BMC Geriatrics最新文献

Background: Delirium is a common yet often underdiagnosed neuropsychiatric syndrome among older adults, especially those residing in the home setting or in residential care. It has been associated with elevated risks of morbidity, mortality, and institutionalization. While delirium has been extensively studied in hospital settings, its prevention and risk factors in the home setting and residential care setting remain insufficiently investigated.

Objectives: This review investigates the prevalence, risk factors, and preventive interventions for delirium among older adults residing in the home setting and in residential care, including assisted home care facilities and nursing homes.

Methods: A scoping review was undertaken, including studies of individuals aged ≥ 65 years diagnosed with delirium through validated assessment tools (e.g., DSM, ICD). Eligible studies were to have a primary emphasis on the prevalence, associated risk factors, or preventive strategies related to delirium. Data on study characteristics, methodological approaches, and key findings were extracted and synthesized in a narrative format, supplemented by tables and figures.

Results: Sixty studies fulfilled the inclusion criteria. Reported delirium prevalence ranged from 0.1% to 44.0% in the home setting and from 1.0% to 70.3% in residential care. Key risk factors associated with delirium in the home setting and in residential care included cognitive impairment, the presence of dementia, and level of dependence, while age was generally not found to be significantly associated with delirium and was only investigated in residential care. Although various preventive interventions were identified, most studies examined their feasibility rather than their effectiveness in reducing the incidence of delirium.

Conclusion: Delirium and its risk factors remain insufficiently studied in non-hospital settings. The use of validated diagnostic criteria in community settings is crucial to reduce variation in prevalence estimates, and randomized controlled trials are needed to assess the effectiveness of interventions.

Trial registration: This scoping review was registered in the Open Science Framework on 9 July 2023 (https://doi.org/10.17605/OSF.IO/DVYWC).

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.