BMC Geriatrics最新文献

Background: Polypharmacy and low literacy increase medication self-administration errors (MSEs) among older adults, adversely affecting both patients and healthcare systems through increased costs and reduced treatment efficacy.

Objectives: This study explored the reasons for MSEs among illiterate and low-literate older adults with polypharmacy from the perspective of older adults, informal family caregivers, physicians, and pharmacists.

Method: The qualitative study used a conventional content analysis approach from September 2022 to April 2023. Purposeful sampling was used to recruit participants for interviews.

Results: The study included fifteen older adults, five caregivers, four physicians, and seven pharmacists. Seven main categories were extracted: 1) Age-related physical and cognitive changes, 2) Medication Mismanagement, 3) Inhibitor beliefs of proper medication use, 4) Caregiving challenges, 5) Deficiency in effective communication and education, 6) Health systems inefficiencies, 7) The challenges of producing, dispensing and obtaining medications.

Conclusion: The origins of MSEs encompass a broad spectrum of factors, ranging from individual to systemic levels. Successful interventions for reducing errors will be those that take into account all aspects of error occurrence and strive to minimize them through a holistic approach. The findings highlight the importance of improving organizational health literacy strategies for older adults with limited literacy. Tailoring health information to the specific needs of older patients is crucial for addressing MSEs.

Background: The scarcity of resources in long-term care demands more than ever that organizations in this sector are prepared for innovation to ensure affordable access to care for older adults. Organizations that are innovation ready are more capable of implementing innovations. Therefore, a better understanding of how stakeholders view innovation readiness in long-term care can provide actionable strategies to enhance their innovative capacities. 'Innovation readiness' indicates the level of maturity of an organization to succeed in any type of innovation. Our study explored perspectives among stakeholders on what they consider important for organizations in long-term care for older adults to be innovation ready.

Methods: Q-methodology, a mixed-methods approach, was used to investigate the perspectives of 30 stakeholders connected to long-term care for older adults in the Netherlands: academics, (top)management, innovation managers, client representatives, staff, and consultants. Stakeholders were asked to rank 36 statements on innovation readiness on importance. Statements were extracted from literature research and qualitative interviews. Thereafter in the post-interviews stakeholders explained their ranking and reflected on the statements. By-person factor analysis was used to identify clusters in the ranking data. Together with the qualitative data from follow-up interviews, these clusters were interpreted and described as perspectives of the stakeholders.

Results: Four distinct perspectives were identified on what they consider important for innovation readiness in long-term care: (1) 'supportive role of management' (2) 'participation of the client (system) and employees' (3) 'setting the course and creating conditions' and (4) 'structuring decision-making, roles and responsibilities'. The 36 statements represented a complete overview of innovation readiness factors. No additional innovation factors to those previously identified in the literature emerged from the interviews.

Conclusions: Stakeholders agree that all factors contributing to innovation readiness of long-term care organizations for older adults are accounted for. The variety of perspectives on what is most important shows there is no agreement among stakeholders about a fixed route toward innovation readiness. However, stakeholders suggested a temporal order of the innovation readiness factors, preferably starting with formulating the innovation ambition. This study's results could contribute to developing an assessment tool to deliver a structured approach for managers to assess the innovation readiness of their organization.

Registration: The study received ethical approval on April 13, 2022 from the Medical Ethics Board of Zuyderland Medical Center in the Netherlands with the number METCZ20220036.

Background: Catatonia is an underdiagnosed neuropsychiatric condition, with only a few studies focusing on medical sequalae among elderly populations. Delayed treatment results in complications with high morbidity and mortality. Among elderly individuals, one such complication is urinary retention. Urinary retention can result in prolonged catheter use. In geriatric populations, prolonged use of catheters become particularly concerning and problematic as it can limit patient mobility, are potential sources for infection, and increase the risk for delirium. Catheter use has been independently associated with increased mortality in nursing home settings. Given the above risks and implications of catheter use, this case series describes clinical cases of catatonia-associated urinary retention specifically in older populations, whereby the use of electroconvulsive therapy (ECT) resulted in resolution of urinary retention concurrent with resolution of depressive and catatonic symptoms using validated scales.

Case presentation: This study involved four patients ranging from 66-84 years old who met criteria for major depressive disorder and catatonia. At admission, Montgomery-Asberg Depression Rating Scale (MADRS) scores ranged from 40-56, indicating severe illness in all patients. All patients also met criteria for catatonia as measured by the Bush Francis Catatonia Rating Scale (BFCRS). During the admission, each patient experienced urinary retention as evidenced by post-void residual (PVR) bladder volumes ranging from 569-1400 mL. Medical workup was completed to exclude alternative causes for urinary retention. Each patient completed ECT treatment, ranging from 14-19 sessions which resulted in resolution of catatonia. All four patients were also noted to have PVR volumes ranging from 6-75 mL, thereby suggesting concurrent resolution of urinary retention. Posttreatment, the MADRS scores ranged from 3-16, indicating a mild or subthreshold index of illness. There was no recurrence of elevated post-void residual volumes, and therefore, all patients were discharged from hospital without the requirements of urinary catheter insertion.

Conclusions: To our knowledge, there are no case reports that describe the concurrent resolution of catatonia, depressive symptoms and urinary retention simultaneously using validated scales throughout the ECT treatment course. Furthermore, there are no prior reports describing catatonia-related urinary retention specifically among a group of geriatric populations. Identifying and treating catatonia in a timely manner can reduce the complications associated with prolonged catheter use. There remains a gap in current research to describe if there exists any overlapping mechanisms and pathways to explain how ECT can treat catatonia, depression, and catatonia-associated urinary retention.

Background: Age-related macular degeneration (AMD) stands as the primary cause of visual impairment and blindness among the elderly population. Patients over 90 years comprise a unique demographic that may necessitate particular attention. The aim of this study was to examine the clinical characteristics and treatment outcomes in patients aged 90 years or older diagnosed with neovascular age-related macular degeneration (nAMD).

Methods: The medical records of treatment-naive patients aged ≥ 90 years diagnosed with nAMD have been retrospectively reviewed in our clinic. The complete ophthalmic examination findings of the patients, along with optical coherence tomography and fundus fluorescein angiography records, as well as their adherence to treatment, and reasons for treatment discontinuation were noted. Clinical data following intravitreal injection loading dose and during the 1st and 2nd years of treatment were evaluated.

Results: The average age of the 45 participants (25 females, 20 males) included in the study was 93.55 ± 5.2 years (range; 90-101). The mean best-corrected visual acuity at diagnosis, at the 4th month of treatment, and during the 1st and 2nd years were LogMAR 0.8, 0.5, 0.7 and 1.0, respectively. The most common reasons for missing appointments and completely discontinuing treatment were death and inability to attend appointments due to additional comorbidities.

Conclusion: In the very elderly patient group, nAMD can lead to severe damage in the macula, and a decrease in visual acuity despite treatment is not uncommon. Close monitoring and support for treatment adherence are necessary for this group of patients.

Background: This study aimed to investigate the modulatory role of prefrontal cortex (PFC) activity in older adults with mild cognitive impairment (MCI) when sensory cues were removed or presented inaccurately (i.e., increased sensory complexity) during sensory manipulation of a balance task. The research sheds light on the neural regulatory mechanisms of the brain related to balance control in individuals with MCI.

Methods: 21 older adults with MCI (male/female: 9/12, age: 71.19 ± 3.36 years) were recruited as the experimental group and 19 healthy older adults (male/female: 10/9, age: 70.16 ± 4.54 years) as the control group. Participants were required to perform balance tests under four standing conditions: standing on a solid surface with eyes open, standing on a foam surface with eyes open, standing on a solid surface with eyes closed, and standing on a foam surface with eyes closed. Functional Near-Infrared Spectroscopy (fNIRS) and force measuring platform are used to collect hemodynamic signals of the PFC and center of pressure (COP) data during the balance task, respectively.

Results: Under the eyes open condition, significant Group*Surface interaction effects were found in the mean velocity of the COP (MVELO), the mean velocity in the medial-lateral (ML) direction (MVELO_ml) and the 95% confidence ellipse area of the COP (95%AREA-CE). Additionally, significant Group*Surface interaction effect was found in the left orbitofrontal cortex (L-OFC). The significant group effects were detected for three ROI regions, namely the left ventrolateral prefrontal cortex (L-VLPFC), the left dorsolateral prefrontal cortex (L-DLPFC), the right dorsolateral prefrontal cortex (R-DLPFC). Under the eyes closed condition, the significant Group*Surface interaction effects were found in root mean square (RMS), the RMS in the ML direction (RMS_ml) and the 95%AREA-CE. Additionally, significant group effects were detected for five ROI regions, namely R-VLPFC, the left frontopolar cortex (L-FPC), L-DLPFC, R-DLPFC and R-OFC.

Conclusion: Our study emphasizes the role of the PFC in maintaining standing balance control among older adults with MCI, particularly during complex sensory conditions, and provides direct evidence for the role of the PFC during balance control of a clinically relevant measure of balance.

Trial registration: ChiCTR2100044221, 12/03/2021.

Background: Patient Reported Outcome Measures (PROMs) are questionnaires that collect health data directly from the patient, without any intervention from a third party. The aim of rehabilitation units is to restore function. Functional gain can be evaluated with classic scales, such as the locomotor subscale of the Functional Independence Measure. This study aimed to assess the accuracy of a new self-assessment questionnaire pertaining to physical, sensory and cognitive ability (abbreviated SEPCO) for the prediction of functional prognosis in older patients admitted to a rehabilitation unit.

Methods: In this multicentre observational study including patients admitted to 12 rehabilitation centres in France, all included patients completed the SEPCO on admission. Poor response to rehabilitation was defined as relative effectiveness < 40% on the evolution of the locomotor FIM subscale. Components of the questionnaire potentially associated with the outcome of rehabilitation were confirmed for inclusion upon expert review and summed to form an overall score. The final score had five components: the depression score of the HADS, the SOFRESC vision score, the SOFRESC balance score, the stress urinary incontinence subscale of the USP, and the EPICES socio-economic deprivation score. A logistic regression model adjusted for baseline characteristics assessed the performance of the SEPCO score to predict change in functional status, defined by the relative functional gain for the locomotion subscale of the Functional Independence Measure (FIM).

Results: A total of 153 patients (mean age 79.2 ± 8.1 years, 72.5% women) were included. By multivariate analysis, a 5-scale SEPCO score ≥ 1.1 predicted worse functional improvement with an odds ratio (OR) of 2.575, 95% Confidence Interval (CI) 1.081 to 6.133, p = 0.03. Sensitivity for this threshold was 67.4% (95% CI 52.0-80.5%), with a specificity of 58.8% (95% CI 46.2-70.6%). Having a SEPCO ≥ 1.1 almost doubled the probability of poor response to rehabilitation (from 27.3 to 52.5%).

Conclusion: The SEPCO score can predict poor functional gain from rehabilitation. Future studies should validate this score on an external cohort. The SEPCO could serve as a complement to the initial clinical evaluation performed by physicians, and assist physicians in setting each patient's rehabilitation goals.

Background: Social participation (SP) affects the physical and mental health of older adults. Post-lunch napping is a prevalent lifestyle practice observed among older adults, and it may have an impact on their SP. However, research that explores the association between these factors is limited, and we thus aimed to examine this association.

Methods: We conducted a cross-sectional study using data from the China Health and Retirement Longitudinal Study (CHARLS), focusing on participants aged 60 and older. SP was measured by both the number and frequency of activities based on participant self-reports. The duration of post-lunch napping was also self-reported. We explored the association between post-lunch napping duration and SP using logistic regression, subgroup analysis, and Restrictive Cubic Spline (RCS) analysis.

Results: We included 4259 participants in the study. Post-lunch napping demonstrated a significant association with decreased odds ratio of poor SP in fully adjusted logistic regression models (odds ratio = 0.77, 95% CI: 0.66 ~ 0.90, p = 0.011). Subgroup analysis indicated consistent proportional effects across all subgroups (p > 0.05). RCS analysis revealed a non-linear "J"-shaped relationship between post-lunch napping duration and SP, with the lowest odds ratio corresponding to a duration of 34.37 min.

Conclusion: Our study suggests that a moderate duration of post-lunch napping, ideally around 34 min, might have the potential to enhance SP, whereas exceeding this duration could could potentially have a limiting effect. This observation implies that incorporating moderate post-lunch napping into health management strategies for older adults might offer some advantages.

Background: The fatigue of the inspiratory musculature, particularly the diaphragm, has been demonstrated to exert systemic effects on the body, impacting cardiovascular and performance outcomes. This study aimed to evaluate the influence of an inspiratory muscle fatigue protocol on respiratory muscle strength, functionality, and muscle oxygen saturation in older adults.

Methods: A single-blinded randomized controlled clinical trial was conducted on twenty-four older adults aged over 60 years, who met inclusion criteria were physically independent in terms of gait and functionality. Participants were randomly assigned to one of three groups: control group, inspiratory muscle fatigue group, or activation group. Diaphragmatic ultrasonography (diaphragmatic thickness, thickening fraction, diaphragm movement curve), maximal inspiratory mouth pressure, muscle oxygen saturation, and functionality (timed up and go test, for five times sit to stand test) were used to measure the study variables at two time points: pre-intervention (T1) and post-intervention (T2).

Results: In the maximum inspiratory pressure variable in the activation group an increase was found between baseline and post-treatment of 3.00 ± 0.93 cmH2O (P < 0.01), while in the inspiratory muscle fatigue a decrease of -6.75 ± 2.66 cmH2O (P < 0.01) was found. In addition, the inspiratory muscle fatigue group showed lower scores for respiratory and functional variables after performing the diaphragmatic fatigue intervention than the activation and control group (P < 0.05), on the other hand, the activation group showed more positive values for functional and respiratory capacity variables after performing the inspiratory muscle activation training (P < 0.05).

Conclusions: Fatigue of the inspiratory musculature appears to negatively impact inspiratory muscle strength, peripheral muscle strength, muscular oxygenation, and functionality in older adults. Activation of the inspiratory musculature could contribute to improved respiratory muscle strength and function in these individuals.

Trial registration: ClinicalTrials.gov ID: NCT06266013.

Introduction: Dementia, an increasingly critical public health concern in low and middle-income countries, is associated with lower socioeconomic status, early cognitive impairment, and elevated dementia-related mortality risk. This study seeks to estimate the prevalence of cognitive impairment, investigate its links with social indicators, and visualize social gradients across different regions in Colombia.

Methods: Secondary data analysis from the SABE 2015 survey, multinomial regression analyses, and equiplot graphs.

Results: A sample of 23,694 individuals 60 years or older from Colombia. Higher risks were observed among individuals with dark skin color (OR 1.27; 95%CI: 1.10 - 1.47), lower educational levels (OR 3.01; 95%CI:2.04 - 4.42) and reading illiteracy (OR 2.14; 95%CI: 1.87 - 2.46). Inequity patterns were identified by region of residence and income.

Discussion: This study underscores the need for targeted interventions aimed at reducing health inequities. The results highlight the higher prevalence rates of cognitive impairment among socially disadvantaged individuals.