Search results for: older members

Authors: Ghassen Kharroubi, Ines Cherif, Leila Bouabid, Adel Gharbi, Aicha Boukthir, Margaret McCarron, Nissaf Ben Alaya, Afif Ben Salah, Jihene Bettaieb

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Influenza vaccination (IV) is recommended for elderly persons, especially those with underlying conditions. In countries where IV rates in the elderly remain unsatisfactory, exploring attitudes of older persons toward the flu vaccine could be useful to identify barriers and facilitators to IV. The aim of this study was to determine the reasons for IV acceptance or decline in the Tunisian elderly. A national cross-sectional study was conducted in 2019, among persons aged 60 years and over with chronic disease. Data were collected using a standard administered questionnaire. Of the 1191 older persons included, 19.4% received the influenza vaccine in the 2018-2019 flu season. The two main reasons that may lead to refusal of vaccination were concerns that the vaccine could cause side effects (71.5%) and a belief that the vaccine was ineffective (33.9%). The main reason that may lead to accepting vaccination was a doctor’s recommendation (41.1%). Doctors were by far the most trusted source for information regarding influenza vaccine (91.5%) followed by pharmacists (17.6%). Our results highlighted the important role that doctors could play in promoting IV among the Tunisian elderly. Physicians should correct misconceptions about adverse events and the efficiency of the vaccine. In fact, influenza vaccines are generally effective and safe among older persons.

Keywords: attitudes, influenza vaccination, older persons, Tunisia

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Authors: Adriane Amend, Leidiene Ferreira Santos, Daniella Pires Nunes

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The experience of assuming or caring for older persons dependents by relatives is a complex task that encompasses or affective involvement, the demand for technical activities and or psychological support. It would be necessary to understand the situations related to the caregiver, the person and the environment, which help the family difficulty, as a caregiver to lead this role. Objective: To identify the forces that drive and restrict the care process of family caregivers of the older adults. Method: Descriptive and exploratory research, with a qualitative approach, which has as a reference the Force Field Theory. Five family caregivers of older adult’s dependents residing in the city of Palmas, Tocantins, Brazil will participate. The data were collected from December 2021 to February 2022, through a semi-structured individual interview, and submitted to content analysis. Results: As forces that drive or process of caring for family caregivers were: the account of compassionate attitudes and patience of the caregiver (I); to the collaboration of the other person to the care and to the body structure of the same (Other); and the supports of other people not cared for and structural, such as adaptations in the room, read and bathroom, as in the presence of air conditioners (Environment). Among the restrictive forces of care we mention difficulties in delegating care to another person, or stress of care and other personal demands (I); imposition of the older person about care and e a transfer from bed to hip (Other); e lack of accessibility of the house and absence of air conditioning and hospital bed (Environment). Conclusion: The results show that there are driving forces with the caregiver's attitude and feelings, a bond as an idol and support for the caregiver and the environment. On the other hand, conflicting ties, absence of physical structure and daily and continuous care shifts, can significantly compromise well-being or the cycle of older adult, caregiver and care.

Keywords: caregivers, frail elderly, perception, geriatric nursing

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Authors: Jiayan Gou, Kexin He, Xin Zhang, Fei Wang, Liuni Zou

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Background: Homocysteine is a high-risk factor for cognitive decline, and folic acid supplementation can lower homocysteine levels. However, current clinical research results are inconsistent, and the effects of folic acid on homocysteine levels and cognitive function in older people are inconsistent. Objective: The objective of this study is to systematically evaluate the effects of folic acid alone or in combination with other nutrients on homocysteine levels and cognitive function in older adults. Methods: Systematic searches were conducted in five databases, including PubMed, Embase, the Cochrane Library, Web of Science, and CINAHL, from inception to June 1, 2023. Randomized controlled trials were included investigating the effects of folic acid alone or in combination with other nutrients on cognitive function in older people. Results: 17 articles were included, with six focusing on the effects of folic acid alone and 11 examining folic acid in combination with other nutrients. The study included 3,100 individuals aged 60 to 83.2 years, with a relatively equal gender distribution (approximately 51.82% male). Conclusion: Folic acid alone or combined with other nutrients can effectively lower homocysteine level and improve cognitive function in patients with mild cognitive impairment. But for patients with Alzheimer's disease and dementia, the intervention only can reduce the homocysteine level, but the improvement in cognitive function is not significant. In healthy older people, high baseline homocysteine levels (>11.3 μmol/L) and good ω-3 fatty acid status (>590 μmol/L) can enhance the improvement effect of folic acid on cognitive function. This trial has been registered on PROSPERO as CRD42023433096.

Keywords: B-complex vitamins, cognitive function, folic acid, homocysteine

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Authors: Mary Butler

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Background: Screening programmes for older drivers in Europe (though not the UK), and in many states in the US and in Australia are based on medical assessment of fitness to drive. These programmes require physicians (including general practitioners) to carry out an assessment of fitness to drive in their offices. In 2006, New Zealand changed from doing on-road driving tests with all older drivers from the age of 80, to a screening programme that uses medical assessment of fitness to drive only. Aim: This study set out to understand the experience of New Zealand GPs as they manage the process of medical assessment of fitness to drive assessments for older people. In particular, it aimed to establish how GPs understand the role of specialist driving assessment and rehabilitation carried out by occupational therapists. Design and setting: The study used an interpretive descriptive approach to analyze data from ten interviews with GPs in New Zealand. Results: The results indicated that GPs lack understanding about how occupational therapists can assist their patients, and tend to refer only when there is a disagreement with the patient. Conclusion: There are problems with the medical assessment of fitness to drive carried out by GPs, and there is a need for a more comprehensive community approach to driving cessation. Patients, families and the multidisciplinary team all have a role in deciding when driving cessation should occur. Occupational therapists have a particular responsibility for strategic leadership in this area of practice.

Keywords: assessment, driving, older people, occupational therapy

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Authors: C. Vázquez, L. M. Gigirey, C. P. del Oro, S. Seoane

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Early detection of visual problems plays a key role in the aging process. However, although vision problems are common among older people, the percentage of aging people who perform regular optometric exams is low. In fact, uncorrected refractive errors are one of the main causes of visual impairment in this group of the population. Purpose: To evaluate functional vision of older residents in order to show the urgent need of visual screening programs in Galician nursing homes. Methodology: We examined 364 older adults aged 65 years and over. To measure vision of the daily living, we tested distance and near presenting visual acuity (binocular visual acuity with habitual correction if warn, directional E-Snellen) Presenting near vision was tested at the usual working distance. We defined visual impairment (distance and near) as a presenting visual acuity less than 0.3. Exclusion criteria included immobilized residents unable to reach the USC Dual Sensory Loss Unit for visual screening. Association between categorical variables was performed using chi-square tests. We used Pearson and Spearman correlation tests and the variance analysis to determine differences between groups of interest. Results: 23,1% of participants have visual impairment for distance vision and 16,4% for near vision. The percentage of residents with far and near visual impairment reaches 8,2%. As expected, prevalence of visual impairment increases with age. No differences exist with regard to the level of functional vision between gender. Differences exist between age group respect to distance vision, but not in case of near vision. Conclusion: prevalence of visual impairment is high among the older people tested in this pilot study. This means a high percentage of older people with limitations in their daily life activities. It is necessary to develop an effective vision screening program for early detection of vision problems in Galician nursing homes.

Keywords: functional vision, elders, aging, nursing homes

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Authors: Courtley Pharaoh, D. J. Visser

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University management is often caught between competing interests from stakeholders like students, trustees, donors, government and the community it serves. This study aimed to identify what management competencies are required by executive management members of universities of technology to effectively manage a university of technology in South Africa from the perspective of the executive management members. This exploratory study will make use of a qualitative methodology to establish what management competencies are deemed as important to manage a university of technology in South Africa from the executive management perspective. Due to the consequences of the COVID-19 Pandemic, the study made use of online face-to-face interviews to ascertain from executive management members of universities of technology what the required management competencies needed by executive management members of universities of technology to effectively manage a University of Technology in South Africa. Qualitative Content Analysis was used to analyse the data collected. The findings of the study identified a total of 26 management competencies which were categorised into three groupings or themes. This study identified a list of required management competencies needed by executive management members of universities of technology to effectively manage a university of technology in South Africa, as per the lived experience of executive management members. The researcher recommends further studies at traditional and comprehensive universities and compares the results of those future studies with the results of this study. A comprehensive list of management competencies could then be identified, which could assist with the compilation of job descriptions of executive management members of universities in South Africa.

Keywords: university of technology, management competencies, executive management, executive management members, important

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Authors: Rukiye Pinar Boluktas

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According to 2015 statistics, in Turkey, 46% of older people live alone in their homes, 55% have poor health perceptions, 18% face poverty, and 43% are unhappy. Prevalence of depression is between 14% and 20%. In 2013, rate of suicide was 6.5. However, the most of older people prefer to live in their community although they are lonely, they face poverty, and face limitations as a result of chronic diseases and disabilities. Community based care for older people is also encouraged by Ministry of Health as it is more cost-effective. Music therapy is a simple, effective, safe, and nonpharmacologic intervention that may be used to decrease depression and to improve cognition, and health related quality of life (HRQOL). In Turkish culture, music is typically described as ‘food for soul’. This study aimed to investigate the effect of Turkish classical music songs in 32 community dwelling older people. Participants were received interventions two or three times per week, 50-60 min per session, for 8 weeks at a day health center. Each intervention session started listening music for 15-20 min to get remember songs, then followed singing songs as a group. Participants were assessed at baseline (week 0), and two follow-up at month 1 and month 2. Compared to baseline, at two follow-up, we observed that cognition improved, depression decreased, and SF-36 scores, including 8 domains and two summary scores increased. We conclude that an intervention comprising listening and singing Turkish classical music improve cognition, depression and HRQOL in older people.

Keywords: cognitive function, depression, elderly, quality of life, Turkish classical music

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Authors: Vahid Rashedi, Banafsheh Ebrahimi, Mahtab Sharif Mohseni, Mohammadali Hosseini

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Introduction: One of the metrics used to evaluate health status is life expectancy. This index alters as people age as a result of several events, illnesses, stress, and anxiety. One of the issues that might develop into a lethal phobia is death anxiety. This study looked at older persons in Tehran, Iran, to see if there was any correlation between life expectancy and fear of dying. Methods: Cluster random sampling was used to select 208 older persons (age 60) who had been sent to adult daycare facilities in Tehran for this correlational descriptive study. A demographic questionnaire, Temper's death anxiety scale, and Snyder's life expectancy scale were used to gather the data. Statistical Package for the Social Sciences softwear version 22 was used to conduct the data analysis. Results: The average age of the senior citizens was 66.60 (6.58) years. With a mean life expectancy of 24.94, it was discovered that the average death anxiety was 12.21. Additionally, Pearson's correlation coefficient demonstrated a bad correlation between fear of dying and life expectancy. Age, residential status, and death fear were the three primary predictors of a decline in life expectancy, according to multiple regression analysis. Conclusion: The findings suggest that there is a link between death fear and a lower life expectancy, which calls for the use of appropriate strategies to increase older individuals' life expectancies as well as the teaching of anxiety coping mechanisms.

Keywords: aged, frailty, death, anxiety, life

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Authors: Lovro Štefan

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The main purpose of the study was to explore if a higher level of Elderly Dietary index score was correlated with lower peak plantar pressures. One-hundred and twenty older adults aged ≥60 years participated in this cross-sectional study. To assess the level of adherence to nutritional recommendations for older adults, we used Elderly Dietary Index score. Plantar pressures beneath the forefoot, midfootandhindfootregions of the foot were determined by pressure platform. Pearson’s coefficient of correlations and partial correlations were used to calculate the relationships. In the unadjusted model, higher Elderly Dietary Index was significantly correlated with lower peak plantar pressure beneath the forefoot (r = -0.45, p<0.001) and hindfoot (r = -0.37, p<0.001) the region, while no significant correlation with peak plantar pressure beneath the (r = -0.15, p=0.113) was observed. When we adjusted for age, body-mass index and gait velocity, higher Elderly Dietary Index remained significantly correlated with lower peak plantar pressure beneath the forefoot (r = -0.41, p<0.001) and hintfoot (r = -0.32, p<0.001) region. This study shows that higher adherence to nutritional recommendations is significantly correlated with lower forefoot and hindfoot peak plantar pressures in older women.

Keywords: elderly, biomechanics, nutrition, associations, force

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Authors: Shakeela Ahmed, Nabanita Hazarika

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The study aims to understand the effects of dementia on family members. The primary objectives of this research are to identify the main reasons for dementia among the elderly, understand the struggles and stigmas faced by the family members, and understand the effects of dementia on family members. The research employs a qualitative method and utilizes unstructured interviews with family members, counselors and caregivers. A descriptive research design is employed, and thematic analysis is used to analyze the data. A total of 17 family members in the age group of 54-69 years were interviewed, along with 2 counselors and 2 caretakers. In understanding dementia, the researcher has reviewed articles, and the studies revealed diverse meanings, symptoms, stages attached to dementia, and the complex interplay of protective and risk factors for dementia. However, in understanding dementia and its effects on families, there is a lack of studies in relation to the significant effects of dementia on family members and their role as primary caregivers. Therefore, an attempt has been made to understand the effects of dementia on family members, along with ways to improve dementia care for family members. The purpose of the study was to understand the effects and challenges of dementia on family members, the psychosocial reasons for dementia among the elderly, and the various struggles and stigmas faced by the family members of dementia patients. The major findings of the study indicate that people with dementia are cared for by family members at home. Dementia has a significant impact on family members. Family member's quality of life is affected; they experience feelings of anxiety, stress, irritation, frustration, and fear as they watch their loved ones struggle with dementia. They also experience financial strain, as dementia care, medication, and therapy are expensive. Another common impact is the role reversal of family members for their loved ones with dementia. There is a lack of awareness and social understanding about dementia, which leads to family members experiencing stigma and struggles. Caregivers are unable to take care of themselves, and many times, the primary caregiver, a spouse who is elderly, experiences acute stress and a physical inability to meet the demands of being a caregiver. Strategies to improve dementia care are understanding dementia, being patient with the person, showing love and care for the person, avoiding provoking the person, distracting them, offering reassurance, playing their favorite music, talking about things they love, going through old memories, following a structured routine, and remaining calm. The study has made an attempt to provide strategies to manage dementia care, understanding the struggles family members go through, and raising awareness about dementia that will enable further research and investigations.

Keywords: elderly, dementia, stigma, family members

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Authors: Qian Sun, Dannie Dai, Vivian Lou

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Background: Changes in population structure and modernization have left traditional channels of achieving intergenerational solidarity in crisis. Policies and projects purposefully structuring intergenerational interaction are regarded as effective ways to enhance positive attitude changes between generations. However, few inter-generational interaction program has put equal emphasis on promoting positive changes on both attitude and behavior across generational groups. Objective: This study evaluated the effectiveness of an intergenerational interaction program which aims to facilitate positive attitude and behavioral interaction between both young and old individuals in Hong Kong. Method: A quasi-experimental design was adopted with the sample of 150 older participants and 161 young participants. Among 73 older and 78 young participants belong to experiment groups while 77 older participants and 84 young participants belong to control groups. The Age Group Evaluation and Description scale (AGED) was adopted to measure attitude toward young people by older participants and the Chinese version of Kogan’s Attitude towards Older People (KAOP) as well as Polizzi’s refined version of the Ageing Semantic Differential Scale (ASD) were used to measure attitude toward older people by the younger generation. The interpersonal behaviour of participants was assessed using Beglgrave’s behavioural observation tool. Six primary verbal or non-verbal interpersonal behaviours including smiles, looks, touches, encourages, initiated conversations and assists were identified and observed. Findings Effectiveness of attitude and behavior changes on both younger and older participants was confirmed in results. Compared with participants from the control group, experimental participants of elderly showed significant positive changes of attitudes toward the younger generation as assessed by AGED (F=138.34, p < .001). Moreover, older participants showed significant positive changes on three out of six behaviours (visual attention: t=2.26, p<0.05; initiate conversation: t=3.42, p<0.01; and touch: t=2.28, p<0.05). For younger participants, participants from experimental group showed significant positive changes in attitude toward older people (with F-score of 47.22 for KAOP and 72.75 for ASD, p<.001). Young participants also showed significant positive changes in two out of six behaviours (visual attention: t=3.70, p<0.01; initiate conversation: t=2.04, p<0.001). There is no significant relationship between attitude change and behaviour change in both older (p=0.86) and younger (p=0.22) groups. Conclusion: This study has brought practical implications for social work. The effective model of this program could assist social workers and allied professionals to design relevant projects for nurture intergenerational solidarity. Furthermore, insignificant results between attitude and behavior changes revealed that attitude change was not a strong predictor for behavior change, hence, intergenerational programs against age-stereotype should put equal emphasis on both attitudinal and behavioral aspects.

Keywords: attitude and behaviour changes, intergenerational interaction, intergenerational solidarity, program design

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Authors: Abhijeet Ostawal, Parmjit Lall

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The run times for a large strategic model that we were managing had become too long leading to delays in project delivery, increased costs and loss in productivity. Software developers are continuously working towards developing more efficient tools by changing their algorithms and processes. The issue faced by our team was how do you apply the latest technologies on validated existing models which are based on much older versions of software that do not have the latest software capabilities. The multi-model transport model that we had could only be run in sequential assignment order. Recent upgrades to the software now allowed the assignment to be run in parallel, a concept called parallelization. Parallelization is a Python script working only within the latest version of the software. A full model transfer to the latest version was not possible due to time, budget and the potential changes in trip assignment. This article is to show the method to adapt and update the Python script in such a way that it can be used in older software versions by calling the latest version and then recalling the old version for assignment model without affecting the results. Through a process of trial-and-error run time savings of up to 30-40% have been achieved. Assignment results were maintained within the older version and through this learning process we’ve applied this methodology to other even older versions of the software resulting in huge time savings, more productivity and efficiency for both client and consultant.

Keywords: model run time, demand model, parallelisation, python scripting

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Authors: Bei Shan Lin, Chun Mei Lu, Ya Ping Chen, Li Chen Lu

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This study explores the ethical issues concerning the use of physical restraint in geriatric care. Physical restraint use in a medical care setting is seen as a controversial form of treatment that has occurred over decades. There is no doubt that people nowadays are living longer than previous generations. The ageing process is inevitable. Common disease such as impaired comprehension, memory loss, and trouble expressing one’s self contribute to the difficulty that these older patients have in adapting to medical institution. For these reasons, physical restraint is often used in reducing the risk of falling, managing wandering behaviour, preventing agitation, and promoting patient compliance in geriatric care. It can mean that physical restraints are considered as a common practice that is used in the care of older patients. It is most commonly used for three specific purposes, including procedural restraint, restraint to prevent falls, and behavioural restraints. Although there have been well documented instances of morbidity and mortality recognised as being potential risks associated with physical restraint use, it continues to be permitted and used in healthcare, often in the name of safety. However, there is insufficient evidence supporting the effectiveness of physical restraint use reducing injuries from falls and controlling challenging behaviour in geriatric care settings. There is barely any empirical evidence of either a scientific basis or clinical trials have evaluated the improvement in patient safety following physical restraint. In difficult clinical situations, guidelines and practical suggestions for Healthcare professionals to comply requirements can help those making appropriate decisions and to facilitate better judgement regarding physical restraint use. The following recommendations are given for physical restraint use in long-term care settings: an interdisciplinary team approach to assess, evaluate, and treat underlying diseases to determine if treatment can ease issues precipitating physical restraint use; a clearly stated purpose of treatment plan should be made after weighing up the risk of physical restraint use against the risk of without physical restraint use; a care plan for physical restraint has to include individualised treatment planning, informed consent, identification and remedial action to avoid negative consequences, regular assessment and modification, reduction and removal of risks; patients and their families must have the opportunity to consider and give voluntary informed consent prior to physical restraint utilisation; patients, family members, and Healthcare professionals should be educated on use and adverse consequences of physical restraints in order to make raise awareness of potential risks and to take appropriate steps to prevent unnecessary harm; after physical restraint removal, Healthcare professionals should discuss with patients and family members about their experience, feelings, and any anxieties regarding the treatment. Physical restraint should always be considered a last resort as deprive patient’s freedom, control, and individuality. Healthcare professionals should emphasise on providing individualized care, interdisciplinary decision-making process, and creative and collaborative alternatives to promote older patient’s rights, dignity and overall well-being as much as possible.

Keywords: ethics healthcare, geriatric care, healthcare, physical restraint

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Authors: Reshma P. Nuri, Ebenezer Dassah

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Introduction: Raising a child with a disability can affect family members in different ways. However, this can be determined by the way in which a family member copes with the situation. There is little research that explores how families develop coping strategies to overcome barriers in raising CWDs. Objective: This study explored family members’ coping mechanism in raising a child with disability in Bangladesh. Method: A qualitative approach that involved 20 interviews with family members of CWDs. A purposive sampling procedure was used in selecting the study participants. A digital recorder was used to record all the interviews. Transcriptions were done in Bengali, translated into English, and then imported to NVivo software 12 for analysis. Thematic analysis was used to analyze the data. Results: The study revealed that family members adopted different coping strategies for their CWDs, including seeking support from formal (e.g., service providers) and informal sources (family members and friends); relying on religious beliefs; accepting the situation. Additionally, to cope with extra cost in raising CWDs, family members strategies included relying on overtime work; borrowing money from financial institutions; selling or mortgaging assets; and replying on donations from community members. Finally, some families had to reduce spending on food and buying toys for their CWDs. Conclusion: This qualitative study highlighted a range of coping mechanism adopted by family members in Bangladesh. The information provided in this study is potentially important to policy makers and service providers as it presents evidence on the coping mechanism of families in raising their CWDs. This underscores the need for policy design and service delivery in government support system in Bangladesh and potentially in other low- and middle-income contexts.

Keywords: Bangladesh, children with disabilities, coping mechanism, family members

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Authors: K. C. Kalam Aswathy, M. V. Anil Kumar

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The possible failure modes of cold-formed steel (CFS) lipped angle (LA) compression members are yielding, local, flexural-torsional, or flexural buckling, and any possible interaction between these buckling modes. In general, the strength estimated by current design guidelines is conservative for these members when flexural-torsional buckling (FTB) is the first global buckling mode, as the post-buckling strength of this mode is not accounted for in the global buckling strength equations. The initial part of this paper reports the results of an experimental and numerical study of CFS-LA members undergoing independent FTB. The modifications are suggested to global buckling strength equations based on these results. Subsequently, the reduction in the ultimate strength from strength corresponding to independent buckling modes for LA members undergoing interaction between buckling modes such as local-flexural torsional, flexural-flexural torsional, local-flexural, and local-flexural torsional-flexural are studied systematically using finite element analysis results. A simple and more accurate interaction equation that accounts for the above interactions between buckling modes in CFS-LA compression members is proposed.

Keywords: buckling interactions, cold-formed steel, flexural-torsional buckling, lipped angle

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Authors: Dhananjay W. Bansod, Santosh Phad

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Non-Communicable Diseases (NCD) are major contributing factors to the disease burden in the world as well as in India. With a growing proportion of older persons in India gives rise to several challenges. With the advancement of age, elderly is exposed to various kinds of health problems more specifically NCDs. Therefore, an effort has been made to examine the prevalence of NCDs among older persons and its treatment-seeking behaviour, also it is tried to explore the association between the NCDs and its effect on the overall wellbeing of older persons. Data used from “Building Knowledge Base of Population Ageing Survey” conducted in 2011 in seven states of India. Six chronic diseases used (non-communicable diseases) namely Arthritis, Hypertension, Cataract, Diabetes, Asthma and Heart diseases to understand the issues related to NCDs. Also seen the effect of NCDs on the wellbeing of the elderly, the subjective well-being consists of nine questions from which SUBI score generated for mental health status, which ranges from 9 to 27. This Index indicates that lower the score better is the mental health status. Further, this index modified and generated three categories of Better (9-15), Average (16-20) and Worse (21-27). The reliability analysis is carried out with the coefficient (Cronbach’s alpha) of the scale was 0.8884. The result shows that Orthopedic / musculoskeletal ailments involving arthritis, rheumatism and osteoarthritis are the most common type of ailment followed by hypertension. Two-thirds of the elderly reported suffering from at least one chronic ailment. Most chronic illness conditions received some form of treatment and mainly depend on public health facilities. Financial insecurity is the primary obstruction in seeking treatment for most of the chronic ailments which typically require a longer duration of medication and repeated medical consultations, both having significant economic implications. According to SUBI index, only 15 per cent of the elderly are in Better mental health status, and one-third of the elderly are with the worse score. Elderly with the ailments like Cataract, Asthma and Arthritis have worse mental health. It depicts that the burden of disease is more among the elderly and it is directly affecting the overall wellbeing of older persons.

Keywords: NCD, well-being, older person, India

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Authors: Afrah Aladwani, Alexander Mullen, Mohammad AlRashidi, Omamah Alfarisi, Faisal Alterkit, Abdulwahab Aladwani, Asit Kumar, Emad Eldosouky

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Introduction: Trastuzumab is a HER-2 targeted humanized monoclonal antibody that significantly improves the therapeutic outcomes of metastatic and non-metastatic breast cancer. However, it is associated with increased risk of cardiotoxicity that ranges from mild decline in the cardiac ejection fraction to permanent cardiomyopathy. Concerns have been raised in treating eligible older patients. This study compares trastuzumab outcomes between two age cohorts in the Kuwait Cancer Control Centre (KCCC). Methods: In a prospective comparative observational study, 93 HER-2 positive breast cancer patients undergoing different chemotherapy protocols + trastuzumab were included and divided into two cohorts based on their age (˂60 and ≥60 years old). The baseline left ventricular ejection fraction (LVEF) was assessed and monitored every three months during trastuzumab treatment. Event of cardiotoxicity was defined as ≥10% decline in the LVEF from the baseline. The lower accepted normal limit of the LVEF was 50%. Results: The median baseline LVEF was 65% in both age cohorts (IQR 8% and 9% for older and younger patients respectively). Whereas, the median LVEF post-trastuzumab treatment was 51% and 55% in older and younger patients respectively (IQR 8%; p-value = 0.22), despite the fact that older patients had significantly lower exposure to anthracyclines compared to younger patients (60% and 84.1% respectively; p-value ˂0.001). 86.7% and 55.6% of older and younger patients, respectively, developed ≥10% decline in their LVEF from the baseline. Among those, only 29% of older and 27% of younger patients reached a LVEF value below 50% (p-value = 0.88). Statistically, age was the only factor that significantly correlated with trastuzumab induced cardiotoxicity (OR 4; p-value ˂0.012), but it did not increase the requirement for permanent discontinuation of treatment. A baseline LVEF value below 60% contributed to developing a post-treatment value below normal ranges (50%). Conclusion: Breast cancer patients aged 60 years and above in Kuwait were at 4-fold higher risk of developing ≥10% decline in their LVEF from the baseline than younger patients during trastuzumab treatment. Surprisingly, previous exposure to anthracyclines and multiple comorbidities were not associated with significant increased risk of cardiotoxicity.

Keywords: breast cancer, elderly, Trastuzumab, cardiotoxicity

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Authors: M. Fry, L. Fitzpatrick, Julie Considine, R. Z. Shaban, Kate Curtis

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Introduction: The vast majority of older Australians lives independently and are self-managing at home, despite a growing number living with a chronic illness that requires health intervention. Evidence shows that between 50% and 80% of people presenting to the emergency department (ED) are in pain. Australian EDs manage 7.2 million attendances every year and 1.4 million of these are people aged 65 years or more. Research shows that 28% of ED patients aged 65 years or more have Cognitive impairment (CI) associated with dementia, delirium and neurological conditions. Background: Traditional ED service delivery may not be suitable for older people who present with multiple, complex and ongoing illnesses. Likewise, ED clinical staff often perceive that their role should be focused more on immediate and potential lifethreatening illness and conditions which are episodic in nature. Therefore, the needs of older people and their family/carers may not be adequately addressed in the context of an ED presentation. Aim: We aimed to explore the utilisation and characteristics of older people presenting to four metropolitan EDs. Method: The findings being presented are part of a program of research exploring pain management practices for older persons with long bone fractures. The study was conducted across four metropolitan emergency departments of older patients (65years and over) and involved a 12-month randomised medical record audit (n=255). Results: ED presentations across four ED sites in 2012 numbered 168021, with 44778 (26.6%) patients aged 65 and over. Of the 44778 patients, the average age was 79.1 years (SD 8.54). There were more females 23932 (53.5%). The majority (26925: 85.0%) of older persons self-referred to the ED and lived independently. The majority arrived by ambulance (n=18553: 41.4%) and were allocated triage category was 3 (n=19,507:43.65%) or Triage category 4 at (n=15,389: 34.43%). The top five triage symptom presentations involved pain (n=8088; 18.25%), dyspnoea (n=4735; 10.7%), falls (n=4032; 9.1%), other (n=3984; 9.0%), cardiac (n=2987; 6.7%). The top five system based diagnostic presentations involved musculoskeletal (n=8902; 20.1%), cardiac (n=6704:15.0%), respiratory (n=4933; 11.0%), neurological (n=4909; 11.0%), gastroenterology (n=4321; 9.7%). On review of one tertiary hospital database the vital signs on average at time triage: Systolic Blood Pressure 143.6mmHg. Heart Rate 83.4 beats/minute; Respiratory Rate 18.5 breaths/ minute; Oxygen saturation 97.0% and Tympanic temperature 36.7 and Blood Glucose Level 7.4mmols/litre. The majority presented with a Glasgow Coma Score of 14 or higher. On average the older person stayed in the ED 4:56 (SD 3:28minutes).The average time to be seen was 39 minutes (SD 48 minutes). The majority of older persons were admitted (n=27562: 61.5%), did not wait for treatment (n= 8879: 0.02%) discharged home (n=16256: 36.0%). Conclusion: The vast majority of older persons are living independently, although many require admission on arrival to the ED. Many arrived in pain and with musculoskeletal injuries and or conditions. New models of care need to be considered, which may better support self-management and independent living of the older person and the National Emergency Access Targets.

Keywords: chronic, older person, aged care, emergency department

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Authors: Gokhan Dok, Hakan Ozturk, Aydin Demir

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The behavior of reinforced concrete (RC) members is quite important in RC structures. When evaluating the performance of structures, the nonlinear properties are defined according to the cross sectional behavior of RC members. To be able to determine the behavior of RC members, its cross sectional behavior should be known well. The moment-curvature (MC) relationship is used to represent cross sectional behavior. The MC relationship of RC cross section can be best determined both experimentally and numerically. But, experimental study on RC members is very difficult. The aim of the study is to obtain the MC relationship of RC shear walls. Additionally, it is aimed to determine the parameters which affect MC relationship. While obtaining MC relationship of RC members, XTRACT which can represent robustly the MC relationship is used. Concrete quality, longitudinal and transverse reinforcing ratios, are selected as parameters which affect MC relationship. As a result of the study, curvature ductility and effective flexural stiffness are determined using this parameter. Effective flexural stiffness is compared with the values defined in design codes.

Keywords: moment-curvature, reinforced concrete, shear wall, numerical

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Authors: Ana Luiza Blanco, Luiza de Pádua Penteado, Daniella Pires Nunes

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Ageism is a widespread and prevalent phenomenon that affects older adults and directly affects healthy aging. Identifying the factors that contribute to ageism is important to discuss interventions that minimizes its social and emotional impact. To identify factors related with ageism in Brazilians older adults. Quantitative study, with a cross-sectional and analytical design. 134 older adults completed an online questionnaire about Sociodemographic and Health Characteristics, Discrimination (Ageism Survey), Depressive Symptoms (The Geriatric Depression Scale), Family Function (Family APGAR) and Loneliness. The Mann Whitney and Kruskal Wallis tests were used for data analysis, with a significance level of 5%. The mean age was 66.93 years (sd=0.50), mostly women (84.20%), married (52.60%) and with more than 12 years of schooling (75.93%). The results showed that older adults with a regular self-perception of health had higher median ageism scores when compared to individuals who rated their health as very good or good (p=0.006). The same occurred for individuals with depressive symptoms when compared to those without signs of depression (p=0.001). Regarding family function, it was observed that people with low family functionality tend to suffer more ageism than those with high functionality (p=0.017). Loneliness was also a factor related with the experience of ageism in this study. Lonely individuals had higher median ageism scores (p=0.002). There was relationship between ageism and self-perception of health, depressive symptoms, loneliness and dysfunctional family. Such findings demonstrate the importance of considering the psychosocial determinants of aging to reduce discrimination and promote healthy aging, focusing on social support and educational interventions.

Keywords: ageism, age stereotypes, healthy aging, social conditions

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Authors: K. Raghu, Altafhusen P. Pinjar

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Cold-formed steel section are extensively used in industry and many other non-industry constructions worldwide, it is relatively a new concept in India. Cold-formed steel sections have been developed as more economical building solutions to the alternative heavier hot-rolled sections in the commercial and residential markets. Cold‐formed steel (CFS) structural members are commonly manufactured with perforations to accommodate plumbing, electrical, and heating conduits in the walls and ceilings of buildings. Current design methods available to engineers for predicting the strength of CFS members with perforations are prescriptive and limited to specific perforation locations, spacing, and sizes. The Direct Strength Method (DSM), a relatively new design method for CFS members validated for members with and without perforations, predicts the ultimate strength of general CFS members with the elastic buckling properties of the member cross section. The design compression strength and flexural strength of Indian (IS 811-1987) standard sections is calculated as per North American Specification (AISI-S100 2007) and software CUFSM 4.05.

Keywords: direct strength, cold formed, perforations, CUFSM

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Authors: Kerdsiri Hongthai, Darunee Jongudomkarn, Rutja Phuphaibul

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In Thailand, many adults in rural areas migrate to seek employ¬ment resulting in skipped-generation family where grandparents care for grandchildren with no other adults present. This is a preliminary study using qualitative case study methods, aimed to explore the situations of older adult grandparents' experiences in skipped-generation family in North-East of Thailand. Data were collected by in-depth inter¬views with 6 grandparents living in skipped-generation families; 5 females and 1 males grandparents, aged 62-75, some of them have diabetes mellitus, hypertension, during November to December, 2017. The finding themes are: ‘Caught up in the middle’: the older adults were pleased to have grandchildren but, at the same time, acknowledge the burden that this placed on them, especially when the migrant children failed to send enough money back to support the family. ‘Getting bad health’: they reported to be fatigued and stressed due to burden of caring for their grandchildren without support. This situation can aggravate problems of poor health status and be worsening economic status of the grandparents. In some cases of deprivation, the grandparents feel that having to be the sole care providers of their grandchildren can negative adversely affect their mental status. It is important to find out in other sectors similar to Thailand and lead to more in-depth research to answer the research questions about policy and social support in skipped-generation family in the future.

Keywords: older adult grandparents, experiences, principle care giver, skipped-generation family

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Authors: J. Y. Lee, H. S. Lim, S. H. Yoon

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This paper presents an analysis of the diagonal crack widths of RC members with various types of materials by simulating a compatibility-aided truss model. The analytical results indicated that the diagonal crack width was influenced by not only the shear reinforcement ratio but also the yield strength of shear reinforcement and the compressive strength of concrete. The yield strength of shear reinforcement and the compressive strength of concrete decreased the diagonal shear crack width of RC members for the same shear force because of the change of shear failure modes. However, regarding the maximum shear crack width at shear failure, the shear crack width of the beam with high strength materials was greater than that of the beam with normal strength materials.

Keywords: diagonal crack width, high strength stirrups, high strength concrete, RC members, shear behavior

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Authors: Zoe Yang, Dena Shenk

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The goal of this research was to highlight stories from voices that are typically disregarded. Five older Asian Americans, who immigrated from Cambodia, Taiwan, and China, were interviewed in person, over Zoom, or through a phone call. Subjects were asked about their opinions towards aging and housing choices. Various Asian American stories reveal factors that contribute to the acceptance or rejection of aging. Through these interviews and research on cultural differences towards aging, findings indicate that personality, age, background, and health status affect one's relationship with housing choices and filial piety.

Keywords: assisted living, filial piety, housing choices, independent living

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Authors: Gali Moritz, Jacqueline H. Becker, Jyoti V. Ankam, Kimberly Arcoleo, Matthew Wysocki, Roee Holtzer, Juan Wisnivesky, Paula J. Busse, Alex D. Federman, Sunit P. Jariwala, Jonathan M. Feldman

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Objective: Cognitive impairment (CI), whose incidence is greater among ethnic/racial minorities, is a significant barrier to asthma self-management (SM) behaviors and outcomes in older adults. The aim of this study was to examine the relationships between CI, assessed using the Montreal Cognitive Assessment (MoCA), and asthma SM behaviors and outcomes in a sample of predominantly Black and Hispanic participants. Additionally, we evaluated whether using two different MoCA cutoff scores influenced the association between CI and study outcomes. Methods: Baseline cross-sectional data were extracted from a longitudinal study of older adults with asthma (N=165) age≥ 60 years and used for analysis. Cognition was assessed using the MoCA. Asthma control, asthma-related quality of life (QOL), inhaled corticosteroid (ICS) dosing, and ICS adherence were assessed using self-report. The inhaler technique was observed and rated. Results: Using established MoCA cutoff scores of 23 and 26 yielded 45% and 74% CI rates, respectively. CI, defined using the 23 cutoff score, was significantly associated with worse asthma control (p=.04) and worse ICS adherence (p=.01). With a cutoff score of 26, only asthma-related QOL was significantly associated with CI (p=.03). Race/ethnicity and education did not moderate the relationships between CI and asthma SM behaviors and outcomes. Conclusions: CI in older adults with asthma is associated with important clinical outcomes, but this relationship is influenced by the cutoff score used to define CI.

Keywords: cognition, respiratory, elderly, testing, adherence, validity

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Authors: María Teresa Baquero, Ester Higueras

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One of the challenges facing 21st century cities, is their adaptation to the phenomenon of an ageing population. International policies have been developed, such as the "Global Network for Age-friendly Cities and Communities". These cities must recognize the diversity of the elderly population, and facilitate an active, healthy, satisfied aging and promote inclusion. In order to promote active and healthy aging, older people should be encouraged to engage in physical activity, sunbathe, socialize and enjoy the public open spaces in the city. Some studies recognize thermal comfort as one of the factors that most influence the use of public open spaces. However, although some studies have shown vulnerability to thermal extremes and environmental conditions in older people, there is little research on thermal comfort for older adults, because it is usually analyzed based on the characteristics of the ¨average young person¨ without considering the physiological, physical and psychological differences that characterize the elderly. This study analyzes the relationship between the microclimate parameters as air temperature, relative humidity, wind speed and sky view factor (SVF) with the personal thermal perception of older adults in three public spaces in Madrid, through a mixed methodology that combines weather measurements with interviews, made during the year 2018. Statistical test like Chi-square, Spearman, and analysis of variance were used to analyze the relationship between preference votes and thermal sensation votes with environmental and personal parameters. The results show that there is a significant correlation between thermal sensation and thermal preference with the measured air temperature, age, level of clothing, the color of clothing, season, time of the day and kind of space while no influence of gender or other environmental variables was detected. These data would contribute to the design of comfortable public spaces that improve the welfare of the elderly contributing to "active and healthy aging" as one of the 21st century challenges cities face.

Keywords: healthy ageing, older adults, outdoor public space, thermal perception

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Authors: C. Vázquez, L. M. Gigirey, C. P. del Oro, S. Seoane

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Poor vision is common among older people, and several studies show connections between visual impairment and cognitive function. 15 older adult live in Galician Government nursing homes, and cognitive decline is one of the main reasons of admission. Objectives: (1) To evaluate functional far and near vision of older people with cognitive impairment. (2) To determine connections between visual and cognitive state of “our” residents. Methodology: A total of 364 older adults (aged 65 years or more) underwent a visual and cognitive screening. We tested presenting visual acuity (binocular visual acuity with habitual correction if warn) for distance and near vision (E-Snellen, usual working distance for near vision). Binocular presenting visual acuity less than 0.3 was used as cut point for diagnosis of visual impairment. Exclusion criteria included immobilized residents unable to reach the USC Dual Sensory Loss Unit for visual screening. To screen cognition we employed the mini-mental examination test (Spanish version). Analysis of categorical variables was performed using chi-square tests. We utilized Pearson and Spearman correlation tests and the variance analysis to determine differences between groups of interest (SPSS 19.0 version). Results: the percentage of residents with cognitive decline reaches 32.2% Prevalence of visual impairment for distance and near vision increases among those subjects with cognitive impairment respect those with normal cognition. Shift correlation exists between distance visual acuity and mini-mental test (age and sex controlled), and moderate association was found in case of near vision (p<0.01). Conclusion: First results shows that people with cognitive impairment have poor functional distance and near vision than those with normal cognition. Next step will be to analyse the individual contribution of distance and near vision loss on cognition.

Keywords: visual impairment, cognition, aging, nursing homes

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Authors: Jonix Owino, Heather Fuller

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Refugees flee from their home countries due to civil unrest, war, persecution and migrate to Western countries such as the United States in search of a safe haven. Transitioning into a new society and culture can be challenging, thereby affecting refugee’s quality of life and well-being in the host communities. Moreover, as individuals age, they experience physical, cognitive and socioemotional changes that may impact their quality of life. However, little is known about the predictors of quality of life among aging refugees. It is not clear how quality of life varies by age, that is, between midlife refugees in comparison to their older counterparts. In addition to age, other sociodemographic factors such as gender, socioeconomic status, or country of origin are likely to have differential associations to quality of life, yet research on such variations among older refugees is sparse. Thus the present study seeks to explore factors associated with quality of life by asking the following research questions: 1) Do sociodemographic factors (such as age and gender) predict quality of life among older refugees, 2) Is there an association between social integration and quality of life, and 3) Is there an association between migratory related experiences (such as post migratory adjustments) and quality of life. The present study recruited 90 refugees (primarily originating from Bhutan, Somalia, Burundi, and Sudan) aged 50 or older living in the US. The participants completed a structured questionnaire which assessed factors such as participant’s sociodemographic attributes (e.g., age, gender, length of residence in the US, country of origin, employment, level of education, and marital status), and validated measures of social integration, post-migration living difficulties, and quality of life. Preliminary results suggest sociodemographic variability in quality of life among these refugees. Further analyses will be conducted using hierarchical regression analyses to address the following hypotheses: first, it is hypothesized that quality of life will vary by age and gender such that younger refugees and men will report higher quality of life. Second, it is expected that refugees with greater levels of social integration will also report better quality of life. Finally, post-migration factors such as language barriers and family stress are hypothesized to predict poorer quality of life. Further results will be analyzed, including potential moderating effects of age and gender, and resulting findings will be interpreted and discussed. The findings from this study have potential implications for communities on how they can better support older refugees as well as develop social programs that can effectively cater to their well-being. Conclusions will be drawn and discussed in light of policies related to both aging and refugee migration within the context of the US.

Keywords: aging out of place, migration, older refugees, quality of life, social integration

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Authors: Natalia Ivanova, Konstantin Adamov

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The importance of acoustics in music classes made us analyse three music rooms in a Bulgarian school. The same music piece was performed in every one of the classrooms. The recording was played to 2 groups of students. A survey was then taken among those students in order to determine their personal preferences and impressions of the acoustic. The results show differences in the preferences of older students compared to younger ones. Results of the survey show a correlation between older students’ preferences and the standard requirements. However, we discover that younger students’ classrooms should be further analysed and adapted to their needs and preferences.

Keywords: acousic, building acoustic, sound quality, scool acoustic

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Authors: Chih-Chun Wu

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Learning information and communication technologies (ICT) helps people survive in current society. For the internet generation also referred as digital natives, learning new technology is like breathing; however, for the elder generations also called digital immigrants, including parents and grandparents, learning new technology could be challenged and frustrated. While majority research focused on the effects of elders’ ICT learning, less attention was paid to the help that the elders got from their other family members while learning ICT. This study utilized the anonymous questionnaire to survey 3,749 undergraduates and demonstrated that families are great places for intergenerational technology learning to be carried out. Results from this study confirmed that in the family, the younger generation both helped set up technology products and educated the elder ones needed technology knowledge and skills. The family elder members in this study applied to those who lived under the same roof with relative relations. Results from this study revealed that 2,331 (62.2%) and 2,656 (70.8%) undergraduates revealed that they helped their family elder members set up and taught them how to use LINE respectively. In addition, 1,481 (49.1%) undergraduates helped their family elder members set up, and 2,222 (59.3%) taught them. When it came to Apps, 2,527 (67.4%) helped their family elder members download them, and 2,876 (76.7%) taught how to use them. As for search engine, 2,317 (61.8%) undergraduates taught their family elders. Furthermore, 3,118 (83.2%), 2,639 (70.4%) and 2,004 (53.7%) undergraduates illustrated that they taught their family elder members smartphones, computers and tablets respectively. Meanwhile, only 904 (24.2%) undergraduates taught their family elders how to make a doctor appointment online. This study suggests to making good use of intergenerational technology learning in the family, since it increases family elders’ technology capital, and thus strengthens our country’s human capital and competitiveness.

Keywords: intergenerational technology learning, adult technology learning, family technology learning, ICT learning

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