BMC Geriatrics最新文献

Background: Global population aging is reshaping social structures and health demands at an unprecedented pace. Existing research indicates that decision-making power is significantly associated with health outcomes in later life. However, the underlying pathways linking household financial decision-making power to mental health remain underexplored in population-based studies. Elucidating multi-pathway effects will provide pathway-based evidence for identifying vulnerable populations and developing clinical interventions.

Methods: We analyzed five waves (2005-2014) of the Chinese Longitudinal Healthy Longevity Survey(CLHLS), comprising 23,994 observations from 9,055 adults aged 65 years or older. Financial decision-making power was self-reported on a four-point ordinal scale. Mental health was assessed via five indicators: psychological resilience, subjective well-being, life satisfaction, self-rated health, and loneliness. Fixed-effects models were applied to control for time-invariant confounders, and inverse probability weighting was used to address attrition bias. Mediation pathways were tested using a bootstrapping approach (500 repetitions).

Results: A graded dose-response relationship was observed: lower financial decision-making power was associated with poorer mental health across all outcomes. Compared to those with full autonomy, older adults without decision-making power showed significantly lower psychological resilience (β = - 0.31, p < 0.001) and subjective well-being (β = - 0.51, p < 0.001). Mediation analyses revealed that activities of daily living (ADL) accounted for 13.0% to 31.8% of the total effect and leisure activities for 10.0% to 34.2%, with the strongest mediation observed for loneliness. Among the participants who were functionally independent at baseline, functional capacity exhibited dual mediating roles: a positive pathway for self-rated health and a suppression effect for loneliness. Heterogeneity analyses revealed more pronounced benefits among economically disadvantaged, financially dependent, female, and younger-old adults, with protective effects partially offsetting vulnerabilities in these populations.

Conclusions: Financial decision-making power is a significant and potentially modifiable factor associated with mental health among older adults, representing an underexplored pathway for promoting healthy aging, with effects partially mediated through ADL and leisure engagement. Mental health promotion strategies should seek to preserve older adults' household financial decision-making power while supporting functional independence and social engagement.

Background: The growing population of centenarians faces unique health challenges. Of particular interest may be the co-occurrence of depressive symptoms and functional dependence, requiring comprehensive exploration.

Objective: To map and summarize existing literature on depressive symptoms and functional dependence in near-centenarians and centenarians, focusing on prevalence rates, screening instruments, and the relationship between these two conditions.

Inclusion criteria: Studies that explored depressive symptoms and functional dependence among individuals aged ≥ 95 years.

Methods: This review was performed in accordance with the JBI Manual for Scoping Reviews. The PRISMA Extension for Scoping Reviews (PRISMA-ScR) standards were followed for reporting. The literature search was conducted in August 2023 in the following bibliographic databases: Embase.com, Medline ALL Ovid, CINAHL with Full Text, APA PsycInfo Ovid, Web of Science Core Collection, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials; including a grey literature search and citation tracking strategies.

Results: Fifty-three studies from 1994 to 2023 were included, with 28.3% conducted in the USA. Most studies were quantitative and cross-sectional. Depressive symptom prevalence ranged from 10.5% to 73% among studies reported individually; the GDS-15 was the most commonly used instrument. Total functional dependence ranged from 20.8% to 30.3% (ADLs) and 27.5% to 63% (IADLs); the OARS Multidimensional Functional Assessment Questionnaire and the Katz Index were the most frequently employed instruments. Only 30.2% of studies explored the association between depressive symptoms and functional dependence, with 56.3% finding a significant relationship.

Conclusions: The findings revealed geographical research disparities and underscored the need for diverse research methodologies for deeper insights into the health trajectories of the very old. Additionally, centenarians may not inherently have higher depressive symptoms than 'younger' seniors, suggesting possible resilience mechanisms. The relationship between depressive symptoms and functional dependence highlighted their mutual influence and potential to increase the risk of adverse outcomes.

Implications: Diversifying research methodologies and expanding geographical scope are essential for a holistic understanding and international comparisons. Standardized guidelines for assessment instruments could facilitate consistent conclusions. Development and implementation of multifaceted interventions, such as preventive measures, professional competency enhancement, and caregiver support are central to addressing the needs of this population effectively.

Background: Due to advanced morphological tissue degradation and chemical alterations resulting from putrefaction, challenges arise in identification as well as in histopathological and toxicological examinations. Consequently, it has been debated that autopsies performed on decomposed bodies may have limited diagnostic and forensic value and may not always yield satisfactory results. With this study, we aimed to mitigate concerns and biases in the literature-particularly the view that autopsy has limited value in decomposed geriatric cases-and to delineate the diagnostic yield, contributory value, and limits of applicability of autopsy and histopathological evaluation.

Methods: We examined 88 decomposed bodies cases arising from non-traumatic, in-home deaths among geriatric individuals. Detailed evaluations were conducted of autopsy, histopathological, toxicological, identification, medical history, and scene investigation findings. Statistical analyses were performed using the Statistical Package for the Social Sciences (SPSS), version 25.0 (Chicago, IL, USA).

Results: 83.0% of the cases were male, and the mean age was 70.9 years. 85.2% lived alone, and 70.5% had a history of chronic disease. On histopathological examination, the coronary arteries were the tissues most resistant to autolysis. Toxicological analysis detected therapeutic-range concentrations of pharmaceutical agents in 56.8% of cases and endogenous ethanol in 21.6%. Identification was achieved via DNA comparison analyses in 29.5% of cases. A cause of death was established in 69.3% of cases; the most common non-traumatic cause of death was cardiovascular diseases (48.9%).

Conclusion: Contrary to common presumptions, forensic autopsy and histopathological examinations of decomposed bodies in our study successfully determined the cause of death in a substantial proportion of cases (69.3%), a finding that is broadly consistent with the literature. In particular, the systematic histopathological evaluation of tissues resistant to autolysis-such as the coronary arteries and myocardium-combined with modern toxicological analyses and the integrated assessment of scene investigation findings and medical history data, enables a forensically satisfactory determination of the cause of death.

Background: Assistive technologies may play a crucial role in addressing needs of people with dementia. While technical feasibility often drives development, the decision-making process that might lead to their adoption (or rejection) is not fully understood. We aim to explore contextual factors influencing this process and "necessities" technology should fulfil from the user-perspective, so that the use of assistive technologies can be better targeted- potentially fostering a more supportive home environment.

Methods: In this qualitative study, interviews (8 people with dementia and 7 partners) and focus groups (7 focus groups included a total of 29 participants) with individuals with milder stages of dementia living at home and their support/care-network were carried out. Grounded Theory and Structuring Content Analysis were used to analyse the data.

Results: Six main thematic categories outline the decision-making process. The "assessment of (one's own) resources", while evaluating the "(potential) benefits of assistive technologies" contrasts with "(potential) adverse effects" of their use (or their non-use respectively), shaping the context of the decision-making process. There is an appraisal of necessary "(pre-existing) trust" in technology. An a priori "openness towards assistive technologies" intersects latter aspects. A very substantial "need for information" is noted.

Conclusions: While technical feasibility and tailored solutions are important, they are not the sole determinants of assistive technology adoption in this group. The desire to preserve self-determination and independence emerges as a key motive for choosing assistive technologies; technology can also be seen to invoke stress and negative emotions, and will consequently be rejected. Technology should, moreover, be perceived to be "meaningful" on different levels. Considering these points when developing technologies and addressing them when counselling those affected by dementia and their networks may "tip the scale" towards acceptance.

Background: Individuals at risk of frequent hospitalisation often experience complex health and social challenges. Peer health navigation programmes have emerged as a promising strategy to support these patients, improve continuity of care, and reduce hospital use. The strategy has strong alignment with the transition of care management model.

Objective: To describe the baseline demographic characteristics, self-reported health status, and frailty of patients enrolled in the Northern Patient Watch (NPW) program. NPW employs peer health navigators, under the supervision of health professionals, to support individuals at high risk of recurrent hospital admissions.

Methods: This observational study examined all patients who enrolled in the NPW programme between November 2021 and October 2024. Baseline data were collected on demographics, health-related quality of life (EQ-5D-5 L), and frailty (Rockwood Clinical Frailty Scale). Descriptive statistics were used to summarise the findings.

Results: A total of 650 patients were enrolled. The mean age was 70 years, and 56% were female. One-third lived alone, and 29% spoke a language other than English at home. The mean EQ-5D-5 L index score was 0.72, with a mean EQ-VAS of 58.9, indicating moderate health-related quality of life. Moderate issues were frequently reported across all EQ-5D-5 L dimensions, particularly in mobility, pain, and mental health. Two-thirds of participants were classified as vulnerable or frail.

Conclusion: Patients who enrol in peer health navigation programmes such as NPW are typically older adults with moderate but not severe health challenges. These individuals may be particularly well positioned to benefit from early, tailored support that can prevent further deterioration. Findings highlight the potential value of peer navigation programmes in engaging at-risk populations before health crises occur.