The phenomenon of the increasing number of ageing people in the world is arguably the most significant economic, health and social challenge that we face today. Additionally, one of the major epidemiologic trends of current times is the increase in chronic and degenerative diseases. This paper tries to deliver a more up to date overview of chronic diseases and other limitations associated with old age and provide a more detailed outlook on the research that has gone into this field. First, challenges for seniors, including chronic diseases and other limitations associated with old age, are specified. Second, a review of seniors’ needs and concerns is performed. Finally, solutions that can improve seniors’ quality of life are discussed. Publications obtained from the following databases are used in this scoping review: Web of Science, PubMed, and Science Direct. Four independent reviewers screened the identified records and selected relevant publications published from 2010 to 2017. A total of 1916 publications were selected. In all, 52 papers were selected based on abstract content. For further processing, 21 full papers were screened.” The results indicate disabilities as a major problem associated with seniors’ activities of daily living dependence. We founded seven categories of different conditions - psychological problems, difficulties in mobility, poor cognitive function, falls and incidents, wounds and injuries, undernutrition, and communication problems. In order to minimize ageing consequences, some areas require more attention, such as education and training; technological tools; government support and welfare systems; early diagnosis of undernutrition, cognitive impairment, and other diseases; communication solutions; mobility solutions; and social contributions. This scoping review supports the view on chronic diseases in old age as a complex issue. To prevent the consequences of chronic diseases and other limitations associated with old age related problems demands multicomponent interventions. Early recognition of problems leading to disability and activities of daily living (ADL) dependence should be one of essential components of such interventions.

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Consequences of chronic diseases and other limitations associated with old age – a scoping review

Background
Dysphagia (swallowing problems), which is common after stroke, is associated with increased risk of death or dependency, occurrence of pneumonia, poor quality of life, and longer hospital stay. Treatments provided to improve dysphagia are aimed at accelerating recovery of swallowing function and reducing these risks. This is an update of the review first published in 1999 and updated in 2012.

Swallowing therapy for dysphagia in acute and subacute stroke.

Post-stroke dysphagia (PSD) is present in more than 50% of acute stroke patients, increases the risk of complications, in particular aspiration pneumonia, malnutrition and dehydration, and is linked to poor outcome and mortality. The aim of this guideline is to assist all members of the multidisciplinary team in their management of patients with PSD. These guidelines were developed based on the European Stroke Organisation (ESO) standard operating procedure and followed the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. An interdisciplinary working group identified 20 relevant questions, performed systematic reviews and meta-analyses of the literature, assessed the quality of the available evidence and wrote evidence-based recommendations. Expert opinion was provided if not enough evidence was available to provide recommendations based on the GRADE approach. We found moderate quality of evidence to recommend dysphagia screening in all stroke patients to prevent post-stroke pneumonia and to early mortality and low quality of evidence to suggest dysphagia assessment in stroke patients having been identified at being at risk of PSD. We found low to moderate quality of evidence for a variety of treatment options to improve swallowing physiology and swallowing safety. These options include dietary interventions, behavioural swallowing treatment including acupuncture, nutritional interventions, oral health care, different pharmacological agents and different types of neurostimulation treatment. Some of the studied interventions also had an impact on other clinical endpoints such as feedings status or pneumonia. Overall, further randomized trials are needed to improve the quality of evidence for the treatment of PSD.

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European Stroke Organisation and European Society for Swallowing Disorders guideline for the diagnosis and treatment of post-stroke dysphagia

In the last chapter, we reviewed some examples of working backward from decisions to understand the value of addressing bottlenecks on actionable learning. For instance, for the pricing example, we needed to understand how much more profit would be expected to be attained if we could better estimate competitors’ bids. And, more particularly, we wanted to know how much more profit would be expected for various levels of accuracy in predicting competitors’ bids. With that information in hand, we could then work backward in our straightforward way to identify the constraints that contributed to the current state of less-than-perfect-predictability of competitors’ bids and determine what it would be worth to resolve those constraints, starting with the constraint that was identified to be the current most-limiting factor in the data-to-learning-to-action chain.

Quantifying the Value

This paper seeks to improve the understanding of the interaction between patients with stroke and the physical environment in their home settings. Stroke care is increasingly performed in the patient's home. Therefore, a systematic review was conducted to identify the existing knowledge about facilitators and barriers in the physical environment of home settings for the stroke rehabilitation process. Based upon Arksey and O'Malley's framework, a Boolean search strategy was performed in the databases; CINAHL, Medline, Web of Science and Scopus. Fifteen articles were retained from the literature search conducted between August and November 2016, and two researchers independently assessed their quality based on the Swedish Council on Health Technology Assessment guidelines. The results suggest that despite the healthcare system's ongoing shift towards home-based rehabilitation, the role played by the physical environment of home settings is still considered a side finding. Moreover, the research appears to focus mainly on how this environment supports mobility and activities of daily living, whereas information regarding the psychosocial and emotional processes that mediate the interaction between stroke survivors and their home setting are missing. A lack of information was also found with regard to the influence of different geographic locations on the stroke rehabilitation process. Future investigations are therefore needed to advance the understanding of the role played by the physical environment of home settings in supporting stroke recovery.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/hsc.12518

Home setting after stroke, facilitators and barriers: A systematic literature review.

[Purpose] Disabilities after stroke are known to have adverse effects on the quality of life. This study investigated the relationship between Communication Activities of Daily Living (C-ADL) and quality life of elderly stroke patients to provide basic data for use in enhancing the quality of life. [Subjects and Methods] One hundred sixty five elderly over the age of 60, who were diagnosed as having stroke and receiving treatment in rehabilitation departments of general hospitals were surveyed. Stroke patients' basic communication ability to survive in daily living was measured using the C-ADL Second Edition, and stroke patients' quality of life was measured with the Stroke-Specific Quality of Life (SSQOL). The relationship between C-ADL and SSQOL was analyzed using multiple regression analysis. [Results] C-ADL had a significant positive relationship with SSQOL. [Conclusion] This result implies that it is necessary to enhance stroke patients' communication ability in daily living in order to raise their quality of life.

The relationship between communication activities of daily living and quality of life among the elderly suffering from stroke.

[Purpose] The effectiveness of neuromuscular electrical stimulation in the rehabilitation of swallowing remains controversial. This study compared the effectiveness of neuromuscular electrical stimulation and thermal tactile oral stimulation, a traditional swallowing recovery treatment, in patients with sub-acute dysphagia caused by stroke. [Subjects and Methods] Subjects of the present study were 55 patients diagnosed with dysphagia caused by stroke. This study had a nonequivalent control group pretest-posttest design. [Results] Analysis of pre-post values of videofluoroscopic studies of the neuromuscular electrical stimulation and thermal tactile oral stimulation groups using a paired t-test showed no significant difference between the two groups despite both having decreased mean values of the videofluoroscopic studies after treatment. [Conclusion] This study’s findings show that both neuromuscular electrical stimulation and thermal tactile oral stimulation significantly enhanced the swallowing function of patients with sub-acute dysphagia.

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Comparison of treatment effect of neuromuscular electrical stimulation and thermal-tactile stimulation on patients with sub-acute dysphagia caused by stroke.

[Purpose] Understanding the normal movements of the pharyngeal stage is important in the assessment of dysphagia. This study classified an elderly population into young-elderly and mid-elderly individuals and investigated the difference in stage transition duration between the two groups to provide basic material for assessment of dysphagia in old age. [Subjects and Methods] The subjects of the study were 12 middle-aged individuals (40-49 years), young-elderly individuals (65-74 years), and 9 mid-elderly individuals (75-84 years). Stage transition duration was defined as the time from the moment food boluses passed the ramus of the mandible until the start of upward movement of the hyoid. All image data were measured using a videofluoroscopic study. Difference in measured values for stage transition duration between the groups were confirmed with one-way analysis of variance. [Results] Although analysis of variance was significantly longer in the young-elderly and mid-elderly individuals than in the middle-aged individuals, there was no significant difference in stage transition duration between the young-elderly and mid-elderly individuals. [Conclusion] In this study, there was no significant difference between the young-elderly and mid-elderly individuals in the movement speed of muscles related to pharyngeal swallowing.

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The duration of stage transition during pharyngeal swallowing among young-elderly, and mid-elderly individuals.

[Purpose] This study explored health science students’ perceptions of motor aphasia and sensory aphasia caused by stroke to provide basic material for the improvement of rehabilitation practitioners’ perceptions of aphasia. [Subjects and Methods] The subjects of this study were 642 freshmen and sophomores majoring in health science. Perceptions of aphasia were surveyed on a semantic differential scale using the Anchoring Vignette Method and the difference in perception of the two types of aphasia was analyzed using multi-dimensional scaling. [Results] The analysis revealed that motor aphasia and sensory aphasia have mutually corresponding images. Motor aphasia had high levels of ‘quiet’, ‘passive’ ‘dumb’, ‘unstable’ and ‘gloomy’ images, while sensory aphasia had high levels of ‘noisy’, ‘unstable’, ‘cheerful’, ‘sensitive’, ‘fluctuating in emotions’, ‘active’, ‘dumb’ and ‘gloomy’ images. [Conclusion] A systematic education is required to be implemented in the future to improve health science students’ negative perceptions of the aftereffects of stroke such as aphasia.

Health science students' perceptions of motor and sensory aphasia caused by stroke.

In order to maintain health during middle age and achieve successful aging, it is important to elucidate and prevent risk factors of middle-age stroke. This study investigated high risk groups of stroke in middle age population of Korea and provides basic material for establishment of stroke prevention policy by analyzing sudden perception of speech/language problems and clusters of multiple risk factors. This study analyzed 2,751 persons (1,191 males and 1,560 females) aged 40–59 who participated in the 2009 Korea National Health and Nutrition Examination Survey. Outcome was defined as prevalence of stroke. Set as explanatory variables were age, gender, final education, income, marital status, at-risk drinking, smoking, occupation, subjective health status, moderate physical activity, hypertension, and sudden perception of speech and language problems. A prediction model was developed by the use of a C4.5 algorithm of data-mining approach. Sudden perception of speech and language problems, hypertension, and marital status were significantly associated with stroke in Korean middle aged people. The most preferentially involved predictor was sudden perception of speech and language problems. In order to prevent middle-age stroke, it is required to systematically manage and develop tailored programs for high-risk groups based on this prediction model.

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Hyeung Woo Koh

Papers

The relationship between communication activities of daily living and quality of life among the elderly suffering from stroke.

Comparison of treatment effect of neuromuscular electrical stimulation and thermal-tactile stimulation on patients with sub-acute dysphagia caused by stroke.

The duration of stage transition during pharyngeal swallowing among young-elderly, and mid-elderly individuals.

Health science students' perceptions of motor and sensory aphasia caused by stroke.

A Feature Analysis of Risk Factors for Stroke in the Middle-Aged Adults