL(0.51 分,95% CI [0.29, 0.73])和 ERS(0.46 分,95% CI [0.24, 0.68])具有显著的组别 × 时间效应:该研究确实显示了 ERS + SMS 的差异,但 SPPB 的差异较小,且不能随着时间的推移而持续。SMS 的额外效果不一致,也不确定。
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引用次数: 0
Navigating dementia feeding decisions in Asia: a mixed methods study of caregivers. 亚洲痴呆症喂养决策导航:对护理人员的混合方法研究。
IF 6 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-10-01 DOI: 10.1093/ageing/afae232
Ellie B Andres, Isha Chaudhry, Ishwarya Balasubramanian, Louisa Poco, Philip Yap, Chetna Malhotra

Background: Tube feeding is discouraged among older adults with advanced dementia; nevertheless, caregivers often find feeding decisions challenging to navigate.

Aim: This study aims to gain a comprehensive understanding of tube feeding among community-dwelling older adults with advanced dementia in Singapore and its relationship to older adult quality of life (QoL) and caregiver psychological distress.

Methods: We use a convergent mixed-methods design, synthesising analysis of qualitative caregiver interviews (n = 25) and two-year prospective, longitudinal cohort survey data (n = 215, 1018 observations).

Results: Findings from the qualitative interviews revealed caregivers' expectations of reduced QoL for older adults with feeding tubes and their own distress related to making feeding decisions and fears prompting plans to tube-feed. Sixteen percent of community-dwelling older adults with advanced dementia relied on feeding tubes during the two-year study period. Adjusting for potential confounding and using instrumental variables estimation, tube feeding was associated with reduced older adult QoL (P < .05) and increased caregiver anxiety and depression (P < .10).

Conclusion: Consistent with expert guidelines, we found that tube feeding was associated with significantly reduced QOL among older adults living with dementia and increased distress among caregivers relative to those of older adults without feeding tubes. Despite caregivers' recognition of reduced QOL associated with older adult use of feeding tubes, many expressed angst related to feeding choices. Our findings suggest the need for decision tools to support caregivers in making informed decisions concordant with their values.

背景:目的:本研究旨在全面了解新加坡社区居住的晚期痴呆症老年人的管饲情况及其与老年人生活质量(QoL)和照顾者心理压力之间的关系:我们采用了一种融合的混合方法设计,综合分析了对护理人员的定性访谈(n = 25)和为期两年的前瞻性纵向队列调查数据(n = 215,1018 次观察):定性访谈的结果显示,护理人员预期插管喂养的老年人的生活质量会下降,他们自己在做出喂养决定时也会感到痛苦,担心插管喂养的计划会失败。在为期两年的研究期间,社区居住的晚期痴呆症老年人中有 16% 需要依靠喂食管喂食。在对潜在的混杂因素进行调整并使用工具变量估算后,插管喂养与老年人生活质量下降有关(P 结论:插管喂养与老年人生活质量下降有关:与专家指南一致,我们发现与未使用喂食管的老年人相比,使用喂食管喂食与痴呆症老年人的 QOL 显著下降以及护理人员的痛苦增加有关。尽管照护者认识到老年人使用喂食管会降低其生活质量,但许多照护者对喂食选择表示焦虑。我们的研究结果表明,需要有决策工具来支持护理者做出符合其价值观的明智决定。
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引用次数: 0
Development and validation of a functional ability index for older adults: a multicohort study. 老年人功能能力指数的开发与验证:一项多队列研究。
IF 6 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-10-01 DOI: 10.1093/ageing/afae231
Yi Chang, Suman Sapkota, Bipin Thapa, Lina Ma, Linghui Sheng, Chaodong Wang, Jagadish K Chhetri, Piu Chan

Background: The aim of this study was to develop and validate a functional ability index (FAI) that incorporates aspects of intrinsic capacity and environmental factors of older individuals based on the World Health Organization framework of healthy ageing.

Methods: Data of 7016 participants ≥60 years participating in the baseline survey of China Health and Retirement Longitudinal Study was used for the development and internal validation of the FAI. External validation was performed in a separate cohort of 1295 older individuals aged ≥60 years. Functional independency was considered the primary outcome and additional proxies of healthy ageing were considered as secondary outcomes. Cluster dendrogram was used to identify the distinct hierarchical clusters of all included variables for inclusion in the FAI. Backward elimination logistic regression model was implemented to identify the most significant variables associated with independency to be included in the FAI.

Results: The FAI score ranged from 0 to 19 and individuals having FAI ≥ 12 were more likely to be independent and at lower risk of negative outcomes. For each unit increase in the FAI the risk of having independency increased by 30%-58% cross-sectionally in the two cohorts, whilst the 2-year risk of independency increased by 20%. The FAI demonstrated a C-statistic of 0.73 (95% confidence interval, 0.72 and 0.75) for the primary outcome.

Conclusions: The FAI we developed effectively measured the functional ability status of community dwelling older individuals. FAI could serve as a tool for evaluating older individual's functional ability in routine health assessment.

研究背景本研究的目的是在世界卫生组织健康老龄化框架的基础上,开发并验证一种包含老年人内在能力和环境因素的功能能力指数(FAI):方法:利用参加中国健康与退休纵向研究基线调查的 7016 名年龄≥60 岁的参与者的数据,对 FAI 进行开发和内部验证。在1295名年龄≥60岁的老年人组成的独立队列中进行了外部验证。功能独立性被视为主要结果,健康老龄化的其他代用指标被视为次要结果。聚类树枝图用于识别所有纳入 FAI 的变量的不同层次聚类。采用后向消除逻辑回归模型来确定与独立相关的最重要变量,并将其纳入 FAI:FAI 分值介于 0 到 19 之间,FAI ≥ 12 的个体更有可能是独立的,且出现负面结果的风险较低。在两个队列中,FAI每增加一个单位,独立的风险就会增加30%-58%,而两年后独立的风险则会增加20%。FAI 对主要结果的 C 统计量为 0.73(95% 置信区间为 0.72 和 0.75):我们开发的 FAI 能有效测量社区老年人的功能能力状况。FAI可作为常规健康评估中评估老年人功能能力的工具。
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Age and ageing
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