Archives of Gerontology and Geriatrics

Editorial Board

2012-07-01

Nutritional status and epidemiological profile of elderly people

2011-07-07

Abstract: We intended to identify and evaluate the association between the socio-demographic and epidemiological characteristics of elderly people with their nutritional characteristics. This is a transversal study PMTI (from the Portuguese name of “Programa Municipal da Terceira Idade”), conducted at Viçosa, MG, Brazil. We analyzed 93 records of elderly people registered since 2006 and who underwent nutritional care. After having analyzed the questionnaire, we performed the descriptive and association analyses in the Epi Info (version 6.04) and Minitab softwares. Of the 93 analyzed records, most elderly people were women (80.4%), with an average of 72 years of age, of which 13.0% were long-lived people. The mean body mass index (BMI) was 27.4kg/m2, and 50.5% were overweight. We have found 26.8% elderly patients with hypertension, and 31.6% took antihypertensives. Elderly patients who were overweight are 4.54 times more likely to have arterial hypertension (odds ratio (OR)=4.54; 95% confidence interval (CI)=1.2–2.45). Only 7.5% smoked, 30.1% were alcoholics and 60.2% made physical activities. Inadequacies were found regarding the servings of fruits, dairy products, vegetables and sugars consumed. However, the servings of cereals, leguminous, meat and fat consumed were appropriate. This study showed that the nutritional diagnosis and the epidemiological and socio-demographic studies are critical tools to understand this population group, in addition to being important to the planning of health actions.

Self-perceived oral health status in institutionalized elderly in Brazil

Grasiela Piuvezam, Kenio Costa de Lima — 2011-05-30

Abstract: This study aims to identify self-perceived oral health status in institutionalized elderly in Brazil, using the Geriatric Oral Health Assessment Index (GOHAI) and to seek associations with objective and subjective conditions and behavior related to oral health, individual traits, and environmental factors. A cross-sectional study using census with institutionalized elderly in Brazil. A total of 1192 individuals were evaluated, and 587 (49.2%) responded to the GOHAI. A questionnaire and an epidemiological survey were applied. The Mann–Whitney, Kruskal–Wallis, Fisher's exact, chi-square, and multiple logistic regression tests were performed. Mean age was 74.98±9.5 years, 51.4% (302) were male. The mean DMFT-index (DMFT=decayed, missing, filled teeth) was 28.8±5.5 and 54.5% (320) of the elderly were toothless. Categorized GOHAI showed that 75% (440) of the individuals had positive self-perception of oral health status. Multiple logistic regression demonstrated that the last visit to the dentist (adjusted prevalence ratio=PR=4.058; confidence interval=CI=1.526–10.789), presence of gingival problems (adjusted PR=5.703; CI=1.754–18.544), and self-rating of teeth, gums, or prosthesis (adjusted PR=19.514; CI=5.075–75.041) remained significant in the model. Predominance of positive self-perception of oral health status was observed despite poor oral conditions. Thus, for the institutionalized population, the present study recommends epidemiological and self-perception surveys to ensure adequate planning of oral health strategies.

The effect of mandibular anterior teeth on the hypermobile tissue in the anterior part of the maxilla

Tonguç Sülün, Olcay Şakar, Hakan Bilhan, Ebru İspirgil — 2011-06-13

Abstract: The absence of posterior occlusal contacts may result in increased anterior occlusal contacts and forces between natural mandibular dentition and artificial maxillary dentition. The impact of natural mandibular anterior teeth on the development of hypermobile tissues in the anterior part of the edentulous maxillary alveolar ridge was investigated in this study. The study group consisted of 410 patients with maxillary complete dentures and various mandibular dentitions from seven rest homes in Istanbul. The data; including hypermobile tissue in the anterior part of the maxilla, occlusal relationship, nocturnal wear, denture age, and duration of the maxillary full edentulism period were recorded. A chi-square test was performed to analyze the effects of following data: Existence of mandibular anterior teeth, poor adaptation of the dentures, nocturnal wear, types of occlusal contacts, and gender, on the resorption of the anterior part of the maxilla. To examine the effects of the presence of anterior mandibular teeth and early maxillary edentulism on bone resorption in the anterior part of the maxilla, a logistic regression analysis was performed. The results reveal that patients with edentulous maxilla and natural mandibular anterior teeth are approximately twice more likely to show risk of hypermobile tissue in the anterior part of the maxilla than are full edentulous patients. Further, edentulous periods exceeding 30 years in maxilla seem to increase this risk approximately 4 times.

Prevention of aspiration pneumonia (AP) with oral care

Akio Tada, Hiroko Miura — 2011-07-18

Abstract: AP is a major cause of morbidity and mortality in elderly patients, especially frail elderly patients. The aim of this article is to review effect of oral care, including oral hygiene and improvement of oral function, on the prevention of AP among elderly people in hospitals and nursing homes. There is now a substantial body of work studying the effect of oral care on the prevention of respiratory diseases. Oral hygiene, consisting of oral decontamination and mechanical cleaning by dental professionals, has resulted in significant clinical effects (decreased incidence of pneumonia and decreased mortality from respiratory diseases) in clinical randomized trials. Moreover, studies examining oral colonization by pneumonia pathogens have shown the effect of oral hygiene on eliminating these pathogens. In addition, swallowing training has been shown to improve the movement and function of swallowing-related muscles, also resulting in decreased incidence of pneumonia. These findings support the contention that oral care is effective in the prevention of AP.

Severe frailty and cognitive impairment are related to higher mortality in 12-month follow-up of nursing home residents

2011-07-18

Abstract: Frailty syndrome (FS) and cognitive impairment are associated with an increased risk of falls, disability, hospitalization and death. We investigated prognostic meaning of FS and cognitive impairment in persons ≥65 years, living in 2 nursing homes. Information about the health status of patients was gathered from history, medical documentation, test assessing FS, according to the Canadian Study of Health and Aging-Clinical Frailty Scale (CSHA-CFS) and the Mini-Mental State Examination (MMSE). The study group included 66 women and 20 men, between 66 and 101 years of age (mean±S.D.=83.8±8.3 years). The frequency of severe frailty (CSHA-CFS=7) among the elderly living in nursing homes was 34.9%, while severe cognitive impairment (MMSE<18) was present in 55.8%. Residents with severe FS and MMSE<18 consisted 33.7% of examined and 50.0% of those who died during 12-month follow-up, p<0.05. Individuals with severe FS and severe cognitive impairment (n=29) as compared to all other patients, were significantly less probable (59% vs. 79%, p=0.03) to survive one year. Neither frailty, nor dementia, nor severe FS or cognitive impairment when considered separately was associated with higher mortality rate. The risk assessment in severely disabled geriatric patients is best performed with measures of functional and cognitive function considered jointly, but not separately.

Physical activity (PA) and the disablement process: A 14-year follow-up study of older non-disabled women and men

Kirsten Schultz-Larsen, Naghmeh Rahmanfard, Claus Holst — 2011-08-26

Abstract: Few studies have explored the associations of reported PA (RPA) with the processes underlying the development of disability. The present study was performed to explore RPA among older persons and its association with onset of functional dependence and mortality. Among a probability sample of 1782 community-living persons, aged 75–83 years, we evaluated the 1021 who reported no disability in basic activities of daily living. Participants were followed for a median of 8.34 years in public registers to determine onset of disability and mortality. RPA predicted mortality in older women (HR=1.77, 95%CI=1.42–2.19) and men (HR=1.65, 95%CI=1.27–2.14) over long time intervals. The effect of RPA persisted among permanently disabled older women, after adjusting for age, baseline vulnerability and grade of disability. Low RPA was independently associated with risk of incident disability (HR=1.56, 95%CI=1.10–2.23) in men. Among older women, the association between RPA and incidence of disability was attenuated in analyses that controlled for baseline mobility function. Thus, the association between physical activity and mortality reflected processes different from those underlying a simple relation between physical activity, disability and mortality. Physical activity was an ubiquitous predictor of longevity, but only for women.

Correlation between the Yale Physical Activity Survey (YPAS) and a submaximal performance-based test: A study in a population of elderly Spanish women

2011-07-15

Abstract: The aim of this study is to research the degree of correlation between the Spanish version of the questionnaire YPAS and the 6-minute walking test (6MWT) in women over 60. In addition, the authors analyzed the relationship between the variables age and body mass index (BMI) and the walked distance. The study was carried out with 44 elderly women (68.1±5.4 years) who filled in the questionnaire and immediately afterwards performed the 6MWT. Total time and energy expenditure (EE) values obtained in the questionnaire are significantly correlated with the 6MWT (p=0.02; p=0.01, respectively), while BMI and age showed an inverse association (r=−0.433; r=−0.318, respectively) with the walked distance. The Spanish version of YPAS is beginning to be considered as a valid and useful tool for habitual physical activity (PA) measurement and can be used among elderly Spanish speaking women.

Mobility assessment of hip fracture patients during a post-acute rehabilitation program

Avital Hershkovitz, Yichayaou Beloosesky, Shai Brill — 2011-08-26

Abstract: Our aim was to describe improvement in mobility level in hip fracture patients during a post-acute rehabilitation program and examine variables that may impede mobility improvement. A retrospective chart review of 138 patients with a proximal hip fracture, admitted consecutively during 2006 was conducted. Main outcome measurements were: 6-meter-walking-time (6mWT), rate of improvement (RI) in the 6mWT, gait velocity (GV), functional independence measure (FIM), motor FIM (mFIM) and length of stay (LOS). Most patients (118, 85.5%) showed improvement in the 6mWT (mean 16.05±20.2s, median 12.08). At discharge, 117 patients (84.7%) achieved GV within household ambulation (<0.4m/s). Patients with high initial GV needed shorter rehabilitation time compare to patients with low admission GV (27.5±12.1 days vs. 31.7±12.2 days; p=0.042). The high RI group (≥1s/day) achieved significantly higher admission and discharge FIM scores (70.7±15.9 vs. 64.1±16.9, p=0.023; 87.3±15.8 vs. 79.9±17.4, p=0.013, respectively) and higher admission and discharge mFIM scores (45.3±12.9 vs. 40.8.1±12.7, p=0.049; 60.7±12.4 vs. 56.2±13.4, p=0.045, respectively) compared with the low performance group (<1s/day). Logistic regression analyzed the variables with significant predictive value for achieving high RI (≥1s/day): performance of the 6mWT at FIM≥4 (OR 1.092; 95% CI, 1.056–1.129) and admission FIM score (OR 1.054; 95% CI, 1.023–1.085). Post-acute hip fracture patients capable of bearing weight on their injured leg, with minimal assistance [manual assistance of ≤25% (FIM≥4)] may considerably improve their mobility regardless of their disability, cognitive level or neurological history. Most patients achieved GV enabling them to ambulate short distances within the home.

Demographic characteristics and clinical benefits of outpatient geriatric evaluation and management service in Taiwan

Ming-Hsien Lin, Chien-Liang Liu, Li-Ning Peng, Yi-Tsun Chen, Liang-Kung Chen — 2011-05-18

Abstract: As Taiwan has become the fastest aging country in the world, developing elderly-friendly health care services is of great importance. Compared with traditional health-care service models, healthcare needs of older people may differ extensively. It has been reported that geriatric evaluation and management (GEM), helps to differentiate the atypical presentations of frail older patients, to discover hidden health-social problems, and to promote long-term clinical outcome. The main purpose of this study was to explore the demographic characteristics of older patients visiting outpatient GEM service and its impact to health-care utilization in a tertiary medical center in Taiwan. From January to October of 2008, 1054 patients visited the outpatient GEM service, and comprehensive geriatric assessment was performed for 140 patients (62.9% males with the mean age was 81.0±6.6 years), and 34.8% of them were college graduates. Overall, the prevalence of functional impairment was 11.4%, depressive symptoms 20.7%, cognitive impairment 32.1%, and abnormal timed up-and-go test 32.1%. During the 12-month follow-up, items of mean oral medications were significantly reduced (3.2±2.7 vs. 3.8±2.8, p<0.001) and the health-related quality of life was significantly improved (64.6±8.0 vs. 61.6±4.0, p<0.001). In conclusion, patients visiting outpatient GEM services in Taiwan are old and well-educated, and they possessed various functional impairments. The outpatient GEM services significantly reduced the items of oral medications and improved quality of life. The possible better compliance of this cohort due to high educational status may overestimate the clinical effectiveness of outpatient GEM services. Further investigations are needed to clarify the long-term benefits of outpatient GEM services.

Examination of balance ability evaluated by a stipulated tempo step test

Sohee Shin, Shinichi Demura — 2011-07-06

Abstract: This study is aimed at examining the correlation between age and gait time using a Single-leg forward step (SFS) test. Two groups consisting of sixty healthy elderly women (age 71.4±6.4 years) and twenty young women (age 20.2±0.9 years) performed the step test. The test subjects put one leg forward and returned it to its original position while matching varying metronome tempos (40bpm, 60bpm, and 120bpm) for 10s. As an evaluation parameter, the time difference between the metronome sound and the time when the subject's foot hits the ground was used. A significant time difference was found only in the group of elderly women. The time differences were greater in the 40bpm and 120bpm step tests than in the 60bpm step test. The time variances showed significantly low correlations with gait time (r=0.33–0.42). Since the SFS test purposefully produces balance instability via shifts in one's center of gravity through forward and backward movements, the elderly with inferior balancing ability as well as a diminished ability to walk might have difficulty succeeding in this test. In conclusion, the SFS test is deemed effective in evaluating elderly subjects’ balancing ability.

Urinary incontinence (UI) and new psychological distress among community dwelling older adults

Heather F. de Vries, Gina M. Northington, Hillary R. Bogner — 2011-05-25

Abstract: This study aimed at determining whether UI is associated with increased risk for the onset of psychological distress. This was a population based longitudinal survey of adults aged 50 and older who did not report psychological distress in 1993 and for whom complete data were available. Participants were classified as having UI if they reported uncontrolled urine loss within 12 months of the 1993 interview. Condition-specific functional loss secondary to UI was assessed by questions on participants’ ability to engage in certain activities due to UI. Psychological distress was assessed using the General Health Questionnaire (GHQ) in 2004. The continuing participants were living in East Baltimore, Maryland in 1981. Persons with UI in 1993 were more likely to experience new psychological distress in 2004 than were persons without UI in 1993 adjusting for potentially influential covariates (relative odds (RO)=2.18, 95% confidence interval (CI)=1.19–4.01). Persons with condition-specific functional loss secondary to UI were more likely to experience new psychological distress than were persons without UI adjusting for potentially influential covariates (RO=7.57, 95%CI=2.92–19.62). We conclude that UI, especially when associated with condition-specific functional loss, predicted the onset of psychological distress among community dwelling older adults.

Caregiver burden associated with behavioral and psychological symptoms of dementia (BPSD) in Taiwanese elderly

Si-Sheng Huang, Meng-Chih Lee, Yi-Cheng Liao, Wen-Fu Wang, Te-Jen Lai — 2011-05-25

Abstract: The purpose of this study was to investigate caregiver burden associated with BPSD in Taiwanese people. The study had a cross-sectional design. Eighty-eight patients with dementia and 88 caregivers who visited the memory clinic of a medical center from January 2007 to December 2007 were recruited. The BPSD were assessed using the neuropsychiatric inventory (NPI); caregiver burden was evaluated using the NPI caregiver distress scale (NPI-D). Demographic data on the patients and caregivers along with patients’ cognitive functions and clinical dementia ratings were collected. In addition to descriptive statistics, we analyzed the relationship between each parameter and caregiver burden using binary correlation. The results showed a statistically significant positive correlation between the total NPI-D score and the total NPI score (r=0.898, p<0.001). For individual BPSD, delusions had the highest mean NPI-D score, followed by agitation/aggression, anxiety, irritability/lability, and dysphoria/depression. The symptom frequency of anxiety, delusions, and agitation/aggression showed a statistically significant positive correlation with caregiver's NPI-D score. These findings suggest that improvement of treatments for delusions, agitation/aggression, anxiety, irritability/lability, and dysphoria/depression among dementia patients may reduce caregiver burden.

Outcomes of a behavioral unit in an acute aged care service

Peter N. Gonski, Insun Moon — 2011-07-15

Abstract: This study involves a retrospective review of the patients admitted to a unit providing specialized management to patients displaying difficult behaviors due to delirium and/or dementia. Medical records from 45 consecutive admissions have been reviewed. A great proportion of patients had dementia with superimposed delirium. Compared to care in general aged care wards, there was no reduction in length of stay (LOS) of patients in this study, ostensibly due to the delayed placement for long-term care. However there was a marked reduction in fall incidence and lesser use of ‘specials’. Psychotropic medications (PMs) were frequently used but their indications were carefully reviewed. Upon discharge there was improvement in the behavioral profile of the patients. Questionnaires completed by carers and staff were used to further assess the efficacy of the unit. There was general satisfaction of the care provided in the unit whist a few areas have been identified that require further attention. This model of intervention presents an improvement to the quality of care for acutely ill elderly patients with behavioral problems.

Association of resident and room characteristics with antipsychotic use in long-term care facilities (LTCF)

2011-08-08

Abstract: Inappropriate and widespread prescribing of antipsychotics in LTCF is of concern. This study aimed to explore the association of resident and room characteristics with antipsychotic use in this setting. This is cross-sectional secondary analysis of the baseline data of 280 residents ≥65 years old, from a prospective, observational, LTCF multi-site (n=7) cohort study on delirium. Demographic data included age, sex and length of stay. Resident characteristics assessed were presence of dementia, disruptive behavior, delirium and use of restraints. Room characteristics assessed were single room, clock/calendar, and telephone. Separate logistic regression models were used to explore the association of resident and room characteristics with antipsychotic use, adjusting for demographic variables. Mean age was 84.9±7.0 years (±S.D.) with 56% female. The mean prevalence of antipsychotics use was 31.1% (range: 25.6–50.0%). The regression model of resident characteristics revealed a significant association between disruptive behavior (OR=1.18, 95% CI=1.12–1.25) and antipsychotic use. The model of room characteristics revealed a significant association between absence of a clock or calendar (OR=1.93, 95% CI=1.04–3.56) and absence of a telephone (OR=2.79, 95% CI=1.48–5.25). Our results suggest that behavior problems are associated with a higher likelihood of antipsychotic use. Absence of a clock/calendar and of a telephone was related to antipsychotic use. Further research is needed to confirm these findings.

Relationship between changes of body mass index (BMI) and cognitive decline in Parkinson's disease (PD)

2011-07-15

Abstract: Decreased BMI has been reported that it may be associated with cognitive decline in the elderly. Weight loss is common in patients with PD. However, studies comparing cognitive changes according to BMI changes in PD have not been done yet. We performed this study to know a relationship between BMI changes and the rate of cognitive decline in PD. PD patients were recruited retrospectively. The patients (n=104) were divided into two groups according to BMI changes during initial 6 months of follow-up: decreased (n=52) vs. stable BMI groups (n=52). Cognitive functions were repeated until 36 months of follow-up using the Korean version of the Mini-Mental State Examination (K-MMSE) and the modified Mini-Mental State (3MS) test. We calculated the rate of cognitive decline (K-MMSE and 3MS score changes/month) and compared it between the two groups. The decreased BMI group showed lower level of cognitive function than that of stable BMI group, especially at the 36th month of follow-up (p<0.05). In addition, the rate of cognitive decline was also significantly faster in the decreased BMI group, particularly at the 36th month of follow-up (p<0.05). This study suggests that decreased BMI during initial 6 months of follow-up in PD might be a useful indicator for future risk of dementia and let clinicians predict faster rate of cognitive decline in patients with PD.

Prevalence and characteristics of restless legs syndrome (RLS) in the elderly and the relation of serum ferritin levels with disease severity: Hospital-based study from Istanbul, Turkey

2011-07-04

Abstract: The RLS is an underdiagnosed condition, characterized by unpleasant sensations in the legs. Pathophysiological mechanisms may include iron deficiency as reflected by low serum ferritin levels and dopaminergic system dysfunction. The purpose of our study was to investigate the prevalence and characteristics of RLS in the elderly and the relation of serum ferritin levels with disease severity. Ambulatory 1012 (621 women, 391 men, mean age: 73.51±7.12 years) consecutive patients above 65 years who admitted to our clinic for any reason were evaluated according to the International RLS Study Group (IRLSSG) criteria: 103 patients (74 women, 29 men, mean age: 72.43±6.31) (10.18%) had RLS diagnosis. Only 9 of them had known RLS. The duration of symptoms was 4.80±4.65 years and 27 patients (26.2%) had positive family history. The average of serum ferritin levels was 39.13±23.74ng/ml and 71 patients (68.9%) had serum ferritin levels ≤50ng/ml. The disease severity was evaluated with IRLSSG rating scale. Patients were classified as severe–very severe group (n=49) and mild–moderate group (n=54). The ferritin levels of severe–very severe disease group were lower than those of mild–moderate disease group (26.01±15.82ng/ml versus 49.87±23.24ng/ml, p<0.001). Our data show that RLS is very common in the elderly and the disease is more severe in patients with lower ferritin levels.

In addition to malnutrition and renal function impairment, anemia is associated with hyponatremia in the elderly

2011-07-15

Abstract: Hyponatremia is the most common electrolyte abnormality among the elderly living in long-term care facilities. In this study, we investigate the associated factors of hyponatremia, and its association with anemia in the institutionalized elderly in Taiwan. A total of 414 participants aged 65 years and above were recruited from eight long-term care facilities in 2002–2003. Baseline characteristics, medical records, and biomarkers were obtained. Hyponatremia was defined as a serum Na-concentration<135mmol/l. Relationships between hyponatremia and the demographic and laboratory characteristics were tested using multiple logistic and linear regression analyses. The prevalence of hyponatremia and anemia was 14.7% and 56.0%, respectively. Anemia, hypouricemia, and the placement of tubes (including nasogastric tube, tracheostomy tube, and Foley catheter) were significantly associated with hyponatremia after adjustment for potential confounders using multiple logistic regression analysis. The adjusted odds ratios (OR) and 95% confidence interval (95%CI) for these three factors were 3.28 (1.40–7.69), 4.98 (2.18–11.36), 9.15 (3.33–25.12), respectively. Multiple linear regression analyses also showed that serum Na concentration was significantly associated with hemoglobin, uric acid, and number of tubes. In conclusion, it was found that anemia, the placement of tubes, and hypouricemia were associated with hyponatremia in the institutionalized elderly. In those with the above conditions, serum Na concentration should be monitored.

Hypothyroidism in the elderly: Diagnostic pitfalls illustrated by a case report

Monica Maselli, Eminè Meral Inelmen, Valter Giantin, Enzo Manzato — 2011-06-03

Abstract: A diagnosis of hypothyroidism in the elderly can easily be overlooked if we rely exclusively on its clinical presentation because this may be highly non-specific, since the signs and symptoms of the disease are common to other diseases typical of old age, and even to the normal aging process. Imaging diagnostics (ultrasound or CT), when considered alone, are also of little use for the purpose of clarifying thyroid gland function. We report here on a case of primary hypothyroidism that was diagnosed late because the correlated signs and symptoms (asthenia, bradycardia, pleural effusions, hyponatremia, worsening renal and respiratory insufficiency, hoarseness) had previously been attributed to the normal aging process and to the patient's other health conditions (Parkinson's disease, PD; chronic obstructive pulmonary disease, COPD). After a couple of weeks of treatment with levothyroxine and liothyronine, there were clinical and laboratory evidences of an improvement in the patient's condition. She became more reactive, with a shriller voice. The pleural effusion disappeared, and so did the bradycardia. Laboratory tests showed normal sodium levels, and the renal insufficiency had improved. The lack of specificity of the clinical presentation of hypothyroidism in the elderly might justify the routine measurement of thyroid-stimulating hormone in these patients.

Association between smoking and outcomes in older adults with atrial fibrillation

2011-07-07

Abstract: Tobacco smoking is a risk factor for atrial fibrillation (AF), but little is known about the impact of smoking in patients with AF. Of the 4060 patients with recurrent AF in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) trial, 496 (12%) reported having smoked during the past two years. Propensity scores for smoking were estimated for each of the 4060 patients using a multivariable logistic regression model and were used to assemble a matched cohort of 487 pairs of smokers and nonsmokers, who were balanced on 46 baseline characteristics. Cox and logistic regression models were used to estimate the associations of smoking with all-cause mortality and all-cause hospitalization, respectively, during over 5 years of follow-up. Matched participants had a mean age of 70±9 years (± S.D.), 39% were women, and 11% were non-white. All-cause mortality occurred in 21% and 16% of matched smokers and nonsmokers, respectively (when smokers were compared with nonsmokers, hazard ratio=HR=1.35; 95% confidence interval=95%CI=1.01–1.81; p=0.046). Unadjusted, multivariable-adjusted and propensity-adjusted HR (95% CI) for all-cause mortality associated with smoking in the pre-match cohort were: 1.40 (1.13–1.72; p=0.002), 1.45 (1.16–1.81; p=0.001), and 1.39 (1.12–1.74; p=0.003), respectively. Smoking had no association with all-cause hospitalization (when smokers were compared with nonsmokers, odds ratio=OR=1.21; 95%CI=0.94–1.57, p=0.146). Among patients with AF, a recent history of smoking was associated with an increased risk of all-cause mortality, but had no association with all-cause hospitalization.

Role of permanent atrial fibrillation (AF) on long-term mortality in community-dwelling elderly people with and without chronic heart failure (CHF)

2011-07-04

Highlights: ► Atrial fibrillation predicts long-term mortality in elderly subjects. ► Elderly subjects with atrial fibrillation are characterized by the “frailty” sindrome. ► Atrial fibrillation predicts long-term mortality in elderly subjects without but not in those with chronic heart failure.Abstract: Permanent AF is characterized by an increased mortality in elderly subjects with CHF. Moreover, AF increased the risk of mortality also in elderly subjects without CHF. Thus, we examined long-term mortality in community-dwelling elderly people with and without CHF. A total of 1332 subjects aged 65 and older were selected from the electoral rolls of Campania, a region of southern Italy. The relationship between AF and mortality during a 12-year follow-up in 125 subjects with CHF and in 1.143 subjects without CHF were studied. Elderly subjects showed a higher mortality in those with respect to those without AF (72.1% vs. 51.8%; p<0.01). Similarly, elderly subjects without CHF showed a higher mortality in those with respect to those without AF (61.8% vs. 49.8%; p<0.05). In contrast, elderly subjects with CHF showed a similar mortality in those with respect to those without AF (74.7% vs. 82.4%; p=0.234). Multivariate analysis shows that AF was predictive of mortality in all elderly subjects (Hazard Risk=HR=1.39, 95% confidence interval (CI)=1.25–2.82; p<0.001). When the analysis was conducted considering the presence and the absence of CHF, AF was strongly predictive of mortality in elderly subjects without CHF (HR=1.95, 95%CI=1.25–4.51; p<0.001) but not in those with CHF (HR=1.12, 95%CI=0.97–3.69; p=0.321). We concluded that AF is able to predict long-term mortality in elderly subjects. Moreover, AF is strongly predictive of long-term mortality in the absence but not in the presence of CHF.

Receiver-operated characteristics (ROCs) of the relationships between obesity indices and multiple risk factors (MRFs) for atherosclerosis at different ages in men and women

Ichiro Wakabayashi, Takashi Daimon — 2011-08-26

Abstract: The aim of this study was to clarify whether age affects ROC curves for the relationships between obesity indices and MRFs for atherosclerosis. Subjects were 35–70-year-old men (n=37,697) and women (n=19,891) who received health checkup examinations. ROC curves were analyzed for relationships of body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WHtR) with MRFs for atherosclerosis consisting of two or more risk factors (RFs) of metabolic syndrome (MetS) including high blood pressure, dyslipidemia (hypertriglyceridemia and/or hypo-HDL-cholesterolemia) and hyperglycemia. Both in men and women, AUC (area under the curve) of the ROC curves tended to be smaller as age increased. In women, cut-off values of WHtR tended to be higher as age increased, while no apparent relationships were found between age and cut-off values of BMI and WC in women and between age and cut-off values of the three obesity indices in men. The results suggest that both in men and women, the associations between obesity and MRFs for atherosclerosis become weaker as age increases, while age does not influence cut-off values of obesity indices except for higher WHtR at an older age in women.

Assessment of the use of hypolipidemic agents (HAs), mainly statins, in elderly subjects aged 80 years and more in Burgundy: Analysis of 13,211 patients

2011-08-26

Abstract: Only few studies have investigated the use of HA in elderly subjects and there are no data in very elderly subjects. We assessed the prescription of HA and analyzed the relationship between such prescriptions and frailty markers among persons aged 80 and more in an observational study. We recorded the prescriptions for 13,211 patients aged 80–109 years and affiliated to the “Mutualité-Sociale-Agricole (MSA)” of Burgundy over a 1-month period. The prescription of a HA among all included patients, and the existence of serious long-term disease(s) (LTD), polypharmacy or a prescription of cardiovascular drugs among patients receiving a HA were recorder. Among the 13,211 patients, 3412 aged 80–98 years were treated with an HA. The main HA were statins (70.4%), and fibrates were used in 27.3% of cases. Of these 3412 patients, 2250 had one or several LTD mainly coronaropathy, hypertension, diabetes mellitus or peripheral artery disease. The mean number of drugs per prescription was 6.37. Among subjects treated with HA, 40% also received antiplatelets, 35.6% β-blockers and 30% inhibitors of the renin–angiotensin system. For 99% of the patients, the prescription of HA was a renewal. Prescribers were mainly general practitioners (96.8%). Statins are the most widely prescribed HA even among very elderly subjects. However, after 80 years the prescription of HA, mainly statins, decreases with aging. This could be explained by polypathology, polypharmacy and the deterioration in metabolic functions which are markers of frailty. This study should encourage research into the use of statins in very elderly subjects.

Relationship between dietary mineral intake and blood pressure (BP) in the elderly in Turkey

2011-07-15

Abstract: The aim of this study was to determine the relationship between daily dietary mineral (Na, K, Ca and Mg) intake and BP in the elderly. This study was conducted on 390 elderly volunteers (≥65 years). Subjects were randomly selected from the general population of Ankara, Turkey. Anthropometric measurements, lipid profiles, and mean systolic and diastolic BP (SBP and DBP) of all the participants were measured. To determine the mineral intake of the participants, food consumption was measured with a 24-h dietary recall. The 49.3% of participants were found to be hypertensive, 25.1% to be pre-hypertensive and 25.6% were normotensive according to the JNC-7 Guidelines, except for daily Mg and Na intake, the energy, macronutrient and micronutrient intake of groups were not significantly different (p>0.05). A significant inverse correlation between daily Ca intake and SBP was found in the pre-hypertensive group when age and gender adjusted regression analyses were performed (B=−0.006, p<0.05). Na intake and Na/K ratio were directly associated with SBP in the hypertensive group. In conclusion, SBP was found to be most related to dietary Na and Ca intake, and Na-to-K ratio in the elderly population.

Age-specific incidence ratios of breast cancer (BC) in Turkey: BC in older people is increasing

Faruk Tas, Serkan Keskin — 2011-07-15

Abstract: Life expectancy has greatly increased in the last century. In the last decades, cancer in the older people has become an increasingly common problem owing to the prolonged life-expectancy of the general population and to the improved management of common cancers. The aim of this study was to demonstrate the age-specific incidence ratios in patients with BC. Data were collected from hospital-based registries from 1988 to 2007. A total of 10,149 patients were assessed. The median age at diagnosis was 50 years. When compared to Surveillance Epidemiology and End Results (SEER) data, these values were found to be 11 years younger than American patients. Trends consist of the median ages of patients were increased during years (p<0.001). Along the years, especially in the last years, the ratios of cancer patients of older than 70 years were significantly increased among the BC patient populations. In conclusion, BC in older person has become an increasingly common problem in the last years.

Stereological analysis of age-related changes of testicular peritubular cells in men

Yan Xia, Wei-Jie Zhu, Shu-Fang Hao, Wei-Bo Liang, Jing Li — 2011-06-02

Abstract: This work aimed to analyze quantitative changes of peritubular cells in testes of aged men. Testicular tissues were obtained from 42 aged men with advanced prostate cancer and 16 young men with biopsy, quantitatively investigated with stereological techniques with quadrate mask grid, measured the parameters volume density (VV), numerical density on area (NA), and numerical density (NV) with grid test points. No significant differences were found in cell ratio, peritubular cell number per tubule, diameter of seminiferous tubules between young and old men (p>0.05). Aged men had higher pathologic assignment score than that of young men, which demonstrated more severe pathologic changes (p<0.05). Peritubular cell VV and pachytene germ cell VV increased significantly in old men compared to young men (p<0.05). Sertoli cell (SC) number per tubule in two-dimensional was significantly less in aged men than that of young men, p<0.01. Peritubular cell NA, NV decreased significantly in aged men compared to young one, p<0.05. It is concluded that the stereological data of peritubular cells from three-dimensional level in testes of aged men suggest a significant decrease when compared with young men, indicating age-related changes.

The reliability and validity of the daily activities dependence on vision (DADV) scale to evaluate vision related functional limitations

2011-07-04

Highlights: ► The DADV scale could be a useful tool for the assessment of visual function and for the early detection of difficulties in performing activities dependent on vision. ► Although the DADV scale is a short questionnaire it showed high correlation with the VF-14 and moderate correlation with visual acuity. ► The results indicate that the DADV scale has acceptable reliability and is valid to efficiently evaluate visual function.Abstract: The purpose was to determine the reliability and validity of the DADV scale to evaluate vision-related functional limitations in persons over 65 years. Cross sectional study was performed to determine the reliability and validity of a questionnaire (9 items). A total of 1387 subjects were selected by random sampling. An analysis of the intra/inter-observer reliability was performed and the convergent validity with the Visual Function Index, 14 items (VF-14) was determined. The number of patients who had some difficulty in performing any of the activities was 223 (19.2%; 95%CI=16.9–21.5). The intraclass correlation coefficient (ICC) of the intra/inter-observer reliability analysis was 0.883 and 0.900, respectively. Factorial analysis demonstrated that one single factor explained 63.2% of the total variance (visual function). The scale showed a high degree of convergent validity (ICC=0.857) with the VF-14. Visual acuity showed a moderate correlation with the DADV score (r=0.366). The Rasch analysis showed a satisfactory model fit for the items. Although the DADV scale is a short questionnaire it showed high correlation with the VF-14 and moderate correlation with visual acuity. The results indicate that the scale has acceptable reliability and is valid to efficiently evaluate visual function.

Analyzing key performance indicators (KPIs) for E-commerce and Internet marketing of elderly products: A review

Yuan-Cheng Tsai, Yu-Tien Cheng — 2011-07-04

Abstract: With the transformation of its population structure and economic environment, Taiwan is rapidly becoming an aging society. There is a growing need for elderly products, and therefore the operation of web shops that sell elderly products is important. In an era which values performance management, searching for key performance indicators (KPIs) helps to reveal, if the goals of a web shop are achieved. In the current study, researchers adopted the constructs of the Balanced Scorecard (BSC) to evaluate web shop performance. Additionally, the Delphi method, along with questionnaires, was used to develop 29 indicators. Finally, the decision making trial and evaluation laboratory (DEMATEL) method assisted in identifying the level of importance of the constructs, in which “internal process” ranked top, followed by “learning and growth”, “customer”, and “financial”. “Internal process” was the key construct that impacted other factors, while “customer” was an important construct affected by other factors. By understanding the influences and relationships among the constructs, enterprises can conduct additional monitoring and management to achieve functions of prevention, continuous improvement, and innovation in order to shape their core competence.

Positive life orientation predicts good survival prognosis in old age

2011-07-18

Abstract: The purpose of this study is to investigate the value of life orientation as a screening tool and survival indicator in old age. A postal questionnaire answered by 2490 random older people (>75 years) included six questions concerning satisfaction with life, feeling needed, plans for future, zest for life, lack of feelings of depression and loneliness. The vital status was followed for 57 months. All-cause mortality rate was 19.1% and 30.3% among elderly with (22%) and without (78%) positive life orientation, respectively (p<0.001). The difference in mortality increased over time. After controlling for age, gender, and subjective health, the protective value of positive life orientation remained significant (hazard ratio, HR=0.78, 95%CI=0.63–0.98, p<0.03). Feeling needed was the strongest independent predictor (HR=0.72, p<0.001). A six-question life orientation identifies old people at risk. Positive life orientation predicts good survival prognosis independently of subjective health.

Terminal lucidity: A review and a case collection

Michael Nahm, Bruce Greyson, Emily Williams Kelly, Erlendur Haraldsson — 2011-07-18

Abstract: The unexpected return of mental clarity and memory shortly before death in patients suffering from severe psychiatric and neurologic disorders, which we have called “terminal lucidity”, has been reported in the medical literature over the past 250 years, but has received little attention. We review a range of terminal lucidity cases in order to encourage investigation of the mechanisms involved and possible insights into both the neuroscience of memory and cognition at the end of life and treatment of terminal illness. These examples include case reports of patients suffering from brain abscesses, tumors, strokes, meningitis, dementia or Alzheimer's disease, schizophrenia, and affective disorders. Several of these accounts suggest that during terminal lucidity, memory and cognitive abilities may function by neurologic processes different from those of the normal brain. We expect that significant contributions to better understanding the processes involved in memory and cognition processing might be gained through in-depth studies of terminal lucidity. Studying terminal lucidity might also facilitate the development of novel therapies. In addition, increased awareness of unusual end-of-life experiences could help physicians, caregivers, and bereaved family members be prepared for encountering such experiences, and help those individuals cope with them.

Massive right atrial myxoma: An unusual presentation in an elderly patient

2011-10-03

Abstract: Primary heart tumors are rare with an estimated incidence ranging 0.0017–0.19%. Myxoma is the most prevalent primary heart tumor. The right atrium is an unusual location, occurring only in the 15–20% of myxoma cases. We describe the case of a massive right atrial myxoma causing right ventricular inflow and tricuspid valve obstruction. The tumor was detected by echocardiography and confirmed by abdomen-thoracic tomography. It was resected along with a section of tricuspid septal leaflet, followed by primary repair. In 2-year follow-up the patient is asymptomatic.

Clinical presentation of urinary tract infection (UTI) differs with aging in women

Zeev Arinzon, Shay Shabat, Alexander Peisakh, Yitshal Berner — 2011-10-03

Abstract: Uncomplicated UTI is among the most common health problems seen in general practice and typically affects immunocompetent, anatomically normal women. The aim of this study was to explore the difference in clinical presentation in acute, uncomplicated UTI in otherwise healthy community dwelling, premenopausal (Pre-M) and postmenopausal (Post-M) women. A UTI was defined as uropathogen of more than 103cfu/ml in midstream urine culture. Symptoms of UTI were divided to three: during voiding, local symptoms, and generalized symptoms. A total of 196 women aged a minimum of 45 years with diagnosis of UTI were studied. The patients were divided into two groups: Pre-M (n=102, mean age 48.14 years) and Post-M (n=94, mean age 69.21 years). The predominant complaints in Pre-M women were local symptoms. The clinical presentations showed more severity in the Post-M group than in Pre-M women, predominantly generalized unspecific symptoms and storage symptoms. Advanced age positively correlated with urgency of urination, painful voiding, urinary incontinence, sexual activity, low-back pain, lower abdominal pain and negatively correlated with frequency, painful and burning of urination and bladder pain. Our study showed that clinical presentation of UTI in Pre-M and Post-M women is different. The differences are presented not only by the voiding itself and by local symptoms but also by unspecified generalized symptoms that is especially important in elderly patients.

Potentially inappropriate prescribing (IP) for elderly medical inpatients in Taiwan: A hospital-based study

2011-08-08

Abstract: Older people tend to have multiple comorbid conditions and subsequent polypharmacy, which place them at higher risk of adverse drug events, drug–drug and drug–disease interactions and IP. IP includes several patterns, such as inappropriate dose or duration, prescribing drugs having significant drug–disease or drug–drug interactions, and the omission of potentially beneficial medications. The main purpose was to evaluate the prevalence of IP among medical inpatients in a medical center, so to evaluate the associative factors of IP in Taiwan. From January to December of 2009, all patients aged 65 years and older who were discharged from the medical wards of Taipei Veterans General Hospital were randomly sampled for study (the sampling rate around 1.0%). The IP was evaluated by the STOPP and START criteria. Each medical record was carefully reviewed by physicians who had been trained. Overall, 520 records of elderly medical ward inpatients (mean age=79.2±6.7 years, 73.8% males) were included for study. In total, 3455 items of medication were prescribed for these 520 patients (mean=6.6±3.2 items). According to STOPP criteria, 36.2% of the study subjects had at least one potentially inappropriate medication (PIM). The most common PIMs were: (1) medications that may adversely affect those who are prone to falls, e.g., benzodiazepines, neuroleptics and first generation antihistamines (14.2%). (2) Ca-channel blockers with chronic constipation (12.3%). (3) Use of neuroleptic agents (5.6%). (4) Long-term, long-acting benzodiazepines (2.5%). (5) Prolonged use of first generation antihistamines (2.1%). Besides, 218 patients (41.9%) had at least one potentially prescribing omission (PPO). Common PPOs included: (1) statin therapy in diabetes mellitus if coexisting major cardiovascular risk factors present (19.0%). (2) Antiplatelet therapy in diabetes mellitus with co-existing major cardiovascular risk factors (12.5%). (3) Metformin with type 2 diabetes with or without metabolic syndrome (in the absence of renal impairment) (8.7%). (4) Angiotensin converting enzyme inhibitor or angiotensin II receptor blockers with chronic heart failure (7.3%). (5) Aspirin or clopidogrel with a documented history of atherosclerotic coronary, cerebral or peripheral vascular disease in patients with sinus rhythm (7.1%). Logistic regression showed that older age and number of medications were significant risk factors for PIMs. In conclusion, the prevalence of PIMs among elderly medical inpatients in a medical center in Taiwan was 36.2% and PPOs was 41.9%. Further study is needed to clarify the underlying causes of potentially IP to promote better quality of prescribing for older patients.

Treatment of community-onset methicillin-resistant Staphylococcus aureus (MRSA) bacteremia: A hospital-based study

2011-08-05

Abstract: S. aureus bacteremia (SAB) is a severe systemic illness, which is associated with high mortality and healthcare cost. It has been reported that older age per se is a poor prognostic factor of SAB, but little is known whether poor clinical outcomes is related to conservative attitudes of treating physicians. A retrospective cohort of 126 patients (mean age: 73.7±13.6years, 72.2% males) with community-onset SAB during 2004–2008 in a tertiary medical center in Taiwan was obtained for study. Demographic data, clinical characteristics, primary infectious focus, metastatic lesions, access to critical care units, performance of invasive procedures, Charlson comorbidity index (CCI) and in-hospital mortality for all study subjects were collected. The overall in-hospital mortality was 32.5%, which was not significantly different between adult and elderly groups. SAB of elderly patients was more likely to be primary than that of the adult patients (20.4% vs. 3.6%, p=0.043). Deep-seated abscess, osteomyelitis and metastatic lesion with central nervous system (CNS) involvement were more common infection foci in the adult patient group. Chronic obstructive pulmonary disease and cerebrovascular accident were more common underlying conditions of the elderly group. Chances of patients admitted to intensive care unit and employment of invasive procedures were not different between groups although elderly patients were supposed to be of a greater risk of mortality. In conclusion, the overall in-hospital mortality of community-onset SAB was 32.5%, which was not different between age groups. In general, older patients were of similar chance to receive critical care and invasive procedures except arterial line and non-tunneled central venous catheters. Further prospective investigation is needed to clarify whether physicians hold different attitudes to older patients with SAB and the differences in treatment attitude resulting in poorer clinical outcomes.

Discovering medical resource utilization in total knee arthroplasty (TKA) using rule-based method

Min-Hsiung Wei, Ching-Hsue Cheng, Jhao-Yu Li — 2011-08-03

Abstract: TKA is a highly effective means of treating (advanced knee arthritis) degenerative joint disease. Previous studies have demonstrated that a high surgical volume for total joint arthroplasty reduces morbidity and improved economic outcome, these methods for themselves are fraught with complexity, uncertainty and non-linear problem in terms of medical datasets may be unable to more accurately finding important information. As medical datasets often include a large number of features (attributes), some of which are irrelevant, and therefore it cannot intuitively understand the corresponding to main factors which affecting the resource utilizations of healthcare. In order to solve the problems mentioned above, this study employs specialist advice to filter relevant cases (records) and proposed an integrated five features selection methods to select the important features. Based on rough set theory (RST), the rules are extracted and compared with other methods in terms of accuracy. The contributions contain: (1) data screening based on specialist opinions, (2) two stage feature selection by analysis of variance (ANOVA) and proposed an integrated feature selection approach (IFSA), and (3) data discretization and rule generation by RST. The proposed model is verified by using three datasets for comparison accuracy. The results can provide a valuable reference for National Health Insurance Bureau (NHI) in establishing the TKA standard.

Interrater reliability of the interRAI Acute Care (interRAI AC)

2011-08-22

Abstract: We examined the interrater reliability of the interRAI AC. An observational study was conducted on 3 geriatric wards. Two trained raters completed independently the interRAI AC between 24 and 48h after admission. A sample of 100 patients (age 84.5±5.6 years; 45% female) was analyzed. Interrater reliability was tested using observed agreement, kappa coefficients, and intraclass correlation coefficients. The overall kappa median value for nominal items was 0.82 (almost perfect). For items on ordinal level, both the overall weighted kappa median and the intraclass correlation coefficient median were 0.86 (almost perfect). According to conventional cut-offs for interpreting kappa statistics, reliability was almost perfect (K≥0.81) for 60% of all items, substantial (0.60

Admission Norton scale scores (ANSS) and postoperative complications following hip fracture surgery in the elderly

Aviram Gold, Ronen Sever, Yaffa Lerman, Moshe Salai, Dan Justo — 2011-08-26

Abstract: We sought to determine if low ANSS, usually associated with high pressure ulcer risk, are also associated with postoperative complications and in-hospital mortality following hip fracture surgery in the elderly. This was a retrospective cross-sectional study conducted in a tertiary medical center. The medical charts of consecutive elderly (≥65 years) patients admitted for hip fracture surgery were studied for the following measurements: ANSS, demographic data, co-morbidities, postoperative complications, the need for revision procedures, and in-hospital mortality. Except for pressure ulcers, postoperative complications included: acute coronary syndrome, acute renal failure, confusion, pneumonia, urinary tract infection, venous thromboembolism, and wound infection. The final cohort included 269 patients: 198 (73.6%) females and 71 (26.4%) males. Mean age for the entire cohort was 82.8±0.4 years. Most patients underwent an internal fixation (n=146; 54.3%) or hemiarthroplasty (n=92; 34.2%). Overall, 110 (40.9%) patients had low (<15) ANSS. Patients with low ANSS had significantly more postoperative complications relative to patients with high ANSS (0.77±0.09 vs. 0.23±0.04; p<0.0001). Among all postoperative complications, urinary tract infection was independently associated with low ANSS (p<0.0001). ANSS were independently associated with postoperative complications (p<0.0001), the need for revision procedures (p=0.019), and in-hospital mortality (p=0.016). We conclude that the Norton scoring system may be used for predicting postoperative complications and in-hospital mortality following hip fracture surgery in the elderly.

Admission Norton scale scores (ANSS) are associated with post-operative complications following spine fracture surgery in the elderly

2011-09-07

Abstract: We sought to determine if low ANSS, usually associated with high pressure ulcer risk, are also associated with post-operative complications following spine fracture surgery in the elderly. This was a retrospective cross-sectional study conducted at the division of orthopedic surgery in a tertiary medical center between January 2008 and October 2010. The medical charts of consecutive elderly (≥65 years) patients admitted for spine fracture surgery were studied for the following measurements: ANSS, demographic data, co-morbidities, and post-operative complications. Except for pressure ulcers, post-operative complications included: acute coronary syndrome, acute renal failure, confusion, pneumonia, urinary tract infection, venous thromboembolism, and wound infection. The final cohort included 90 patients: 66 (73.3%) females and 24 (26.7%) males. Mean age for the entire cohort was 78.9±0.7 years. Most patients had lumbar fractures (n=49; 54.4%) or thoracal fractures (n=26; 28.9%). Most patients underwent kyphoplasty (n=65; 72.2%). Mean ANSS was 15.9±0.3, and 29 (32.2%) patients had low (<15) ANSS. Patients with low ANSS had significantly more post-operative complications relative to patients with high ANSS (1.0±0.2 vs. 0.2±0.1; p<0.0001). Among all post-operative complications, urinary tract infection was independently associated with ANSS (p<0.0001). Binary regression analysis showed that ANSS were independently associated with post-operative complications (p=0.001). We conclude that low ANSS are associated with post-operative complications and urinary tract infection in particular, following spine fracture surgery in the elderly. Hence, the Norton scoring system may be used for predicting and preventing post-operative complications in this population.

The relationship of pre-sarcopenia (low muscle mass) and sarcopenia (loss of muscle strength) with functional decline in individuals with intellectual disability (ID)

Eli Carmeli, Bita Imam, Joav Merrick — 2011-07-18

Abstract: The aim was to determine the association between loss of muscle mass, loss of muscle strength, and physical ability in individuals with ID. Upper and lower extremity strength, muscle mass and muscle quality (MQ) were calculated. Physical ability was measured according to the Katz activities of daily living (ADL), stair climb test, and sit-to-stand test. We found a strong correlation between quadriceps strength and physical ability in ADL (r=0.92 for males, and r=0.88 for females), and a low-moderate correlation between hand grip strength and physical ability in ADL (r=0.40 for males, and r=0.46 for females). MQ showed a strong relationship between pre-sarcopenia and sarcopenia. Quadriceps strength is a promising measure of age-related muscle changes and it is strongly associated with physical and functional decline.

Severity of injuries associated with falls in the community dwelling elderly are not affected by fall characteristics and physical function level

Shinichi Demura, Takayoshi Yamada, Kosho Kasuga — 2011-07-28

Abstract: Many elderly people experience difficulty with independent living after injuries associated with falls. This study aimed to examine the influence of fall characteristics and physical function level on the severity of fall related injuries. The surveys were conducted in 1955 community dwelling elderly. The questions regarded the following: fall experience within the past year, fall direction, fall cause, injured parts and degree of injury, and an activity of daily living (ADL) questionnaire from the Ministry of Education, Culture, Sports, Science and Technology Japan. Data of 1850 subjects with available and complete responses were used for analysis. Three hundred and eighty-six (20.9%) elderly people experienced a fall within the past year and 257 (66.7%) were injured. ADL score was significantly higher in the elderly without fall experience than the elderly with fall experience. No significant difference was found in frequency of fall cause and fall direction between the elderly with and without injuries caused by falling. Significant correlations were found between fall direction and fall cause and injured parts (φ=0.49 and 0.32). ADL score of the elderly who fell by leg backlash was significantly lower than that of the elderly who fell by tripping, slipping and staggering. A decrease of ADL affects the rate of falls in the elderly, but not the degree of injury. Fall characteristics may not be related to the extent of fall injury.

Health and nursing problems of elderly patients related to bio-psycho-social need deficiencies and functional assessment

2011-08-22

Abstract: Elderly population is characterized by larger need for social welfare and medical treatment than other age groups. Along with aging, there is a number of emerging health, nursing, caring, psychological and social problems. Complexity of these problems results from overlapping and advancing involutional changes, multi-illness, decreased functional efficiency and other factors. The aim of the study was the assessment of health problems in geriatric patients as well as bio-psycho-social need deficiencies in a view of selected parameters of functional efficiency. The research group consisted of the Chair and Clinic of Geriatrics, 186 women and 114 men, 300 persons in total. The research was carried out using a diagnostic poll method with the application of the Activities of Daily Living (ADL) questionnaire of assessment of daily efficiency on the basis of the Katz Scale; the Care Dependency Scale (CDS) questionnaire used to measure the level of the care dependency and human needs, Norton's bed sores risk assessment scale, the Nursing Care Category (NCC) questionnaire applied to assess the need for nursing care. In most patients the results unveiled manifestations of three or more illnesses. Functional efficiency was at low and average level. Half of the subjects were endangered by risk of bed sores as well as showed high need fulfillment deficiency. The highest level of the deficiency was observed in patients in the eldest age group as well as suffering from multi-illness. Material status, education, place of residence or gender showed no significant influence on the level of need fulfillment.

The analysis of aging and elderly age quality in empirical research: Data based on University of the Third Age (U3A) students

Halina Zielińska-Więczkowska, Marta Muszalik, Kornelia Kędziora-Kornatowska — 2011-10-03

Abstract: The aim of the study was to evaluate aging and elderly age quality in elderly individuals and persons entering the elderly age participating U3A continuous education courses. The research included 255 students of the U3A located in Bydgoszcz, Poland. The research included 235 women and 20 men of mean age 64.43 years. The dominant group was persons with secondary education (65.9%), and higher education (28.2%) as well as married (54.5%). All of the subjects included in the study were fully mobile. The study was conducted based on authors’ original questionnaire which consisted of 24 questions and a basic personal data form surveying age, gender, marital status, level of education as well as self-reported illnesses and health problems. The research assumed the majority of positive responses as the sign of happy aging and experiencing one's own old age. Positive correlation was observed between the statement that human beings influence quality and shape of their lives, and therefore they are responsible for their own life. The higher the level of fulfilling aims in life the more frequently elderly age was perceived as a happy period. In the research data there was a relationship observed between levels of education and discrimination, i.e., the higher level of education the fewer cases of discrimination experienced: χ2=12.992 (df=2; p<0.01). Moreover, a very weak correlation was observed between marital status and a sense or absence of sense of emptiness in life ρ=0.128; p<0.05. The most appreciated values in life, according to the subjects were health, happiness in family and mental efficiency. The biggest worries concerned serious diseases and being dependent on other people. Most often indicated ways to lead happy elderly life were being active and open to people as well as showing optimistic attitude. The research, which was conducted on a relatively large group of people (n=255), proves positive aging direction among the elderly and persons entering late adulthood period who attend continuous education courses at U3A.

Caregiving of aged people, either professional job or acquiring merit in God's sight: An example of qualitative research

Özlem Cankurtaran Őntaş, Melike Tunç — 2011-09-02

Abstract: Nowadays because of lots of reasons, lifespan is increasing and caregiving of aged people becomes more and more important. Today it is understood how the professional care of aged people is significant, instead of being carried out by volunteers. Because of this, in this study we aimed to understand the problems, and thoughts of aging of caregivers who are working in nursing homes. This study was made using the so-called qualitative research, which is one of the research designs. Including general aim, interviews with 13 caregivers with structured questions, supported by spontaneous ones. Interviews were taped and transcribed verbatim. After that, they were grouped with the same themes. Thoughts are grouped with three main themes, which are about “aging”, “working life”, “caregiving of aged people”. Aged people are described like people who are dependent, need interest, and represent the wisdom period. Also caregiving is described like both good job and punishment. Besides, the reason of working as a caregiver, is the economic needs. The suggestions of caregivers are increasing payment, giving psychological and emotional support, and also improving physical conditions. Economic satisfaction of caregivers, giving psychological support, caregivers with aged people and improving physical conditions are important to increase the quality of professional caregiving.

Attitudes toward the elderly among the health care providers: Reliability and validity of Turkish version of the UCLA Geriatrics Attitudes (UCLA-GA) scale

Sevnaz Sahin, Aliye Mandiracioglu, Nil Tekin, Fisun Senuzun, Fehmi Akcicek — 2011-09-21

Abstract: The population of above 65 years of age is increasing fast in societies, as the life expectancy is increasing and it leads to high demands for health care service. Health care service for the elderly should be provided by trained team in this field. Success of health care service to be rendered is related to knowledge, skill and attitudes of team members in different profession group (doctor, nurse, social worker, psychologist, etc.) about health of elderly. The aim of this study is to establish the Turkish validity and reliability of 14-question UCLA-GA scale, validity and reliability of which was proven and used the most frequently among the scales that assess attitudes of health care providers toward elderly. A total 256 people, 150 of them were post-graduates, 106 of them were pre-graduates were involved in the study at Ege University, medical faculty between the dates of December 2010 and February 2011. Majority of the participants (63.67%) were women and in the age group of 18–29 (58.3%). The ratio of the ones undergoing geriatric education is 38.2%. It was found out that the Kaiser–Meyer–Olkin (KMO) sampling adequacy test presented high correlation among the items in both single adult households of 14 items of the scale was 0.72. Cronbach alpha value of the scale was found as 0.67 and satisfying. As a result of examination with Tukey's test of additivity, it was seen that items of the scale have additive quality (F=85.25, p<0.0001). When we calculated the correlation of each item with total score, it was found that correlation coefficient varied between 0.32 and 0.68. Test–retest reliability was defined by use of Pearson correlation analysis. It was determined that test–retest consistency of correlation scale between two measurements was r=0.51. As a result of test–retest application, the correlation between the first and second application scores of each item was analyzed to determine the internal consistency of each item of the scale. Based on this analysis it was found as p<0.01 between r=0.22 and 0.65. As a conclusion, Turkish validity and reliability of UCLA-GA scale was demonstrated in this study. Since Turkish version of UCLA-GA scale is short and clear, it is recommended to use it for determining attitudes of health care providers toward elderly in geriatrics.

Trajectories and covariates of life satisfaction among older adults in Taiwan

Hui-Chuan Hsu — 2011-09-12

Abstract: The goals of this study were to identify different life satisfaction trajectory groups among the Taiwanese elderly and to explore the relationships between life satisfaction and time-varying physical, mental, social, health, and economic variables. The data used herein were from five waves of a longitudinal study conducted from 1993 to 2007. Those who completed at least three waves were included in the analysis, for a total of 2584 participants. A group-based trajectory model was used to analyze the data. Time-constant variables and time-varying covariates were used as the moderators of changes in life satisfaction trajectories. Four life satisfaction trajectories were identified: low (21.8%), middle (39.7%), increasing (25.9%), and high-declining (12.5%). Having more education and better physical and psychological health, social support, and economic satisfaction were predictors of a higher life satisfaction trajectory, and maintaining good physical and emotional health, having a spouse, and having better economic satisfaction were associated with an increase in life satisfaction over time.