Showing papers in "Age and Ageing in 2015"
TL;DR: Factor measured earlier in adulthood were associated with grip strength decline in late midlife and old adulthood, suggesting that it may be worthwhile to conduct research on grip and muscle strength separately for men and women.
Abstract: Background: few studies have examined associations of multi-faceted demographic, health and lifestyle factors with longterm change in grip strength performance across the adult lifespan. The aim of ...
269 citations
TL;DR: In this article, the authors examined the prevalence of frailty and disability in people aged 60 and over and the proportion of those with disabilities who receive help or use assistive devices.
Abstract: OBJECTIVE: to examine the prevalence of frailty and disability in people aged 60 and over and the proportion of those with disabilities who receive help or use assistive devices. METHODS: participants were 5,450 people aged 60 and over from the English Longitudinal Study of Ageing. Frailty was defined according to the Fried criteria. Participants were asked about difficulties with mobility or other everyday activities. Those with difficulties were asked whether they received help or used assistive devices. RESULTS: the overall weighted prevalence of frailty was 14%. Prevalence rose with increasing age, from 6.5% in those aged 60-69 years to 65% in those aged 90 or over. Frailty occurred more frequently in women than in men (16 versus 12%). Mobility difficulties were very common: 93% of frail individuals had such difficulties versus 58% of the non-frail individuals. Among frail individuals, difficulties in performing activities or instrumental activities of daily living were reported by 57 or 64%, respectively, versus 13 or 15%, respectively, among the non-frail individuals. Among those with difficulties with mobility or other daily activities, 71% of frail individuals and 31% of non-frail individuals said that they received help. Of those with difficulties, 63% of frail individuals and 20% of non-frail individuals used a walking stick, but the use of other assistive devices was uncommon. CONCLUSIONS: frailty becomes increasingly common in older age groups and is associated with a sizeable burden as regards difficulties with mobility and other everyday activities.
251 citations
TL;DR: Questions discussed here include the following: what is driving age-structural change in human populations?
Abstract: The 20th century saw an unprecedented increase in average human lifespan as well as a rapid decline in human fertility in many countries of the world The accompanying worldwide change in demographics of human populations is linked to unanticipated and unprecedented economic, cultural, medical, social, public health and public policy challenges, whose full implications on a societal level are only just beginning to be fully appreciated Some of these implications are discussed in this commentary, an outcome of Cultures of Health and Ageing, a conference co-sponsored by the University of Copenhagen (UCPH) and the Center for Healthy Ageing at UCPH, which took place on 20–21 June 2014 in Copenhagen, Denmark Questions discussed here include the following: what is driving age-structural change in human populations? how can we create ‘age-friendly’ societies and promote ‘ageing-in-community’? what tools will effectively promote social engagement and prevent social detachment among older individuals? is there a risk that further extension of human lifespan would be a greater burden to the individual and to society than is warranted by the potential benefit of longer life?
164 citations
TL;DR: Multicomponent interventions are effective in preventing incident delirium among elderly inpatients and effects seemed to be stable among different settings, due to the limited amount of data.
Abstract: Background: delirium is a complex neuropsychiatric syndrome that is common among elderly inpatients. It has been associated with increased mortality, longer hospital stays, cognitive and functional decline and increased institutionalisation rates. Multicomponent interventions, a series of non-pharmacological strategies frequently handled by nursing staff, might be useful for prevention. Objectives: to assess the efficacy of multicomponent interventions in preventing incident delirium in the elderly. Methods: a systematic review of randomised trials was undertaken. Two independent reviewers performed iterative literature searches in seven databases without language restrictions. Grey literature repositories were considered as well. The quality of included trials was assessed by using the criteria established by the Cochrane Collaboration. When possible, data were synthesised into a meta-analysis. Heterogeneity was assessed using the χ 2 and I 2 tests. Findings: a total of 21,788 citations were screened, and seven studies of diverse quality were included in the review, comprising 1,691 participants. Multicomponent interventions significantly reduced incident delirium (relative risk [RR] 0.73, 95% confidence interval [CI] 0.63–0.85, P< 0.001) and accidental falls during the hospitalisation (RR 0.39, 95% CI 0.21, 0.72, P= 0.003), without evidence of differential effectiveness according to ward type or dementia rates. Non-significant reductions in delirium duration, hospital stay and mortality were found as well. Interpretation: multicomponent interventions are effective in preventing incident delirium among elderly inpatients. Effects seemed to be stable among different settings. Due to the limited amount of data, potential benefits in survival need to be confirmed in further studies. Future research should be aimed at contrasting different multicomponent programmes to select the most useful interventions.
143 citations
TL;DR: In middle-aged and older adults, polypharmacy, including antidepressant or benzodiazepine use, was associated with injurious falls and a greater number of falls.
Abstract: Background: polypharmacy is an important risk factor for falls, but recent studies suggest only when including medications associated with increasing the risk of falls. Design: a prospective, population-based cohort study. Subjects: 6,666 adults aged ≥50 years from The Irish Longitudinal study on Ageing. Methods: participants reported regular medication use at baseline. Any subsequent falls, any injurious falls and the number of falls were reported 2 years later. The association between polypharmacy (>4 medications) or fall risk-increasing medications and subsequent falls or injurious falls was assessed using modified Poisson regression. The association with the number of falls was assessed using negative binomial regression. Results: during follow-up, 231 falls per 1,000 person-years were reported. Polypharmacy including antidepressants was associated with a greater risk of any fall (adjusted relative risk (aRR) 1.28, 95% CI 1.06–1.54), of injurious falls (aRR 1.51, 95% CI 1.10–2.07) and a greater number of falls (adjusted incident rate ratio (aIRR) 1.60, 95% CI 1.19–2.15), but antidepressant use without polypharmacy and polypharmacy without antidepressants were not. The use of benzodiazepines was associated with injurious falls when coupled with polypharmacy (aRR 1.40, 95% CI 1.04–1.87), but was associated with a greater number of falls (aIRR 1.32, 95% CI 1.05–1.65), independent of polypharmacy. Other medications assessed, including antihypertensives, diuretics and antipsychotics, were not associated with outcomes. Conclusion: in middle-aged and older adults, polypharmacy, including antidepressant or benzodiazepine use, was associated with injurious falls and a greater number of falls.
140 citations
TL;DR: Dementia is common in older people admitted to acute hospitals, particularly in acute medical admissions, and rural hospitals, where services may be less available.
Abstract: BACKGROUND: previous studies have indicated a prevalence of dementia in older admissions of ∼42% in a single London teaching hospital, and 21% in four Queensland hospitals. However, there is a lack of published data from any European country on the prevalence of dementia across hospitals and between patient groups. OBJECTIVE: to determine the prevalence and associations of dementia in older patients admitted to acute hospitals in Ireland. METHODS: six hundred and six patients aged ≥70 years were recruited on admission to six hospitals in Cork County. Screening consisted of Standardised Mini-Mental State Examination (SMMSE); patients with scores <27/30 had further assessment with the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Final expert diagnosis was based on SMMSE, IQCODE and relevant medical and demographic history. Patients were screened for delirium and depression, and assessed for co-morbidity, functional ability and nutritional status. RESULTS: of 598 older patients admitted to acute hospitals, 25% overall had dementia; with 29% in public hospitals. Prevalence varied between hospitals (P < 0.001); most common in rural hospitals and acute medical admissions. Only 35.6% of patients with dementia had a previous diagnosis. Patients with dementia were older and frailer, with higher co-morbidity, malnutrition and lower functional status (P < 0.001). Delirium was commonly superimposed on dementia (57%) on admission. CONCLUSION: dementia is common in older people admitted to acute hospitals, particularly in acute medical admissions, and rural hospitals, where services may be less available. Most dementia is not previously diagnosed, emphasising the necessity for cognitive assessment in older people on presentation to hospital.
133 citations
TL;DR: The results suggest that lower hand-grip strength, standardised using age and gender, is both cross-sectionally and longitudinally associated with depressive symptoms.
Abstract: BACKGROUND: no study has examined the longitudinal association between hand-grip strength and mental health, such as depressive symptoms. Objective: we investigated the relationship between baseline hand-grip strength and the risk of depressive symptoms. Design: a prospective cohort study. Setting and Subjects: a prospective cohort study with a 1-year follow-up was conducted using 4,314 subjects from community-dwelling individuals aged 40-79 years in two Japanese municipalities, based on the Locomotive Syndrome and Health Outcomes in Aizu Cohort Study (LOHAS, 2008-10). Methods: we assessed baseline hand-grip strength standardised using national representative data classified by age and gender, and depressive symptoms at baseline and after the follow-up using the five-item version of the Mental Health Inventory (MHI-5). Results: the 4,314 subjects had a mean age of 66.3 years, 58.5% were women, and mean unadjusted hand-grip strength was 29.8 kg. Multivariable random-effect logistic regression analysis revealed that subjects with lower hand-grip strength (per 1SD decrease) had higher odds of having depressive symptoms at baseline [adjusted odds ratio (AOR) 1.15, 95% confidence interval (CI) 1.06-1.24; P = 0.001]. Further, lower hand-grip strength (per 1SD decrease) was associated with the longitudinal development of depressive symptoms after 1 year (AOR 1.13, 95% CI 1.01-1.27; P = 0.036). Conclusions: using a large population-based sample, our results suggest that lower hand-grip strength, standardised using age and gender, is both cross-sectionally and longitudinally associated with depressive symptoms. Language: en
125 citations
TL;DR: A synthesis of existing practice recommendations for the diagnosis and management of dementia, based upon moderate-to-high quality dementia guidelines is offered, with a general agreement between guidelines for many practice recommendations.
Abstract: Background dementia is a highly prevalent acquired cognitive disorder that interferes with activities of daily living, relationships and quality of life. Recognition and effective management strategies are necessary to provide comprehensive care for these patients and their families. High-quality clinical practice guidelines can improve the quality and consistency of care in all aspects of dementia diagnosis and management by clarifying interventions supported by sound evidence and by alerting clinicians to interventions without proven benefit. Objective we aimed to offer a synthesis of existing practice recommendations for the diagnosis and management of dementia, based upon moderate-to-high quality dementia guidelines. Methods we performed a systematic search in EMBASE and MEDLINE as well as the grey literature for guidelines produced between 2008 and 2013. Results thirty-nine retrieved practice guidelines were included for quality appraisal by the Appraisal of Guidelines Research and Evaluation II (AGREE-II) tool, performed by two independent reviewers. From the 12 moderate-to-high quality guidelines included, specific practice recommendations for the diagnosis and/or management of any aspect of dementia were extracted for comparison based upon the level of evidence and strength of recommendation. Conclusion there was a general agreement between guidelines for many practice recommendations. However, direct comparisons between guidelines were challenging due to variations in grading schemes.
106 citations
TL;DR: Investigation of the prevalence of hyperosmolar dehydration in hospitalised older adults admitted as an emergency and the impact on short-term and long-term outcome demonstrated that participants dehydrated at admission were 6 times more likely to die in hospital than those euhydrated.
Abstract: Background: older adults are susceptible to dehydration due to age-related pathophysiological changes. We aimed to investigate the prevalence of hyperosmolar dehydration (HD) in hospitalised older adults, aged ≥65 years, admitted as an emergency and to assess the impact on short-term and long-term outcome. Methods: this prospective cohort study was performed on older adult participants who were admitted acutely to a large UK teaching hospital. Data collected included the Charlson comorbidity index (CCI), national early warning score (NEWS), Canadian Study of Health and Aging (CSHA) clinical frailty scale and Nutrition Risk Screening Tool (NRS) 2002. Admission bloods were used to measure serum osmolality. HD was defined as serum osmolality >300 mOsmol/kg. Participants who were still in hospital 48 h after admission were reviewed, and the same measurements were repeated. Results: a total of 200 participants were recruited at admission to hospital, 37% of whom were dehydrated. Of those dehydrated, 62% were still dehydrated when reviewed at 48 h after admission. Overall, 7% of the participants died in hospital, 79% of whom were dehydrated at admission (P= 0.001). Cox regression analysis adjusted for age, gender, CCI, NEWS, CSHA and NRS demonstrated that participants dehydrated at admission were 6 times more likely to die in hospital than those euhydrated, hazards ratio (HR) 6.04 (1.64–22.25); P= 0.007. Conclusions: HD is common in hospitalised older adults and is associated with poor outcome. Coordinated efforts are necessary to develop comprehensive hydration assessment tools to implement and monitor a real change in culture and attitude towards hydration in hospitalised older adults.
99 citations
TL;DR: Dutasteride, fesoterodine and finasteride were classified as beneficial in older persons or frail elderly people (FORTA B) and for most drugs, in particular those from the group of α-blockers and antimuscarinics, use in this group seems questionable or should be avoided ( FORTA D).
Abstract: Aim: we aimed to systematically review drugs to treat lower urinary tract symptoms (LUTS) regularly used in older persons to classify appropriate and inappropriate drugs based on efficacy, safety and tolerability by using the Fit fOR The Aged (FORTA) classification.
Methods: to evaluate the efficacy, safety and tolerability of drugs used for treatment of LUTS in older persons, a systematic review was performed. Papers on clinical trials and summaries of individual product characteristics were analysed regarding efficacy and safety in older persons (≥65 years). The most frequently used drugs were selected based on current prescription data. An interdisciplinary international expert panel assessed the drugs in a Delphi process.
Results: for the 16 drugs included here, a total of 896 citations were identified; of those, only 25 reported clinical trials with explicit data on, or solely performed in older people, underlining the lack of evidence in older people for drug treatment of LUTS. No drug was rated at the FORTA-A-level (indispensable). Only three were assigned to FORTA B (beneficial): dutasteride, fesoterodine and finasteride. The majority was rated FORTA C (questionable): darifenacin, mirabegron, extended release oxybutynin, silodosin, solifenacin, tadalafil, tamsulosin, tolterodine and trospium. FORTA D (avoid) was assigned to alfuzosin, doxazosin, immediate release oxybutynin, propiverine and terazosin.
Conclusions: dutasteride, fesoterodine and finasteride were classified as beneficial in older persons or frail elderly people (FORTA B). For most drugs, in particular those from the group of α-blockers and antimuscarinics, use in this group seems questionable (FORTA C) or should be avoided (FORTA D).
98 citations
TL;DR: Three distinct multimorbidity patterns were differentially associated with functional ability and decline, and the CVD pattern was associated with the greatest decline in ADL between 2005 and 2011, whereas the NMH pattern wasassociated with the most decline in IADL.
Abstract: Background: we aimed to identify multimorbidity patterns and relate these patterns to functional ability and decline. Methods: we included 7,270 participants of the older cohort of the Australian Longitudinal Study on Women's Health, who were surveyed every 3 years from 2002 to 2011. We used factor analysis to identify multimorbidity patterns from 31 selfreported chronic conditions among women aged 76-81 in 2002. We applied a linear increments model to account for attrition and related the multimorbidity patterns to functional ability and decline at subsequent surveys, as measured by activities of daily living (ADL) and instrumental activities of daily living (IADL). For each pattern, we determined mean ADL and IADL scores in the middle and highest third of factor score in comparison to a reference group. Results: we identified three multimorbidity patterns, labelled musculoskeletal/somatic (MSO), neurological/mental health (NMH) and cardiovascular (CVD). High factor scores for NMH, MSO and CVD were associated with significantly higher mean ADL and IADL scores (poorer functional ability) in 2005 compared with the reference group of low factor scores for all three factors. The CVD pattern was associated with the greatest decline in ADL between 2005 and 2011, whereas the NMH pattern was associated with the greatest decline in IADL. Conclusions: distinct multimorbidity patterns were differentially associated with functional ability and decline. Given the paucity of studies on multimorbidity patterns, future studies should seek to assess the reproducibility of our findings in other populations and settings, and investigate the potential implications for improved prediction of functional decline.
TL;DR: Among men, the effect of eating alone on depression may be reinforced by living alone, but appears to be broadly comparable in women living alone and women living with others.
Abstract: Background: eating by oneself may be a risk factor for mental illness among older adults, but may be influenced by cohabitation status. We examined the association between eating alone and depression in the context of cohabitation status in older adults in Japan.
Design: a longitudinal, population-based study.
Setting: data from the Japan Gerontological Evaluation Study.
Subjects: we analysed 17,612 men and 19,581 women aged ≥65 without depression (Geriatric Depression Scale <5) at baseline in 2010.
Methods: eating status was classified into two categories: eating with others and eating alone. The risk of depression onset by 2013 was estimated using Poisson regression.
Results: after adjusting for socioeconomic status, physical health, nutritional status, social support, social participation, frequency of meet friends, employment status and marital status, the adjusted rate ratio (ARR) for depression onset in men who ate alone compared with those who ate with others was 2.36 (95% confidence intervals [CI]: 1.18–4.71) for those living alone and 1.03 (95% CI: 0.81–1.32) for those living with others. Among women, the ARR for depression for those who ate alone compared with those who ate with others was 1.31 (95% CI: 1.00–1.72) for those living alone and 1.21 (95% CI: 1.01–1.44) for those living with others.
Conclusions: eating alone may be a risk factor for depression. Among men, the effect of eating alone on depression may be reinforced by living alone, but appears to be broadly comparable in women living alone and women living with others.
TL;DR: Frailty is measured to understand its nature and biology, to aid diagnosis and care planning, to measure outcomes and to stratify risk.
Abstract: Frailty is measured to understand its nature and biology, to aid diagnosis and care planning, to measure outcomes and to stratify risk. Such goals oblige two types of frailty measures - for screening and for assessment - and recognition that not all measures will serve all purposes. When the goal is broad identification of people at risk, a dichotomised approach (frailty is present or absent ) is appropriate. If, however, the degree of risk varies, strategies to test grades of frailty will be required. Frailty measures should be implemented and evaluated in relation to the goal for their use.
TL;DR: Characteristics of frailty are similar regardless of whether self-reported or test-based measures are used exclusively to construct a frailty index, except for sex differences.
Abstract: Background: previously, frailty indices were constructed using mostly subjective health measures The reporting error in this type of measure can have implications on the robustness of frailty findings
Objective: to examine whether frailty assessment differs when we construct frailty indices using solely self-reported or test-based health measures
Design: secondary analysis of data from The Irish LongituDinal study on Ageing (TILDA)
Subjects and methods: 4,961 Irish residents (mean age: 619 ± 84; 542% women) over the age of 50 years who underwent a health assessment were included in this analysis We constructed three frailty indices using 33 self-reported health measures (SRFI), 33 test-based health measures (TBFI) and all 66 measures combined (CFI) The 2-year follow-up outcomes examined were all-cause mortality, disability, hospitalisation and falls
Results: all three indices had a right-skewed distribution, an upper limit to frailty, a non-linear increase with age, and had a dose–response relationship with adverse outcomes Levels of frailty were lower when self-reported items were used (SRFI: 012 ± 009; TBFI: 017 ± 015; CFI: 014 ± 013) Men had slightly higher frailty index scores than women when test-based measures were used (men: 017 ± 009; women: 016 ± 010) CFI had the strongest prediction for risk of adverse outcomes (ROC: 064–081), and age was not a significant predictor when it was included in the regression model
Conclusions: except for sex differences, characteristics of frailty are similar regardless of whether self-reported or test-based measures are used exclusively to construct a frailty index Where available, self-reported and test-based measures should be combined when trying to identify levels of frailty
TL;DR: Reactive stepping behaviour in response to forward loss of balance and physiological profile assessment are independent predictors of a future fall in community-dwelling older adults.
Abstract: Background: a fall occurs when an individual experiences a loss of balance from which they are unable to recover. Assessment of balance recovery ability in older adults may therefore help to identify individuals at risk of falls. The purpose of this 12-month prospective study was to assess whether the ability to recover from a forward loss of balance with a single step across a range of lean magnitudes was predictive of falls. Methods: two hundred and one community-dwelling older adults, aged 65–90 years, underwent baseline testing of sensorimotor function and balance recovery ability followed by 12-month prospective falls evaluation. Balance recovery ability was defined by whether participants required either single or multiple steps to recover from forward loss of balance from three lean magnitudes, as well as the maximum lean magnitude participants could recover from with a single step. Results: forty-four (22%) participants experienced one or more falls during the follow-up period. Maximal recoverable lean magnitude and use of multiple steps to recover at the 15% body weight (BW) and 25%BW lean magnitudes significantly predicted a future fall (odds ratios 1.08–1.26). The Physiological Profile Assessment, an established tool that assesses variety of sensori-motor aspects of falls risk, was also predictive of falls (Odds ratios 1.22 and 1.27, respectively), whereas age, sex, postural sway and timed up and go were not predictive. Conclusion: reactive stepping behaviour in response to forward loss of balance and physiological profile assessment are independent predictors of a future fall in community-dwelling older adults. Exercise interventions designed to improve reactive stepping behaviour may protect against future falls.
TL;DR: The first version of the SarQoL, a specific quality of life questionnaire for sarcopenic subjects, has been developed and has been shown to be comprehensible by the target population.
Abstract: Background: the impact of sarcopenia on quality of life is currently assessed by generic tools. However, these tools may not detect subtle effects of this specific condition on quality of life. Objective: the aim of this study was to develop a sarcopenia-specific quality of life questionnaire (SarQoL, Sarcopenia Quality of Life) designed for community-dwelling elderly subjects aged 65 years and older. Settings: participants were recruited in an outpatient clinic in Liege, Belgium. Subjects: sarcopenic subjects aged 65 years or older. Methods: the study was articulated in the following four stages: (i) Item generation—based on literature review, sarcopenic subjects’ opinion, experts’ opinion, focus groups; (ii) Item reduction—based on sarcopenic subjects’ and experts’ preferences; (iii) Questionnaire generation—developed during an expert meeting; (iv) Pretest of the questionnaire—based on sarcopenic subjects’ opinion. Results: the final version of the questionnaire consists of 55 items translated into 22 questions rated on a 4-point Likert scale. These items are organised into seven domains of dysfunction: Physical and mental health, Locomotion, Body composition, Functionality, Activities of daily living, Leisure activities and Fears. In view of the pretest, the SarQoL is easy to complete, independently, in 10 min. Conclusions: the first version of the SarQoL, a specific quality of life questionnaire for sarcopenic subjects, has been developed and has been shown to be comprehensible by the target population. Investigations are now required to test the psychometric properties (internal consistency, test–retest reliability, divergent and convergent validity, discriminant validity, floor and ceiling effects) of this questionnaire.
TL;DR: Cognitive impairment in the absence of manifest dementia is an important independent predictor of mortality, especially among men, and the administration of cognitive tests among older adults may provide relevant information for patient care and treatment decisions.
Abstract: Background cognitive impairment is widespread among older adults even in the absence of dementia, but very little is known about the association between cognitive impairment not due or not yet converted to dementia and mortality. The association between cognitive impairment and mortality contributes to assessing cognitive impairment-related risk constellation in old age in the absence of manifest dementia. Objective to assess the impact of cognitive impairment on all-cause and cause-specific mortality among non-demented older adults and to explore the nature of the association between cognitive impairment and mortality. Design an observational cohort study (ESTHER study; 2000-present). Setting German state of Saarland. Subjects a subsample of 1,622 participants aged ≥70 with measurement of cognitive function through the Cognitive Telephone Screening Instrument (COGTEL) and exclusion of a possible dementia diagnosis at both COGTEL baseline (2005-08) and over the mortality follow-up (2005-13). Results during an average follow-up of 6.1 years, 231 participants (14.2%) died. Participants with low COGTEL total scores had ∼60% increased mortality compared with participants with higher COGTEL total scores in Cox regression models adjusting for a wide range of possible confounders (hazard ratio = 1.62; confidence interval 1.13-2.33). Dose-response analyses with restricted cubic splines indicate a monotonic inverse relationship between cognitive function and mortality. Conclusion cognitive impairment in the absence of manifest dementia is an important independent predictor of mortality, especially among men. The administration of cognitive tests among older adults may provide relevant information for patient care and treatment decisions. Sources of funding financial sponsors played no role in the design, execution, analysis and interpretation of data.
TL;DR: The trial suggested that, to fight against anorexia, the stimulation of touch (finger food; chewing, even on edentulous gums) and hearing (intra-oral sounds) could be valuable alternatives to sight, smell and taste alterations.
Abstract: Background and objective To evaluate the impact of a solid nutritional supplement on the weight gain of institutionalised older adults>70 years with protein-energy malnutrition. The innovation of these high-protein and high-energy cookies was the texture adapted to edentulous patients (Protibis®, Solidages, France). Design An open, multicentre, randomised controlled trial. Setting Seven nursing homes. Participants One hundred and seventy-five malnourished older adults, aged 86±8 years. Intervention All participants received the standard institutional diet. In addition, Intervention group participants received eight cookies daily (11.5 g protein; 244 kcal) for 6 weeks (w0-w6). Measurements Five visits (w-4, w0, w6, w10 and w18). Main outcome Percentage of weight gain from w0 to w6 (body mass in kg). Secondary outcomes Appetite, rated using a numerical scale (0: no appetite to 10: extremely good appetite); current episodes of pressure ulcers and diarrhea. Results Average weight increased in Intervention group (n=88) compared with Control group (n=87) without cookies supplementation (+1.6 versus -0.7%, P=0.038). Weight gain persisted 1 month (+3.0 versus -0.2%, P=0.025) and 3 months after the end of cookies consumption (+3.9 versus -0.9%, P=0.003), with diarrhea reduction (P=0.027). There was a synergistic effect with liquid/creamy dietary supplements. Subgroup analysis confirmed the positive impact of cookies supplementation alone on weight increase (P=0.024), appetite increase (P=0.009) and pressure ulcers reduction (P=0.031). Conclusion The trial suggested that, to fight against anorexia, the stimulation of touch (finger food; chewing, even on edentulous gums) and hearing (intra-oral sounds) could be valuable alternatives to sight, smell and taste alterations.
TL;DR: People with dementia who are undiagnosed are older, have fewer years in education, are more likely to be unmarried, male and have less severe dementia than those with a diagnosis.
Abstract: Background: delays in diagnosing dementia may lead to suboptimal care, yet around half of those with dementia are undiagnosed. Any strategy for case finding should be informed by understanding the characteristics of the undiagnosed population. We used cross-sectional data from a population-based sample with dementia aged 71 years and older in the United States to describe the undiagnosed population and identify factors associated with non-diagnosis. Methods: the Aging, Demographics and Memory Study (ADAMS) Wave A participants (N = 856) each underwent a detailed neuropsychiatric investigation. Informants were asked whether the participant had ever received a doctor's diagnosis of dementia. We used multiple logistic regression to identify factors associated with informant report of a prior dementia diagnosis among those with a study diagnosis of dementia. Results: of those with a study diagnosis of dementia (n = 307), a prior diagnosis of dementia was reported by 121 informants (weighted proportion = 42%). Prior diagnosis was associated with greater clinical dementia rating (CDR), from 26% (CDR = 1) to 83% (CDR = 5). In multivariate analysis, those aged 90 years or older were less likely to be diagnosed (P = 0.008), but prior diagnosis was more common among married women (P = 0.038) and those who had spent more than 9 years in full-time education (P = 0.043). Conclusions: people with dementia who are undiagnosed are older, have fewer years in education, are more likely to be unmarried, male and have less severe dementia than those with a diagnosis. Policymakers and clinicians should be mindful of the variation in diagnosis rates among subgroups of the population with dementia.
TL;DR: The JLA Dementia Priority Setting Partnership was set up as an independent and evidence-based project to identify and prioritise unanswered questions (‘uncertainties') about prevention, diagnosis, treatment and care relating to dementia.
Abstract: Background: the James Lind Alliance (JLA) created an approach to elicit the views of those under-represented in research priority exercises. Building on this, the JLA Dementia Priority Setting Partnership was set up as an independent and evidence-based project to identify and prioritise unanswered questions (‘uncertainties') about prevention, diagnosis, treatment and care relating to dementia.
Methods: a survey was widely disseminated to stakeholders with an interest in the needs of the older population. Thematic analysis was used to identify themes from the large amount of questions collected from which research questions were developed using PICO framework (Population, Intervention, Comparator, Outcome). Each question was checked against an extensive evidence base of high-quality systematic reviews to verify whether they were true uncertainties.
Findings: one thousand five hundred and sixty-three questionnaires were received, from people with dementia, carers/relatives, and health and care professionals; 85 uncertainties were identified from other sources. Questions were refined and formatted iteratively into 146 unique uncertainties. An interim prioritisation process involving diverse organisations identified the top 25 ranked questions. At a final face-to-face prioritisation workshop, 18 people representing the above constituencies arrived by consensus at the top 10 priority questions. The impact of patient and public involvement on the priorities is discussed.
Interpretation: the long (146 questions) and top 10 lists of dementia research priorities provide a focus for researchers, funders and commissioners. They highlight a need for more research into care for people with dementia and carers, and a need for high-quality effectiveness trials in all aspects of dementia research.
TL;DR: Feature of land use have complex associations with cognitive impairment and dementia and environmental features at the community level in older people should focus on environmental influences on cognition to inform health and social policies.
Abstract: Background: few studies have investigated the impact of the community environment, as distinct from area deprivation, on cognition in later life. This study explores cross-sectional associations between cognitive impairment and dementia and environmental features at the community level in older people.
Method: the postcodes of the 2,424 participants in the year-10 interview of the Cognitive Function and Ageing Study in England were mapped into small area level geographical units (Lower-layer Super Output Areas) and linked to environmental data in government statistics. Multilevel logistic regression was conducted to investigate associations between cognitive impairment (defined as MMSE ≤ 25), dementia (organicity level ≥3 in GMS-AGECAT) and community level measurements including area deprivation, natural environment, land use mix and crime. Sensitivity analyses tested the impact of people moving residence within the last two years.
Results: higher levels of area deprivation and crime were not significantly associated with cognitive impairment and dementia after accounting for individual level factors. Living in areas with high land use mix was significantly associated with a nearly 60% reduced odds of dementia (OR: 0.4; 95% CI: 0.2, 0.8) after adjusting for individual level factors and area deprivation, but there was no linear trend for cognitive impairment. Increased odds of dementia (OR: 2.2, 95% CI: 1.2, 4.2) and cognitive impairment (OR: 1.4, 95% CI: 1.0, 2.0) were found in the highest quartile of natural environment availability. Findings were robust to exclusion of the recently relocated.
Conclusion: features of land use have complex associations with cognitive impairment and dementia. Further investigations should focus on environmental influences on cognition to inform health and social policies.
TL;DR: The ISAR has modest predictive accuracy and may serve as a decision-making adjunct when determining which older adults can be safely discharged, according to a systematic review and meta-analysis of the Identification of Seniors At Risk.
Abstract: Background Older adults are the most frequent users of emergency services, accounting for up to a quarter of all emergency department (ED) attendances. In addition, older adults require more healthcare resources, experience longer ED stays and demonstrate higher rates of adverse outcomes following emergency care such as return to ED, emergency hospitalisation and death. The aim of this study is to perform a systematic review and meta-analysis of validation studies of the ISAR to determine its predictive value in identifying older adults at risk of adverse outcomes within 30, 90 or 180 days after ED or hospital discharge. Methods A systematic literature search was conducted to identify studies validating the ISAR rule in adults aged ≥65 years attending the ED. The methodological quality of selected studies was assessed by two independent reviewers using the quality of diagnostic accuracy studies tool (QUADAS-2). A score of ≥2 was used to identify high risk patients. A bivariate random effects model was applied to generate pooled summary estimates of sensitivity and specificity. Heterogeneity was assessed graphically using summary receiver-operating characteristic (ROC) graphs and statistically using the variance of the logit transformed sensitivity and specificity. Results Thirty studies including 23 unique patient cohorts are included. The methodological quality of the studies is varied, particularly regarding blinding of outcome assessors. A total of 11,334 patients are included in the meta-analysis. At a cut-off of ≥2, the pooled sensitivity of the ISAR rule for predicting ED return, hospitalisation and mortality at 6 months is 0.84 (95% CI 0.73–0.91), 0.84 (95% CI 0.76–0.90) and 0.89 (95% CI 0.79–0.95) respectively, with a pooled specificity of 0.28 (95% CI 0.22–0.36), 0.28 (95% CI 0.22–0.35) and 0.33 (95% CI 0.24–0.45). Similar values are demonstrated for these outcomes at 30 and 90 days. There is little heterogeneity across studies. Discussion The ISAR screening tool demonstrates high pooled estimates of sensitivity across all outcomes and time-points, indicating that it can be used to rule out adverse events in older adults who are deemed low risk (
TL;DR: Dietary intake of vegetables, fruits and both vegetables and fruits was associated with a significantly reduced risk of sarcopenia after controlling for covariates in men and women.
Abstract: Background: several studies have found nutrients, including antioxidants, to be associated with sarcopenia. However, whether specific foods, such as vegetables and fruits, are associated with sarcopenia has not been studied. Objective: to examine the association of the frequency of vegetables and fruits consumption with sarcopenia in older people. Methods: this study used cross-sectional data from the Fourth Korea National Health and Nutrition Examination Survey in 2008–09. Subjects were community-dwelling 823 men and 1,089 women aged ≥65 years. Frequency of food group consumption was obtained by using the food frequency questionnaire. Body composition was measured with the dual-energy X-ray absorptiometry and sarcopenia was defined as appendicular lean mass adjusted for height and fat mass. Logistic regression was used to assess the association of the frequency of food group consumption with sarcopenia, controlling for sociodemographics and health-related variables. Results: dietary intake of vegetables, fruits and both vegetables and fruits was associated with a significantly reduced risk of sarcopenia after controlling for covariates in men (P= 0.026 for trend, P= 0.012 for trend, P= 0.003 for trend, respectively). Men in the highest quintile, compared with those in the lowest quintile, of vegetables [odds ratio (OR) = 0.48; 95% confidence interval (CI): 0.24–0.95], fruits (OR = 0.30; 95% CI: 0.13–0.70) and vegetables and fruits consumption (OR = 0.32; 95% CI: 0.16–0.67) demonstrated a lower risk of sarcopenia. In women, high consumption of fruits demonstrated a lower risk of sarcopenia (OR = 0.39; 95% CI: 0.18–0.83). Conclusion: frequent vegetables and fruits consumption was inversely associated with sarcopenia in older adults.
TL;DR: Assessing the attitudes of older people in East Midlands through the development and administration of a survey found that although a third of the respondents were in favour of discussing ACP if the opportunity was available with their GP, only a relative minority had actively engaged.
Abstract: Background: advance care planning (ACP) is a process to establish an individual's preference for care in the future; few UK studies have been conducted to ascertain public attitudes towards ACP.Objective: the aim of this study was to assess the attitudes of older people in East Midlands through the development and administration of a survey.Design: the survey questionnaire was developed on the basis of a literature review, exploratory focus groups with older adults and expert advisor input. The final questions were then re-tested with lay volunteers.Setting: thirteen general practices were enrolled to send out surveys to potential participants aged 65 or older. There were no additional inclusion or exclusion criteria for participants.Methods: simple descriptive statistics were used to describe the responses and regression analyses were used to evaluate which items predicted responses to key outcomes.Results: of the 5,375 (34%) community-dwelling older peoples, 1,823 returned questionnaires. Seventeen per cent of respondents had prepared an ACP document; of whom, 4% had completed an Advance Decision to Refuse Treatment (ADRT). Five per cent of respondents stated that they had been offered an opportunity to talk about ACP. Predictors of completing an ACP document included: being offered the opportunity to discuss ACP, older age, better physical function and male gender. Levels of trust were higher for families than for professionals. One-third of the respondents would be interested in talking about ACP if sessions were available.Conclusion: although a third of the respondents were in favour of discussing ACP if the opportunity was available with their GP, only a relative minority (17%) had actively engaged. Preferences were for informal discussions with family rather than professionals.
TL;DR: There appear to be a class effect as well as dose-response relationship between the ACB and both outcomes, and future research should focus on understanding the relationship between ACBs and mortality, and cardiovascular disease and possibly minimising ACB load where feasible.
Abstract: Background: studies have raised concerns that medications with anticholinergic property have potential adverse effects on health outcomes Objectives: the objective of this study is to examine the prospective relationships between total anticholinergic burden (ACB) from medications and mortality, and cardiovascular disease (CVD) in a general population Design: observational study Setting: community cohort Subjects: we examined data collected from 21,636 men and women without cancer at the baseline who participated in a baseline survey 1993–97 in the European Prospective Investigation into Cancer (EPIC)-Norfolk They were followed until 2009/11 Methods: we performed Cox-proportional hazards models to determine the associations between total ACB and the subsequent risk of all-cause mortality and incident CVD during the follow-up Results: there were a total of 4,342 people died and 7,328 had an incident CVD during the study follow-up (total person years= 322,321 years for mortality and 244,119 years for CVD event) Compared with people with no anticholinergic burden (ACB=0), people with total ACB ≥3 from medications had hazards ratios of 183 (153, 220) and 217 (187, 252) for mortality and CVD incidence outcomes, respectively, after adjusting for potential confounders Repeating the analyses after excluding people with prevalent illnesses, and events occurring within the first 2 years of follow-up, only slightly attenuated the results Conclusion: there appear to be a class effect as well as dose–response relationship between the ACB and both outcomes Future research should focus on understanding the relationship between ACB and mortality, and cardiovascular disease and possibly minimising ACB load where feasible
TL;DR: Test the hypothesis that levels of perceived stress increase with increasing age and detect factors that may account for the association and health-related stress seems to play an important role in the association.
Abstract: Background psychological and health-related stressors often occur in advanced ages, but little is known about perceived stress in adults aged 65 and over. This study aimed to test the hypothesis that levels of perceived stress increase with increasing age and to detect factors that may account for the association. Methods a dementia-free cohort of 1,656 adults aged 66-97 years living at home or in institutions, participating in the Swedish National Aging and Care study, Kungsholmen (SNAC-K) was assessed for levels of perceived stress using the 10-item perceived stress scale (PSS). Results prevalence of high stress according to the top tertile of the population (PSS score 20+) was 7.8% in adults aged 81+ years, 7.5% in adults aged 72-78 and 6.2% in adults aged 66 years (P = 0.020). More women than men reported high stress, 8.3 versus 5.4% (P = 0.001). Levels of stress increased with increasing age (P = 0.001) in the linear regression model. This association remained after adjustment for demographic and psychosocial factors, but no longer was present after adjusting for health-related factors. Conclusion health-related stress is highly prevalent in older adults and seems to play an important role in the association between levels of perceived stress and age in older adults.
TL;DR: The finding that a walking programme is ineffective in preventing falls supports previous research and questions the suitability of recommending walking as a fall prevention strategy for older people.
Abstract: Background: walking is the most popular form of exercise in older people but the impact of walking on falls is unclear. This study investigated the impact of a 48-week walking programme on falls in older people. Methods: three hundred and eighty-six physically inactive people aged 65+ years living in the community were randomised into an intervention or control group. The intervention group received a self-paced, 48-week walking programme that involved three mailed printed manuals and telephone coaching. Coinciding with the walking programme manual control group participants received health information unrelated to falls. Monthly falls calendars were used to monitor falls (primary outcome) over 48 weeks. Secondary outcomes were self-reported quality of life, falls efficacy, exercise and walking levels. Mobility, leg strength and choice stepping reaction time were measured in a sub-sample (n= 178) of participants. Results: there was no difference in fall rates between the intervention and control groups in the follow-up period (IRR = 0.88, 95% CI: 0.60–1.29). By the end of the study, intervention group participants spent significantly more time exercising in general, and specifically walking for exercise (median 1.69 versus 0.75 h/week, P< 0.001). Conclusion: our finding that a walking programme is ineffective in preventing falls supports previous research and questions the suitability of recommending walking as a fall prevention strategy for older people. Walking, however, increases physical activity levels in previously inactive older people.
TL;DR: Limited high-quality data is provided to guide confident recommendations about optimal ED community transition strategies, highlighting a need to encourage better integration of researchers and clinicians in the design and evaluation process, and increased reporting.
Abstract: Background a decline in health state and re-attendance are common in people aged ≥65 years following emergency department (ED) discharge. Diverse care models have been implemented to support safe community transition. This review examined ED community transition strategies (ED-CTS) and evaluated their effectiveness. Methods a systematic review and meta-analysis using multiple databases up to December 2013 was conducted. We assessed eligibility, methodological quality, risk of bias and extracted published data and then conducted random effects meta-analyses. Outcomes were unplanned ED representation or hospitalisation, functional decline, nursing-care home admission and mortality. Results five experimental and four observational studies were identified for qualitative synthesis. ED-CTS included geriatric assessment with referral for post-discharge community-based assistance, with differences apparent in components and delivery methods. Four studies were included in meta-analysis. Compared with usual care, the evidence indicates no appreciable benefit for ED-CTS for unplanned ED re-attendance up to 30 days (odds ratio (OR) 1.32, 95% confidence interval (CI) 0.99-1.76; n = 1,389), unplanned hospital admission up to 30 days (OR 0.90, 95% CI 0.70-1.16; n = 1,389) or mortality up to 18 months (OR 1.04, 95% CI 0.83-1.29; n = 1,794). Variability between studies precluded analysis of the impact of ED-CTS on functional decline and nursing-care home admission. Conclusions there is limited high-quality data to guide confident recommendations about optimal ED community transition strategies, highlighting a need to encourage better integration of researchers and clinicians in the design and evaluation process, and increased reporting, including appropriate robust evaluation of efficacy and effectiveness of these innovative models of care.
TL;DR: The current findings suggest that aspects of sexual behaviour and quality of life were positively associated, and researchers are encouraged to consider aspects of sex and sexuality when exploring determinants of well-being in later life.
Abstract: Background: while sexual behaviours are potentially important for quality of life in older adults, they are under-researched. The current study examined associations between frequency and importance of sexual behaviours and quality of life in older adults. Method: one hundred and thirty-three participants (mean 74 years, SD = 7.1) provided information about the frequency with which they participated in six sexual behaviours and the perceived importance of these: touching/holding hands, embracing/hugging, kissing, mutual stroking, masturbating and intercourse. Participants also completed the WHO Quality of Life scale, providing an overall quality of life score, in addition to the domains of physical health, psychological health, social relationships and environment. Participants provided information on their marital status, living arrangements and self-reported health. Results: both the frequency and importance of sexual behaviours were moderately positively correlated with quality of life (r = 0.52 and 0.47, respectively, both P < 0.001). In separate regression analyses, the frequency of sexual behaviours was a significant predictor of quality of life in the social relationships domain (β = 0.225, P < 0.05), and the importance of sexual behaviours was associated with the psychological domain (β = 0.151, P < 0.05), independent of the presence of a spouse/partner and self-reported health. Conclusions: with ageing trends, a broader understanding of the factors that influence quality of life in older adults is increasingly important. The current findings suggest that aspects of sexual behaviour and quality of life were positively associated. Researchers are encouraged to consider aspects of sex and sexuality when exploring determinants of well-being in later life.
TL;DR: The VMS-tool plus age (VMS+) offers an efficient instrument to identify frail hospitalised older adults at risk for adverse outcome and in clinical practice, it is important to weigh costs and benefits of screening given the rather low-predictive power of screening instruments.
Abstract: Background: screening for frailty might help to prevent adverse outcomes in hospitalised older adults.
Objective: to identify the most predictive and efficient screening tool for frailty.
Design and setting: two consecutive observational prospective cohorts in four hospitals in the Netherlands.
Subjects: patients aged ≥70 years, electively or acutely hospitalised for ≥2 days.
Methods: screening instruments included in the Dutch Safety Management Programme [VeiligheidsManagementSysteem (VMS)] on four geriatric domains (ADL, falls, undernutrition and delirium) were used and the Identification of Seniors At Risk, the 6-item Cognitive Impairment Test and the Mini-Mental State Examination were assessed. Three months later, adverse outcomes including functional decline, high-healthcare demand or death were determined. Correlation and regression tree analyses were performed and predictive capacities were assessed.
Results: follow-up data were available of 883 patients. All screening instruments were similarly predictive for adverse outcome (predictive power 0.58–0.66), but the percentage of positively screened patients (13–72%), sensitivity (24–89%) and specificity (35–91%) highly differed. The strongest predictive model for frailty was scoring positive on ≥3 VMS domains if aged 70–80 years; or being aged ≥80 years and scoring positive on ≥1 VMS domains. This tool classified 34% of the patients as frail with a sensitivity of 68% and a specificity of 74%. Comparable results were found in the validation cohort.
Conclusions: the VMS-tool plus age (VMS+) offers an efficient instrument to identify frail hospitalised older adults at risk for adverse outcome. In clinical practice, it is important to weigh costs and benefits of screening given the rather low-predictive power of screening instruments.