BMC Geriatrics最新文献

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.

Introduction: Older adults are more likely than younger people to have multiple chronic health conditions and increased health and/or social needs. As older people generally prefer living at home in the community as they age and residential care can be expensive, there is a need for effective alternatives to residential care in the community. The objective of this review was to synthesize evidence about programs aimed at enabling older people with ongoing health and social care needs to remain in the community.

Methods: This review followed the JBI methodology for systematic reviews of effectiveness. Included studies reported on complex, multifactorial interventions that were based in the community and included more than one type of service. Six databases and gray literature were searched for published and unpublished research. Titles and abstracts, and full-text selections were screened by two or more reviewers and assessed for methodological quality using JBI critical appraisal tools. Results related to quality of life and healthcare outcomes were extracted.

Results: Fifty-five full text articles, reporting on 51 unique complex interventions, were included in the review. Studies were predominantly randomized controlled trials (n=24) and quasi-experimental studies (n=23), with five cohort and three case series studies included. The overall quality of the included studies was moderate. Key characteristics of the interventions included case management, care planning, a comprehensive assessment, and in-home visits. Comparative meta-analyses were completed for five of the outcomes (hospital admission, emergency department visits, long-term care use, primary care use and quality of life). The results showed effects in the direction of interventions for the number of hospital admissions and LTC use, however, none of the meta-analyses were statistically significant.

Conclusions: There is little agreement about the effectiveness of complex interventions on quality of life and health system outcomes. Jurisdictional differences may make the integration of literature reporting on such interventions particularly difficult. There is an ongoing need to understand what helps older people with complex needs live well in the community and what level of health system engagement is optimal.

Systematic review registration: PROSPERO reference number CRD42022324061.

Background: Aging is intimately linked to alterations in neuromuscular control, which can severely affect mobility. This study aimed to investigate how muscle synergies in older adults contribute to distinct forms of gait.

Methods: We measured the surface electromyography signals from 14 muscles in the lower limbs and trunk of healthy older adults during mechanically perturbed walking. Muscle weight and temporal activation coefficients for muscle synergies were extracted through a non-negative matrix factorization framework.

Results: Five distinct muscle synergies were identified in each gait pattern. Among these, four muscle synergies observed in the perturbed step and the first recovery step exhibited high similarity to their corresponding patterns in the normal step. Key differences were observed in the first recovery step: a specific muscle synergy pattern dominated by the gluteus medius and tibialis anterior muscles replaced the synergy dominated by the erector spinae in the normal step. The numbers of major activated muscles in the muscle synergy dominated by the vastus medialis and the gluteus medius decreased in the perturbed step, while these numbers increased in the first recovery step. During the transition phase of the stance in the first recovery step, the activation phase of the major synergistic muscles extended.

Conclusions: Specific muscle synergy patterns are associated with balance recovery and stability maintenance. Fractionation and merging of muscle synergies triggered in response to perturbations may relate to functional decline in older adults, serving as a mechanism for remodeling to adapt to changes in limb biomechanics and multiple motor task commands.

Clinical trial number: Not applicable.