BMC Geriatrics最新文献

Background: Anxiety disorders in older adults have become a prominent public health problem due to their concomitant chronic conditions, reduced quality of life and even death. However, fewer studies have been conducted on differences in anxiety among older individuals in different aged-care models, and the interactive relationship between the influencing factors on anxiety remains unclear. The study aimed to examine the disparities in the prevalence of anxiety between community-dwelling and institutionalized older adults and related influencing factors.

Methods: Data were collected from the Anhui Healthy Longevity Survey (AHLS) and the Anhui Elderly Caring Social Organizations Survey (AECSOS). Data on demographic variables, lifestyle factors and health-related variables in 6968 older adults were used for analysis. Anxiety symptoms were evaluated using the Generalized Anxiety Disorder Assessment Scale (GAD-7). Binary logistic regression models and a Classification and Regression Tree model (CART) were utilized to examine the relationship between variables.

Results: The prevalence of anxiety were 24.3% and 16.7% among community-dwelling older adults and institutionalized older adults, respectively. Several factors including age, gender, residence, education, income level, live alone, and number of chronic diseases showed a linkage with anxiety among community-dwelling older adults. For the institutionalized older adults, gender, residence, source of income, and number of chronic diseases exhibited a significant association with anxiety. We noted the interactive effect, suggesting that community-dwelling female older adults with an income level of less than 6500 RMB per year and reported chronic disease comorbidities had the highest likelihood of anxiety, and institutionalized female older adults with income sources such as pension, subsidy, family providing, and resident in rural areas have the greatest risk of experiencing anxiety.

Conclusions: This study has brought to light the higher risk of anxiety among community-dwelling older adults compared to institutionalized older adults. Targeted interventions are, therefore emphasized to address the negative impact of anxiety for populations at higher risk.

Background: There is growing interest in developing sensing solutions for remote health monitoring to support the safety and independence of older adults. To ensure these technologies are practical and relevant, people-centred design is essential. This study aims to explore the involvement of various stakeholders across different developmental stages to inform the design and assess the capabilities of unobtrusive sensing solutions being developed as part of the Advanced Care Research Centre (ACRC), Edinburgh, UK.

Methods: This study was conducted in two phases. In Phase I (Ideation), discussions were held with stakeholders (n = 19), including senior geriatricians (n = 2), healthcare and care home professionals (n = 4), PPI experts (n = 2), researchers (n = 4) and public members aged 65 and above from the ACRC Patient and Public Involvement (PPI) Network (n = 7). The goal was to identify clinically significant health parameters and design preferences. Based on this, prototypes of unobtrusive sensors for monitoring movement, hydration, and respiration were developed. In Phase II (Development and Co-Design), an in-person PPI workshop was conducted with PPI experts (n = 2), researchers (n = 4) and PPI members (n = 8). The developed prototypes were demonstrated, and qualitative feedback was collected through focus group discussions on themes such as acceptability, usability, privacy, data sharing, and functionality enhancement.

Results: Stakeholder input from Phase I emphasized the importance of non-contact sensing technologies that maintain privacy. Movement, hydration, and respiration were identified as critical health parameters. In Phase II, PPI members were optimistic about the prototypes, valuing their unobtrusive design and privacy-preserving features. Key themes identified included (1) the need for user-customized alarms, (2) clear data-sharing protocols, and (3) the importance of embedding sensors into familiar household objects. Suggestions for refining the prototypes included adding functionality for detecting deviations in daily routines and integrating feedback mechanisms for caregivers.

Conclusions: Involving diverse stakeholders from the early stages of technology development enhanced the relevance and acceptability of unobtrusive sensing solutions. This study highlights the importance of integrating public perspectives into the design process. For successful implementation, developers of healthcare technologies should prioritize privacy, usability, and clear communication with end-users and caregivers.

Background: Fall-prevention interventions are efficient but resource-requiring and should target persons at higher risk of falls. We need to ensure that fall risk is systematically assessed in everyday practice. We conducted a quality improvement (QI) intervention to systematize fall risk assessment and prevention in older adults hospitalized on general internal medicine wards. We evaluated the efficacy of the intervention in a pre-post intervention study and assessed its feasibility and acceptability through a mixed methods process evaluation, which results are reported in here.

Methods: The QI intervention was conducted between 09/2022 and 10/2023 and targeted the nursing staff and residents in two tertiary hospitals of two different language and cultural regions of Switzerland. The intervention comprised an oral presentation, an e-learning, and reminder quizzes. We conducted a process evaluation including 25 interviews and a survey sent to all participants to assess feasibility and acceptability of the intervention. Quantitative data were analyzed descriptively and qualitative data with a mixed deductive and inductive approach. Results were integrated through meta-inferences.

Results: Among 544 clinicians, 59% completed the e-learning, 74% found the intervention useful, and 25% reported an increase in interprofessional team working. A rewarding system was deemed motivating by 33% of clinicians. Main implementation barrier was the high workload. A concise and clear content as well as regular reminders were perceived as facilitators.

Conclusions: A concise and multimodal QI intervention with regular reminders seemed to be feasible and well-accepted. Future QI intervention projects should consider the barriers and facilitators identified in this project to improve quality of care in older hospitalized adults.

Trial registration: The conducted research was not pre-registered.

Background: Ageing populations are set to drive up demand for aged care services, placing strain on economies funding social care systems. Rehabilitation, reablement, and restorative care approaches are essential to this demographic shift as they aim to support independent function and quality of life of older people. Understanding the impact of these approaches requires nuanced insights into their definitions, funding, and delivery within the aged care context. This scoping review mapped and compared systematic review-level research on rehabilitation, reablement, and restorative care approaches within aged care with the aim of determining definitional clarity, key themes, and the professional groups delivering each approach.

Methods: Nine databases were searched (2012 to September 2023) to identify English-language systematic reviews on aged care-based rehabilitation, reablement and/or restorative care. Two reviewers independently screened studies following predetermined eligibility criteria. Only reviews reporting quality appraisal findings were eligible. Data charting and synthesis followed the Arksey and O'Malley approach and are reported according to PRISMA-ScR guidelines.

Results: Forty-one reviews met inclusion criteria. Most (68%) reported on rehabilitation in aged care, and eight (20%) combined the approaches. Only 14 reviews (34%) defined the approach they described. Reviews centred on services for older people in the home or community (n = 15), across a mix of settings including community, hospital, and residential care (n = 10). Ten distinct themes highlight the importance of multidisciplinary teams, allied health, risk of falls, hip fracture, reduced functional independence, and specific types of interventions including physical activity, technology, cognitive rehabilitation, goal setting, and transition care. Most reviews described the role of occupational therapists (n = 22), physiotherapists (n = 20) and nurses (n = 14) with wider support from the multidisciplinary team. The quality of primary studies within the reviews varied widely.

Conclusions: This scoping review summarises the evidence landscape for rehabilitation, reablement, and restorative care approaches in the context of aged care. Despite their role in enhancing independence and quality of life for older people, policy, funding, and terminology variation means the evidence lacks clarity. This fragmented evidence makes it challenging to argue the effectiveness of one approach over another for older people in receipt of aged care services.

Clinical trial number: Not applicable.

Introduction: Mental disorders are prevalent among older adults, often leading to the use of multiple medications, many with anticholinergic properties. Polypharmacy, common in this population, is a major contributor to anticholinergic burden, which is linked to cognitive and physical decline. This study investigates the relationship between polypharmacy and anticholinergic burden across seven anticholinergic burden scales in elderly patients attending the psychiatric outpatient.

Methods: Study was conducted at a psychiatry outpatient clinic at All India Institute of Medical Sciences, Rishikesh, India, from December 2021 to March 2023. Elderly patients (aged ≥ 60 years) who were on at least one psychotropic medication and had a primary working diagnosis of psychiatric illness were included. All psychotropic medications, including antidepressants, antipsychotics, mood stabilizers, and hypnotics, were evaluated. Anticholinergic burden scales were calculated by the respective tools. Univariate analysis was adopted to determine the factors that may affect polypharmacy.

Results: Study included 1165 elderly patients aged ≥ 60 years. The prevalence of polypharmacy was 20.43% (n = 238). Clonazepam (n = 364, 17.28%), escitalopram (n = 197, 9.35%), metformin (n = 165, 7.83%), sertraline (n = 141, 6.69%), mirtazapine (n = 129, 6.12%), and lorazepam (n = 110, 5.22%) were among the most frequently prescribed anticholinergic drugs. Univariate analysis demonstrated that all anticholinergic risk assessment scales were closely correlated with polypharmacy, with the strongest association observed for the Anticholinergic Load Scale (ALS) (Odds Ratio = 4.3; p < 0.001). Polypharmacy was also positively associated with adverse drug reactions (Odds Ratio = 1.81; 95% Confidence Interval = 1.27-2.56).

Conclusion: The anticholinergic burden in this cohort of elderly psychiatry patients was high, with 95.1% (n = 1108) experiencing a significant burden. Adverse drug events and anticholinergic burden scales were positively associated with polypharmacy, with a stronger correlation between polypharmacy and ALS scores than with other anticholinergic burden scales in older adults.

Background: Dementia is a growing public health issue. Non-drug interventions targeting individuals before the onset of overt cognitive decline may be effective. Subjective cognitive decline (SCD) is present in > 50% of older adults and associated with progression to dementia. Here, we tested the compliance and effectiveness of a Multidomain Lifestyle Intervention Program using the mini-program, Cognitive Evergreenland, (MLIP-CE), based on the Health Action Process Approach model to support home-based intervention in older adults with SCD.

Methods: Cognitive Evergreenland was designed to improve cognitive reserve and maintain brain function in people at high risk of dementia and included: cognitive stimulation, cognitive training, health education, vascular risk monitoring, social support, and functional assessment, among other features. This was an exploratory trial designed to examine participant compliance with the mobile lifestyle intervention and its effectiveness, as well as changes in health-related indicators and cognitive function of older adults with SCD from baseline to 12 and 24 weeks post-intervention.

Results: The retention rate for MLIP-CE was 90.2% (37/41). Mean participant age was 70.93 ± 6.91 years, 73.2% of participants were female, and mean Montreal Cognitive Assessment score was 24.51 ± 2.87. Throughout the 24 weeks of the prescribed intervention, app usage remained consistently high, with over 92% of participants using the mini-program at least once a week and successfully completing corresponding health management tasks. In terms of average usage, cognitive training emerged as the most frequently used functional module (95.73%), closely followed by health education (95.02%). The health behavior levels of older adults with SCD, measured in terms of ability, opportunity, and motivation, were significantly increased relative to baseline (p < 0.001). Regarding cognitive function, Mini-Mental State Examination scores were significantly improved post-intervention, with a moderate effect size (Hedges' g = 0.60).

Conclusions: These findings suggest that MLIP-CE, which was designed based on a theoretical framework, has potential for implementation, and support ongoing research into use of MLIP-CE for individuals at high risk of SCD or other dementia conditions.

Trial registration: The trial was prospectively registered at the Chinese Clinical Trials Registry with the registration number ChiCTR2200058665 on 13 April 2022.

Background: Innovative technologies such as virtual reality may improve physical and cognitive functions in older people. While there are some experimental studies on virtual reality, qualitative studies related to the virtual reality experiences of older people are limited in the literature. This study aims to describe older people's perceptions about their experiences regarding virtual reality.

Methods: The study has qualitative descriptive design. The data were collected through semi-structured individual interviews with older people (n = 37). The interviews were conducted during a two-months period, from February to March 2022. Thematic and descriptive analysis was used to analyse data. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was used to report the study.

Results: Four themes and 15 sub-themes were identified from the interviews. The themes were (a) time travel through virtual reality, (b) comparing the past and present through virtual reality, (c) benefits of virtual reality, and (d) the meaning of virtual reality.

Conclusions: This study provides in-depth information about the views of older people regarding the virtual reality experience. The study revealed that older people had positive experiences with virtual reality and showed that it has the potential to be useful in elderly care. In the study, virtual reality also enabled older people to have a time-traveling experience. It is recommended that virtual reality should be integrated into the care of older people by nurses and healthcare professionals.

Background: Living Labs, as a type of academic-practice partnerships, possess the potential to transform care and research into a participatory partnership and narrow the research-practice gap to improve evidence-based and Person-centred care. Given the lack of systematic investigations of Living Labs in healthcare, we will establish a dementia-specific academic-practice partnership (Living Lab Dementia) in Germany and conduct a process evaluation. The aim of this study is to gain insights into the intervention itself (mechanisms of impact) and its implementation process (degree of implementation, barriers, and facilitators).

Methods: This process evaluation of the multi-center research project PraWiDem (German acronym for linking professional nursing practice and research in dementia) will be conducted applying a convergent mixed methods design and will be based on the Medical Research Council (MRC) framework for the development and evaluation of complex interventions. The intervention is presented in a logic model which describes relevant basic theoretical assumptions, intervention components, implementation aspects, mechanisms of impact, relevant outcomes, and the context in which the intervention is delivered. Data will be collected before the intervention (T₀), during the intervention period, and at follow-up after 18 months (T₁). Qualitative data will be collected through semi-structured interviews and focus groups. Quantitative data sources will be process documents and questionnaires.

Discussion: Our study will provide important insights into the Living Lab Dementia intervention and its implementation processes. The results of this evaluation will contribute to the refinement of the intervention and its implementation processes, and will enable to measure the impact of these processes in future studies.

Background: With a shortage of geriatricians and an aging population, strategies are needed to optimise the distribution of geriatricians across different healthcare settings (acute care, rehabilitation and community clinics). The perspectives of knowledge users on staffing geriatricians in different healthcare settings are unknown. We aimed to understand the acceptability and feasibility (including barriers and facilitators) of implementing a geriatrician-led comprehensive geriatric assessment (CGA) in acute care, rehabilitation, and community clinic settings.

Methods: A qualitative description approach was used to explore the experience of those implementing (administrative staff), providing (healthcare providers), and receiving (patients/family caregivers) a geriatrician-led CGA in acute care, rehabilitation and community settings. Semi-structured interviews were conducted in Toronto, Canada. The theoretical domains framework and consolidated framework for implementation research informed the interview guide development. Analysis was conducted using a thematic approach.

Results: Of the 27 participants (8 patients/caregivers, 9 physicians, 10 administrators), the mean age was 53 years and 14 participants (52%) identified as a woman (13 [48%] identified as a man). CGAs were generally perceived as acceptable but there was a divergence in opinion about which healthcare setting was most important for geriatricians to staff. Acute care was reported to be most important by some because no other care provider has the intersection of acute medicine skills with geriatric training. Others reported that community clinics were most important to manage geriatric syndromes before hospitalization was necessary. The rehabilitation setting appeared to be viewed as important but as a secondary setting. Facilitators to implementing a geriatrician-led CGA included (i) a multidisciplinary team, (ii) better integration with primary care, (iii) a good electronic patient record system, and (iv) innovative ways to identify patients most in need of a CGA. Barriers to implementing a geriatrician-led CGA included (i) lack of resources or administrative support, (ii) limited team building, and (iii) consultative model where recommendations were made but not implemented.

Conclusions: Overall, participants found CGAs acceptable yet had different preferences of which setting to prioritise staffing if there was a shortage of geriatricians. The main barriers to implementing the geriatrician-led CGA related to lack of resources.

Clinical trial number: Not applicable.

Background: Physical activity was associated with the risk of all-cause and cardiovascular mortality. However, little is known about older adults, especially those aged over 80 years.

Methods: 2863 older adults in the Chinese Longitudinal Healthy Longevity Survey (CLHLS) were enrolled. Physical activity score was used to evaluate the physical activity. Serum 25-hydroxyvitamin D and demographic characteristics were collected at baseline. We used multivariable-adjusted Cox regression models and stratified analysis to determine the association between physical activity, vitamin D and all-cause/cardiovascular mortality. Mediation analysis was performed to evaluate the mediating effect of vitamin D between physical activity and all-cause/cardiovascular mortality.

Results: The median age of this population was 87 years, and 70.27% were the oldest-old (age ≥ 80 years). We observed a tendency for a higher vitamin D concentration in participants with higher physical activity score levels. Both physical activity and vitamin D levels were inversely associated with all-cause and cardiovascular mortality in all participants. Between physical activity and all-cause/cardiovascular mortality, the mediation proportions of vitamin D were 7.76% (P < 0.001) and 4.13% (P < 0.001), respectively. The mediating effect of vitamin D remained all significant in various types of physical activities. Furthermore, vitamin D accounted for a greater mediating proportion in the physical activities of housework and raising domestic animals/pets.

Conclusions: Physical activity could reduce the risk of all-cause/cardiovascular mortality and was mediated by vitamin D in older Chinese adults.