Search results for: older patients

Authors: Ajit Kumar Sah, Rajesh Kumar Jha, Phoolgen Sah, Dev Kumar Shah

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Older individuals often suffer from multiple systemic diseases and are particularly more vulnerable to potentially inappropriate medicine prescribing. Inappropriate medication can cause serious medical problem for the elderly. The purpose of this study was to determine the prevalence of potentially inappropriate medicine (PIM) prescribing in older Nepalese patients in a medicine outpatient department. Beers’ criteria are the most widely used tools to assess PIM to elderly patients. Prospective observational analysis of drugs prescribed in medicine out-patient department (OPD) of a hospital of Bharatpur, Chitwan, Nepal during November 2011 to October 2012 to 869 older adults aged 65 years and above. The use of potentially inappropriate medications (PIM) in elderly patients was analyzed using Beers Criteria updated to 2013. In the 869 patients included the average number of drugs prescribed per prescription was 5.56. The most commonly used drugs were atenolol (24.3%), amlodipine (23.16%), paracetamol (17.6%), salbutamol (15.72%) and vitamin B complex (13.26%). The total number of medications prescribed was 4833. At least one instance of PIM was experienced by approximately 26.3% of patients when evaluated using the Beers criteria. Potentially inappropriate medications are highly prevalent among older patients attending medical OPD and are associated with a number of medications prescribed. Further research is warranted to study the impact of PIMs towards health-related outcomes in these elderly.

Keywords: Beers criteria, elderly, polypharmacy, potentially inappropriate medicines

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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: Ali Kassem, Sharf Eldeen-Shazly, Alshemaa Lotfy

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Introduction: Contrast-induced nephropathy (CIN) has been the third leading cause of hospital-acquired renal failure. Patients with cardiac diseases are particularly at risk especially with repeated injections of contrast media. CIN is generally defined as an increase in serum creatinine concentration of > 0.5 mg/dL or 25% above baseline within 48 hours after contrast administration. Aim of work: To examine the frequency of CIN for patients undergoing cardiac catheterization at Sohag University Hospital (Upper Egypt) and to identify possible risk factors for CIN in these patients. Material and methods: The study included 104 patients with mean age 56.11 ±10.03, 64(61.5%) are males while 40(38.5%) are females. 44(42.3%) patients are diabetics, 43(41%) patients are hypertensive, 6(5.7%) patients have congestive heart failure, 69(66.3%) patients on statins, 74 (71.2 %) are on ACEIs or ARBs, 19(15.4%) are on metformin, 6 (5.8%) are on NSAIDs, 30(28.8%) are on diuretics. RESULTS: Patients were classified at the end of the study into two groups: Group A: Included 91 patients who did not develop CIN. Group B: Included 13 patients who developed CIN, of which serum creatinine raised > 0.5mg/dl in 6 patients and raised > 25% from the baseline after the procedure in 13 patients. The overall incidence of CIN was 12.5%. CIN increased with older age. There was an increase in the incidence of CIN in diabetic versus non-diabetic patients (20.5% and 6.7%) respectively. (p< 0.03). There was a highly significant increase in the incidence of CIN in patients with CHF versus those without CHF (100% and 71%) respectively, (P<0001). Patients on diuretics showed a significant increase in the incidence of CIN representing 61.5% of all patients who developed CIN. Conclusion: Older patients, diabetic patients, patients with CHF and patients on diuretics have higher risk of developing CIN during coronary catheterization and should receive reno-protective measures before contrast exposure.

Keywords: cardiac diseases, contrast-induced nephropathy, coronary catheterization, CIN

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Authors: Maureen Kamau, Gulnaz Mohamoud, Adelaide Lusambili, Njeri Nyanja

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Life expectancy has increased over the last century amongst older individuals, and in particular, those 60 years and over. The World Health Organization estimates that the world's population of persons over 60 years will rise to 22 per cent by the year 2050. Ageing is associated with increasing disability, multiple chronic conditions, and an increase in the use of health services. These multiple chronic conditions are managed with polypharmacy. Polypharmacy has numerous adverse effects including non-adherence, poor compliance to the various medications, reduced appetite, and risk of fall. Studies on polypharmacy and ageing are few and poorly understood especially in low and middle - income countries. The aim of this study was to explore the knowledge, attitudes and beliefs of older people towards polypharmacy. A qualitative study of 15 patients aged 60 years and above, taking more than five medications per day were conducted at the Aga Khan University using Semi-structured in-depth interviews. Three interviews were pilot interviews, and data analysis was performed on 12 interviews. Data were analyzed using NVIVO 12 software. A thematic qualitative analysis was carried out guided by Braun and Clarke (2006) framework. Themes identified; - knowledge of their co-morbidities and of the medication that older persons take, sources of information about medicines, and storage of the medication, experiences and attitudes of older patients towards polypharmacy both positive and negative, older peoples beliefs and their coping mechanisms with polypharmacy. The study participants had good knowledge on their multiple co-morbidities, and on the medication they took. The patients had positive attitudes towards medication as it enhanced their health and well-being, and enabled them to perform their activities of daily living. There was a strong belief among older patients that the medications were necessary for their health. All these factors enhanced compliance to the multiple medication. However, some older patients had negative attitudes due to the pill burden, side effects of the medication, and stigma associated with being ill. Cost of healthcare was a concern, with most of the patients interviewed relying on insurance to cover the cost of their medication. Older patients had accepted that the medication they were prescribed were necessary for their health, as it enabled them to complete their activities of daily living. Some concerns about the side effects of the medication arose, and brought about the need for patient education that would ensure that the patients are aware of the medications they take, and potential side effects. The effect that the COVID 19 pandemic had in the healthcare of the older patients was evident by the number of the older patients avoided coming to the hospital during the period of the pandemic. The relationship with the primary care physician and the older patients is an important one, especially in LMICs such as Kenya, as many of the older patients trusted the doctors wholeheartedly to make the best decision about their health and about their medication. Prescription review is important to avoid the use of potentially inappropriate medication.

Keywords: polypharmacy, older patients, multiple chronic conditions, Kenya, Africa, qualitative study, indepth interviews, primary care

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Authors: Weiju Zhou, Alex Hopkins, Ruoling Chen

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Background: China has increased the gap in income between richer and poorer over the past 40 years, and the number of deaths from people with angina has been rising. It is unclear whether socioeconomic status (SES) is associated with increased mortality in older people with angina. Methods: Data from a cohort study of 2,380 participants aged ≥ 65 years, who were randomly recruited from 5-province urban communities were examined in China. The cohort members were interviewed to record socio-demographic and risk factors and document doctor-diagnosed angina at baseline and were followed them up in 3-10 years, including monitoring vital status. Multivariate Cox regression models were employed to examine all-cause mortality in relation to low SES. Results: The cohort follow-up identified 373 deaths occurred; 41 deaths in 208 angina patients. Compared to participants without angina (n=2,172), patients with angina had increased mortality (multivariate adjusted hazard ratio (HR) was 1.41, 95% CI 1.01-1.97). Within angina patients, the risk of mortality increased with low satisfactory income (2.51, 1.08-5.85) and having financial problem (4.00, 1.07-15.00), but significantly with levels of education and occupation. In non-angina participants, none of these four SES indicators were associated with mortality. There was a significant interaction effect between angina and low satisfactory income on mortality. Conclusions: In China, having low income and financial problem increase mortality in older people with angina. Strategies to improve economic circumstances in older people could help reduce inequality in angina survival.

Keywords: angina, mortality, older people, socio-economic status

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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: Jenny Kwon

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Following the outbreak of the COVID-19 pandemic globally, another type of pandemic, ageism, appeared on the surface. Ageism, the stereotypes, prejudice, and discrimination directed towards others or oneself based on chronological age, has adversely impacted older adults' lives during the pandemic. In the short term, older adults struggled with health issues (e.g., high rate of infection and mortality) and experienced social disconnection (e.g., loneliness and depression). Ultimately, older adults' self-perceptions of aging, self-esteem and intergenerational relationships were negatively influenced. To closely look into the impact of ageism during the pandemic on U.S. older adults' aging process, the current study has three specific purposes. First, the study introduces a theoretical foundation (i.e., stereotype embodiment theory) in the development of ageism research. Second, the study reports on examples of ageism toward U.S. older adults manifested in the context of COVID-19. Finally, collective responsibilities and future research directions are proposed to fight against ageism.

Keywords: ageism, COVID-19, older adults, pandemic, stereotype embodiment

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Authors: Siriporn Poolsuwan

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This research aims to explore the information needs, information usages, and problems of information usage of the older people club’s members in Dusit District, Bangkok. There are 12 clubs and 746 club’s members in this district. The research results use for older person service in this district. Data is gathered from 252 club’s members by using questionnaires. The quantitative approach uses in research by percentage, means and standard deviation. The results are as follows (1) The older people need Information for entertainment, occupation and academic in the field of short story, computer work, and religion and morality. (2) The participants use Information from various sources. (3) The Problem of information usage is their language skills because of the older people’s literacy problem.

Keywords: information behavior, older person, information seeking, knowledge discovery and data mining

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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: Jeong-Moh John Yahng, Angelika Na

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Introduction: Increasing numbers of general surgical patients are being prescribed antiplatelet and anticoagulant medications (APAC) for various cardiovascular and cerebrovascular conditions. Surgical patients who are on APAC present a management challenge as bleeding risk needs to be balanced with thromboembolic risk. Although guidelines exist in regards to APAC management in elective surgery, there is a lack of guidelines in the emergency surgery setting. In this study we aim to characterise APAC usage in emergency general surgical patients admitted to a rural hospital. We also assess the impact of APAC usage on clinical management of these patients. Methods: Prospective study of emergency general surgical admissions at Northeast Health Wangaratta (Victoria) from 2 July to 25 Oct 2014. Questionnaire collected demographics data, admission diagnosis, APAC usage, anaesthesia techniques, operation types, transfusion requirement and morbidity / mortality data. Results: During the 4 month study, 118 patients were classified into two groups: non-APAC (n=96, 81%) and APAC (n=22, 19%). Patients in the APAC group were older compared to the non-APAC patients (mean age 72 vs 42 years old). Amongst patients younger than 60 years old, only 1% of them were on APAC. In contrast, 49% of patients older than 60 years old were on APAC (p<0.001). Patients who were admitted with a bleeding problem were more likely to be on APAC (p<0.05). 19% of emergency general surgery patients were on APAC. The majority (91%) of them were on antiplatelet medication, with two patients being on dual antiplatelet agents (aspirin + clopidogrel or ticagrelor). 15% of emergency general surgical patients requiring operations were on APAC. 11% of all laparotomies and 33% of gastroscopy for haematemesis/melaena patients were on APAC. Both of the patients operated for bleeding following surgery at another hospital were in the APAC group. In regards to impact on clinical management, 59% of APAC patients had their medications interrupted or ceased, on average by 3.5 days (range 1-13 days). 2 out of 75 operations were delayed due to APAC usage. There was no difference in the use of central venous or arterial line for increased monitoring (p=0.14) or in the use of warming blanket (Bair Hugger™) (p=0.94). Overall, transfusion rate was higher amongst APAC patients (14% vs 3%) (p 0.04). The recorded morbidity (n=2) and mortality (n=1) in this study were all in the APAC group. Discussion: Nineteen percent of emergency general surgical admissions and fifteen percent of operated patients were on APAC. The prevalence of APAC usage was higher in those aged sixty and above. General surgical patients who were admitted with a bleeding problem were more likely to be on APAC. Two patients who were operated for bleeding following surgery at another hospital were in the APAC group. Note that there was no patient in the non-APAC group who was admitted for post-operative bleeding. We observed two cases in which operation was delayed due to APAC usage. Transfusion, morbidity and mortality rate were higher in the APAC group. Conclusion: In this study, nineteen percent of emergency general surgical admissions were on APAC. The use of APAC is more prevalent in the older age group, particularly those aged sixty and above. Higher proportion of APAC compared to non-APAC patients were admitted and operated for bleeding problems. There is an urgent need for clinical guidelines regarding APAC management in emergency general surgical patients.

Keywords: antiplatelet, anticoagulants, emergency general surgery, rural general surgery, morbidity, mortality

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Authors: Van Truong Pham

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Background: Self-management was described as a potential strategy for blood pressure control in patients with hypertension. However, the effects of self-management interventions on blood pressure, self-efficacy, medication adherence, and body mass index (BMI) in older adults with hypertension have not been systematically evaluated. We evaluated the effects of self-management interventions on systolic blood pressure (SBP) and diastolic blood pressure (DBP), self-efficacy, medication adherence, and BMI in hypertensive older adults. Methods: We followed the recommended guidelines of preferred reporting items for systematic reviews and meta-analyses. Searches in electronic databases including CINAHL, Cochrane Library, Embase, Ovid-Medline, PubMed, Scopus, Web of Science, and other sources were performed to include all relevant studies up to April 2019. Studies selection, data extraction, and quality assessment were performed by two reviewers independently. We summarized intervention effects as Hedges' g values and 95% confidence intervals (CI) using a random-effects model. Data were analyzed using Comprehensive Meta-Analysis software 2.0. Results: Twelve randomized controlled trials met our inclusion criteria. The results revealed that self-management interventions significantly improved blood pressure control, self-efficacy, medication adherence, whereas the effect of self-management on BMI was not significant in older adult patients with hypertension. The following Hedges' g (effect size) values were obtained: SBP, -0.34 (95% CI, -0.51 to -0.17, p < 0.001); DBP, -0.18 (95% CI, -0.30 to -0.05, p < 0.001); self-efficacy, 0.93 (95%CI, 0.50 to 1.36, p < 0.001); medication adherence, 1.72 (95%CI, 0.44 to 3.00, p=0.008); and BMI, -0.57 (95%CI, -1.62 to 0.48, p = 0.286). Conclusions: Self-management interventions significantly improved blood pressure control, self-efficacy, and medication adherence. However, the effects of self-management on obesity control were not supported by the evidence. Healthcare providers should implement self-management interventions to strengthen patients' role in managing their health care.

Keywords: self-management, meta-analysis, blood pressure control, self-efficacy, medication adherence, body mass index

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Authors: Abdul-Ganiyu Fuseini, Bernice Redley, Helen Rawson, Lenore Lay, Debra Kerr

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Aim: The study aimed to develop and validate a culturally appropriate patient-reported outcome measure for measuring dignity for older adults during acute hospital admissions. Design: A three-phased mixed-method sequential exploratory design was used. Methods: Concept elicitation and generation of items for the scale was informed by older adults’ perspectives about dignity during acute hospitalization and a literature review. Content validity evaluation and pre-testing were undertaken using standard instrument development techniques. A cross-sectional survey design was conducted involving 270 hospitalized older adults for evaluation of construct and convergent validity, internal consistency reliability, and test–retest reliability of the scale. Analysis was performed using Statistical Package for the Social Sciences, version 25. Reporting of the study was guided by the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. Results: We established the 15-item Hospitalized Older Adults’ Dignity Scale that has a 5-factor structure: Shared Decision-Making (3 items); Healthcare Professional-Patient Communication (3 items); Patient Autonomy (4 items); Patient Privacy (2 items); and Respectful Care (3 items). Excellent content validity, adequate construct and convergent validity, acceptable internal consistency reliability, and good test-retest reliability were demonstrated. Conclusion: We established the Hospitalized Older Adults Dignity Scale as a valid and reliable scale to measure dignity for older adults during acute hospital admissions. Future studies using confirmatory factor analysis are needed to corroborate the dimensionality of the factor structure and external validity of the scale. Routine use of the scale may provide information that informs the development of strategies to improve dignity-related care in the future. Impact: The development and validation of the Hospitalized Older Adults Dignity Scale will provide healthcare professionals with a feasible and reliable scale for measuring older adults’ dignity during acute hospitalization. Routine use of the scale may enable the capturing and incorporation of older patients’ perspectives about their healthcare experience and provide information that informs the development of strategies to improve dignity-related care in the future.

Keywords: dignity, older adults, hospitalisation, scale, patients, dignified care, acute care

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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: Elizabeth Waleola Afolabi-Soyemi

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As the population of older adults continues to grow, improving health outcomes for this demographic has become an increasingly important public health goal. Health promotion interventions have been developed to address the unique health needs and challenges faced by older adults. This abstract reviews the literature on health promotion interventions for older adults and their effectiveness in improving health outcomes. Various interventions have been found to be effective, including physical activity programs, nutrition education, medication management, and social support programs. These interventions have been shown to improve outcomes such as functional status, quality of life, and disease management. Despite the success of these interventions, there are still barriers to their implementation, such as a lack of access to resources and inadequate funding. Further research is needed to identify effective strategies for overcoming these barriers and to develop more tailored interventions for specific populations of older adults. Overall, health promotion interventions have great potential to improve the health outcomes and quality of life of older adults and should be a priority for public health efforts.

Keywords: health, humanity, health promotion, older adults

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Authors: Aigul Abduldayeva, Gulnar Tuleshova

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Osteoporosis (OP) is a major socio-economic problem and is a major cause of disability, reduced quality of life and premature death of elderly people. In Astana, the study involved 93 respondents, of whom 17 were men (18.3%), and 76 were women (81.7%). Age distribution of the respondents is as follows: 40-59 (66.7%), 60-75 (29.0%), 75-90 (4.3%). In the city of Astana general breach of bone mass (CCM) was determined in 83.8% (nationwide figure - RRP - 79.0%) of the patients, and normal levels of ultrasound densitometry were detected in 16.1% (RRP 21.0%) of the patients. OP was diagnosed in 20.4% of people over 40 (RRP for citizens is 19.0%), 25.4% in the group older than 50 (23.4% PIU), 22,6% in the group older than 60 (RRP 32.6%), 25.0% in the group older than 70 (47.6% of RRP). OPN was detected in 63.4% (RRP 59.6%) of the surveyed population. These data indicate that, there is no sharp difference between Astana and other cities in the country regarding the incidence of OP, that is, the situation with the OP is not aggravated by any regional characteristics. In the distribution of respondents by clusters it was found that 80.0% of the respondents with CCM were in the "best urban cluster", 93.8% were in "average urban cluster", and 77.4% were in a "poor urban cluster". There is a high rate construction of new buildings in Astana, presumably, that the new settlers inhabit the outskirts of the city, and very difficult to trace the socio-economic differences there. Based on these data the following conclusions can be made: 1. According to the ultrasound densitometry of the calcaneus the prevalence rate of NCM among the residents of Astana is 83.3%, OP - 20.4%, which generally coincides with data elsewhere in the country. 2. The urban population of Astana is under a high degree of risk for low energetic fracture, 46.2% of the population had medium and high risks of fracture, while the nationwide index is 26.7%. 3. In the development of CCM residents of Akmola region play a significant role gender, age, ethnic factors. According to the ultrasound densitometry women are more prone to Astana OP - 22.4% of respondents than men - 11.8% of respondents.

Keywords: nutrition, osteoporosis, elderly, urban population

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Authors: Jessica Hemberg, Anna K. Forsman, Johanna Nordmyr

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With a considerable increase in the aging population in the Nordic countries there is a call for a deeper understanding of healthy aging and its underlying mechanisms. The aim of this study is to uncover health and well-being for older adults according to their own views and understand what role the existential dimension play? The study uses a hermeneutical approach. Material was collected through focus group interviews with 18 older adults. The texts were interpreted through hermeneutical reading. The underlying mechanisms of health among older adults are described, illustrating the key prerequisites for health as being in the present. This implies ‘living on the continuums of life and death’ and in this field of forces also ‘living on the continuum of the past and the future’. Important aspects for being in the present was balancing ambivalent emotions, considering existential issues, and being in connectedness. Health for older adults may be understood in the light of the metaphor of taking it one day at a time. Being in the present was emphasized as a health potential for older adults highlighting the existential health dimension. From a societal point of view, this implies that health promotion should focus on highlighting the importance of the existential dimension of health since it holds health-promoting potentials for older adults. Optimal health for older adults requires awareness of one’s attitude to life through being in the present as a basis for a positive and healthy outlook on life.

Keywords: focus group interviews, hermeneutics, life experiences, older adults

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Authors: Dr Elliroma Gardiner

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Extending the working life of older workers is one important strategy in alleviating the social and economic challenges associated with the ageing population. The Australian government has implemented several strategies to improve the participation rates of older workers, however, the success of these initiatives has been limited. The aim of this project is to identify what workplace practices influence the workforce participation decisions of older workers. Thirty semi-structured interviews were conducted with older Australians who were either recently retired or currently working. Participants were asks about the factors that influenced their decision to retire/continue working and their current (or former) workplace practices. The results of the thematic analysis identified several factors which either supported (i.e., job autonomy and managerial support) or hindered (i.e., perceptions of age discrimination and age-based stereotypes) continued workplace participation. This research has several important applications for organisation managing intergenerational workforces, as well as policy makers interested in increasing the working life of ageing workers.

Keywords: ageing workers, older workers, age discrimination, age diversity

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Authors: Rina Yadav, Lih-Yau Song

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The claim for elderly care center has increased enormously with the world demographic revolution as the number of senior citizens increased in the 21st century. As per the world progress into contemporaneousness, a large number of people are engaged in daily routine to bring about the senior citizens to lose the care that they in fact need. New design suggestions have been made on the basis of available guidelines and two case studies in Taiwan. Interior design can provide positive and sensory stimulation through memory stimulation, and by creating a friendly and comfortable environment for demented older people, which can reduce patient anxiety and reduce stress on caregivers. This report pursues to reveal the better design of an elderly care center with a new tactic in a direction to offer better service for demented elderly people which could upraise their living standard.

Keywords: daycare center, dementia patients, interior designing, older adults

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Authors: Erhong Sun, Xuchun Ye

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Technophobia, namely the fear or dislike of modern advanced technologies, plays a central role in age-related digital divides and is considered a new risk factor for older adults, which can affect the daily lives of people through low adherence to digital living. Indeed, there is considerable heterogeneity in the group of older adults who feel technophobia. Therefore, the aim of this study was to identify different technophobia typologies of older people and to examine their associations with the subjective age factor. A sample of 704 retired elderly over the age of 55 was recruited in China. Technophobia and subjective age were assessed with a questionnaire, respectively. Latent profile analysis was used to identify technophobia subgroups, using three dimensions including techno-anxiety, techno-paranoia, and privacy concerns as indicators. The association between the identified technophobia subgroups and subjective age was explored. In summary, four different technophobia typologies were identified among older adults in China. Combined with an investigation of personal background characteristics and subjective age, it draws a more nuanced image of the technophobia phenome among older adults in China. First, not all older adults suffer from technophobia, with about half of the elderly subjects belonging to the profiles of “Low-technophobia” and “Medium-technophobia.” Second, privacy concern plays an important role in the classification of technophobia among older adults. Third, subjective age might be a protective factor for technophobia in older adults. Although the causal direction between identified technophobia typologies and subjective age remains uncertain, our suggests that future interventions should better focus on subjective age by breaking the age stereotype of technology to reduce the negative effect of technophobia on older. Future development of this research will involve extensive investigation of the detailed impact of technophobia in senior populations, measurement of the negative outcomes, as well as formulation of innovative educational and clinical pathways.

Keywords: technophobia, older adults, latent profile analysis, subjective age

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Authors: Suvorov Vasyl, Filipchuk Viktor

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Background: If non-surgical treatment of developmental dysplasia of the hip (DDH) fails or if DDH is late-detected, surgery is necessary. Salter pelvic osteotomy (SPO) is an effective surgical option for such cases. The objectives of this study were to assess the results after SPO, evaluate risk factors, and reveal those radiological parameters that may correlate with the results. Mid- and long-term postoperative results after SPO in 17 patients (22 hip joints) were analyzed. Risk factors included those that do not depend on the surgeon (patient's age, value of the acetabular index (AI) preoperatively, DDH Tonnis grade) and those that depend on the surgeon (amount of AI correction). To radiological parameters which may correlate with the amount of AI correction, we referred distance "d" and the lateral rotation angle. Results: SPO allows performing AI correction in ranges 24.1 ± 6.5°. Excellent and good clinical results were obtained in 95.5% of patients; excellent and good radiological results in 86.4% of patients. Risk factors that do not depend on the surgeon were older patient’s age and higher preoperative AI values (p < 0.05). The risk factor that depends on the surgeon was the amount of AI correction (p < 0.05). The distance "d" was recognized as a radiological parameter that may indicate sufficient AI correction (p < 0.05). Conclusion: In older patients with a higher preoperative AI value, the results will be predictably worse. The surgeon may influence the result with a greater amount of AI correction (which may also be indicated radiologically by the distance "d" values).

Keywords: developmental dysplasia of the hip, results, risk factor, pelvic osteotomy, salter osteotomy

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Authors: Mohd Taufiq bin Azmy, Yahaya Hassan, Shubashini Gnanasan, Loganathan Fahrni

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Inappropriate prescribing in older patients has been associated with resource utilization and adverse drug events (ADE) such as hospitalization, morbidity and mortality. Globally, there is a lack of published data on ADE induced by inappropriate prescribing. Our study is specific to an older population and is aimed at identifying risk factors for ADE and to develop a model that will link ADE to inappropriate prescribing. The design of the study was prospective whereby computerized medical records of 302 hospitalized elderly aged 65 years and above in 3 public hospitals in Malaysia (Hospital Serdang, Hospital Selayang and Hospital Sungai Buloh) were studied over a 7 month period from September 2013 until March 2014. Potentially inappropriate medications and potential prescribing omissions were determined using the published and validated START-STOPP criteria. Patients who had at least one inappropriate medication were included in Phase II of the study where ADE were identified by local expert consensus panel based on the published and validated Naranjo ADR probability scale. The panel also assessed whether ADE were causal or contributory to current hospitalization. The association between inappropriate prescribing and ADE (hospitalization, mortality and adverse drug reactions) was determined by identifying whether or not the former was causal or contributory to the latter. Rate of ADE avoidability was also determined. Our findings revealed that the prevalence of potential inappropriate prescribing was 58.6%. A total of ADEs were detected in 31 of 105 patients (29.5%) when STOPP criteria were used to identify potentially inappropriate medication; All of the 31 ADE (100%) were considered causal or contributory to admission. Of the 31 ADEs, 28 (90.3%) were considered avoidable or potentially avoidable. After adjusting for age, sex, comorbidity, dementia, baseline activities of daily living function, and number of medications, the likelihood of a serious avoidable ADE increased significantly when a potentially inappropriate medication was prescribed (odds ratio, 11.18; 95% confidence interval [CI], 5.014 - 24.93; p < .001). The medications identified by STOPP criteria, are significantly associated with avoidable ADE in older people that cause or contribute to urgent hospitalization but contributed less towards morbidity and mortality. Findings of the study underscore the importance of preventing inappropriate prescribing.

Keywords: adverse drug events, appropriate prescribing, health services research

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Authors: Maryam Panahiazar, Andrew M. Bishara, Yorick Chern, Roohallah Alizadehsani, Dexter Hadleye, Ramin E. Beygui

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Early detection plays a crucial role in enhancing the outcome for a patient with coronary artery disease (CAD). We utilized a big data analytics platform on ~23,000 patients with CAD from a total of 960,129 UCSF patients in 8 years. We traced the patients from their first encounter with a physician to diagnose and treat CAD. Characteristics such as demographic information, comorbidities, vital, lab tests, medications, and procedures are included. There are statistically significant gender-based differences in patients younger than 60 years old from the time of the first physician encounter to coronary artery bypass grafting (CABG) with a p-value=0.03. There are no significant differences between the patients between 60 and 80 years old (p-value=0.8) and older than 80 (p-value=0.4) with a 95% confidence interval. This recognition would affect significant changes in the guideline for referral of the patients for diagnostic tests expeditiously to improve the outcome by avoiding the delay in treatment.

Keywords: electronic medical records, coronary artery disease, data analytics, young women

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Authors: Mimi My Tse

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The prevalence of chronic non-cancer pain is high among community-dwelling older adults. Pain affects physical and psychosocial abilities. Older adults tend to be less mobile and have a high tendency to fall risk. In addition, older adults with pain are depressed, anxious, and not too willing to join social activities. This will make them feel very lonely and social isolation. Instead of giving pain management education and programs to older adults/clients, both older adults and their caregivers, it is sad to find that the majority of existing services are given to older adults only. Given the importance of family members in increasing compliance with health-promoting programs, we proposed to offer pain management programs to both older adults with his/her caregiver as a “dyad.” We used the Health Promotion Model and implemented a dyadic pain management program (DPM). The DPM is an 8-week group-based program. The DPM comprises 4 weeks of center-based, face-to-face activities and 4 weeks of digital-based activities delivered via a WhatsApp group. There were 30 dyads (15 in the experimental group with DPM and 15 in the control group with pain education pamphlets). Upon the completion of DPM, pain intensity and pain interference were significantly lower in the intervention group as compared to the control group. At the same time, physical function showed significant improvement and lower depression scores in the intervention group. In conclusion, the study highlights the potential benefits of involving caregivers in the management of chronic pain for older adults. This approach should be widely promoted in managing chronic pain situations for community-dwelling older adults and their caregivers.

Keywords: pain, older adults, dyadic approach, education

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Authors: Hind Mohammed A. Asiri, Asia Mohammed Asiri, Hana Falah Alruwaili, Joseph Almazan

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With the rapid growth of the older adult population, an underlying growth of public health concern is also seen. Various technologies were developed to help mitigate the arising problems of older adults with cognitive impairment and the improvement of their cognitive functions. This scooping review used the Joanna Briggs Institute (JBI) and the PRISMA extension for scoping reviews. The eligibility criteria were defined using the Population, Concept, Context (PCC) framework, as described in the JBI’s Reviewers Manual (Peters et al.,2020). The population of interest for this review is older adults 65 years old or older. Studies involving monitoring technology devices utilized in caring with older adult with cognitive impairment. This scoping review has shown information that researchers are more focused on creating alternative and novel methods or technological devices and use these as a tool for designing interventions depending on the data of the patient. This study has shown the type of technologies that have been explored in terms of assessing, detecting, monitoring, and interventions for cognitive impairment. Thus, there is a need for this technology to be applied in the practical field to further strengthen the evidence that it could enhance the lives of older adults.

Keywords: technology devices, cognitive impairment, older adult, nursing care, caring

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Authors: Xin Qi Dong, Melissa Simon

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Aims: Elder mistreatment and suicidal ideation are important public health concerns among aging populations. This study will examine the association between elder mistreatment and suicidal ideation among Chinese older adults in the USA. Methods: Guided by a community-based participatory research approach, in this study we conducted in-person interviews with Chinese older adults aged 60 years and older in the Greater Chicago area from 2011 to 2013. Elder mistreatment was assessed by a 10-item instrument derived from the Hwalek-Sengstock Elder Abuse Screening Test (H-S/EAST) and the Vulnerability to Abuse Screening Scale (VASS). Suicidal ideation was assessed by the ninth item of the Patient Health Questionnaire-9 (PHQ-9) and the Geriatric Mental State Examination-Version A (GMS-A). Results: Overall, 3,159 Chinese older adults participated in this study, and their mean age was 72.8 years. After controlling for age, gender, education, income, medical comorbidities, depressive symptoms, and social support, elder mistreatment was significantly associated with 2-week suicidal ideation (OR 2.46, 95% CI 1.52--4.01) and 12-month suicidal ideation (OR 2.46, 95% CI 1.62--3.73). With respect to gender differences, the study found that the association remained significant for older women but not for older men after adjusting for all confounding factors. Conclusion: As the largest epidemiology study conducted among Chinese older adults in the USA, this study suggests that elder mistreatment is significantly associated with 2-week and 12-month suicidal ideation in older women but not in older men. Longitudinal studies should be conducted to explore the mechanisms through which elder mistreatment links with suicidal ideation.

Keywords: suicidal ideation, elder abuse, family violence, Asian health equity

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Authors: Ophir Segal, Daniel Weltsch, Shay Tenenbaum, Ran Thein

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Purpose: Patients with lateral patellar dislocation (LPD) are not always referred to perform an MRI. This might be the case in first time LPD patients without surgical indications or in patients with recurrent LPD who had MRI in previous episodes. Unfortunately, in some cases, there are additional knee pathological findings, which include tearing of the collateral or cruciate ligaments and injury to the tendons or menisci. These findings might be overlooked during the physical examination or masked by nonspecific clinical findings like knee pain, effusion, or hemarthrosis. The prevalence of these findings, which can be revealed by MRI, is misreported in literature and is considered rare. In our practice, all patients with LPD are sent for MRI after LPD. Therefore, we have designed a retrospective comparative study to evaluate the prevalence of additional pathological findings in patients with acute traumatic LPD that had performed MRI, comparing different groups of patients according to age, sex, and Tibial Tuberosity-Trochlear Groove(TT-TG) distance. Methods: MRI of the knee in patients after traumatic LPD were evaluated for the presence of additional pathological findings such as injuries to ligaments: Anterior/Posterior cruciate ligament(ACL, PCL), Medial/Lateral collateral ligament(MCL, LCL), injuries to tendons(QUADICEPS, PATELLAR), menisci(Medial/Lateral meniscus(MM, LM)) and tibial plateau, by a fellowship-trained, senior musculoskeletal radiologist. A comparison between different groups of patients was performed according to age (age group < 25 years, age group > 25 years), sex (Male/Female group), and TT-TG distance (TT-TG<15 groups, TT-TG>15 groups). A descriptive and comparative statistical analysis was performed. Results: 150 patients were included in this study. All suffered from LPD between the years 2012-2017 (mean age 21.3( ± SD 8.9), 86 males). ACL, PCL, MCL, and LCL complete or partial tears were found in 17(11.3%), 3(2%), 22(14.6%), and 4(2.7%) of the patients, respectively. MM and LM tears were found in 10(6.7%) and 3(2%) of the patients, respectively. A higher prevalence of PCL injury, MM tear, and LM tear were found in the older age group compared to the younger group of patients (10.5% vs. 1.8%, 18.4% vs. 2.7%, and 7.9% vs. 0%, respectively, p<0.05). A higher prevalence of non-displaced MM tear and LCL injury was found in the male group compared to the female group (8.1% vs. 0% and 8.1% vs. 0% respectively, p<0.05). A higher prevalence of ACL injury was found in the normal TT-TG group compared to the pathologic TT-TG group (17.5% vs. 2.3%, p= 0.0184). Conclusions: Overall, 43 out of 150 (28.7%) of the patient's MRI’s were positive for additional pathological radiological findings. Interestingly, a higher prevalence of additional pathologies was found in the groups of patients with a lower risk for recurrent LPD, including males, patients older than 25, and patients with TT-TG lower than 15mm, and therefore might not be referred for an MRI scan. Thus, we recommend a strict physical examination, awareness to the high prevalence of additional pathological findings, and to consider performing an MRI in all patients after LPD.

Keywords: additional findings, lateral patellar dislocation (LPD), MRI scan, traumatic patellar dislocation, cruciate ligaments injuries, menisci injuries, collateral ligaments injuries

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Authors: W. Pungchompoo, A. Richardson, L. Brindle

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Background: The developing of a culturally acceptable end of life survey (the VOICES-ESRD/Thai questionnaire) is an essential instrument for evaluation health services provision of older persons with ESRD in Thailand. The focus of the questionnaire was on symptoms, symptom control and the health care needs of older people with ESRD who are managed without dialysis. Objective: The objective of this study was to develop and adapt VOICES to make it suitable for use in a population survey in Thailand. Methods: The mixed methods exploratory sequential design was focussed on modifying an instrument. Data collection: A cognitive interviewing technique was implemented, using two cycles of data collection with a sample of 10 bereaved carers and a prototype of the Thai VOICES questionnaire. Qualitative study was used to modify the developing a culturally acceptable end of life survey (the VOICES-ESRD/Thai questionnaire). Data analysis: The data were analysed by using content analysis. Results: The revisions to the prototype questionnaire were made. The results were used to adapt the VOICES questionnaire for use in a population-based survey with older ESRD patients in Thailand. Conclusions: A culturally specific questionnaire was generated during this second phase and issues with questionnaire design were rectified.

Keywords: VOICES-ESRD/Thai questionnaire, cognitive interviewing, end of life survey, health services provision, older persons with ESRD

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Authors: Saranchuluun Otgon, Sugarmaa Myagmarjav, Khorolsuren Lkhagvasuren, Fabio Casati

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Background: Flourishing is a eudaimonic dimension of psychological well-being that has been associated with positive social and health-related outcomes. Determining the factors associated with health and well-being is important to the development of evidence-based intervention programs, policies, and action plans targeting the older adult population, especially in low- and middle-income countries, such as Mongolia, where evidence-based research on aging, health, and well-being is still scarce. This study makes important contributions to the study of well-being in later age and also to policy activities for the older population in Mongolia. Methods: We employed multiple regression models to predict the factors of flourishing using data from 304 older adults living in urban and rural Mongolia. Data is collected by the standardized and validated questionnaire adopted by Ed Diener. Results: The median score of the flourishing of urban and rural older adults in Mongolia was significantly different, 53 and 50, respectively. The sex (β = 2.52,p = 0.034), level of education(β = 0.94, p = 0.026), receive help for the activity of daily living (β = 2.16, p = 0.022) determine the flourishing of older adults living in a rural area, while self-reported health (β = 0.94, p = 0.026), the number of social activities, friends network determine to flourish of older adults living urban area. Conclusion: Older adults who live in urban areas have more psychological resources and strengths than those in rural areas. Determinants of flourishing are different in different settings. For instance, individual and family factors determine flourishing in rural areas, and social ties determine flourishing in urban areas.

Keywords: flourishing, predictors, older adults, Mongolia, psychological well-being

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Authors: Noppawan Piaseu, Surat Komindr

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This study aimed to determine factors predicting food insecurity in older Thai women living in crowded urban communities. Through purposive sampling, 315 participants were recruited from community dwelling older women in Bangkok, Thailand. Data collection included interview from questionnaires and anthropometric measurement. Results showed that approximately half of the sample were 60-69 years old (51.1%), married (50.6%), obtained primary education (52.3%), had low family income (51.7%), lived in poor physical environment (49.9%) with normal body mass index (51.0%). Logistic regression analysis revealed that older women who were widowed/divorced/separated (OR = 1.804, 95% CI = 1.052-3.092, p = .032), who reported low family income (OR =.654, 95% CI = .523-.817, p < .001), and who had poor physical environment surrounding home (OR = 2.338, 95% CI = 1.057-5.171, p = .036) were more likely to have food insecurity. Results support that social and environmental factors are major factors predicting food insecurity in older women living in the urban community. Health professionals need to identify and monitor psychosocial, economic and environmental dimensions of food insecurity among them.

Keywords: food insecurity, older women, urban communities, Thailand

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Authors: Sharon Ganzer

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Older adults want choices about where they ‘age-in-place’ and express the desire to remain in their home for as long as possible because it maintains feelings of independence and autonomy, perpetuates a sense of identity, enable people to have space for their belongings and supports connections and social engagement. When circumstances change, and alternative living arrangements are required, more and more older adults are considering a transition to a retirement village – the liminal space between home and residential care. This qualitative study explores the lived experience of older adults who relocate to a retirement village in Queensland, Australia, and the role that material culture plays in this process.

Keywords: material culture, social gerontology, concepts of home, retirement villages

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