Showing papers in "Gerontology and Geriatric Medicine in 2019"

Adherence to Exercise Programs in Older Adults: Informative Report.

Abstract: This informative report focuses on filling information gaps regarding adherence to physical activity and exercise in the health care spectrum of older adults (OA) and an overview of the benefits of physical activity for OA. Healthy People 2000, 2010, and 2020 are public health programs from the U.S. Department of Health and Human Services that set national goals and objectives for promoting health and preventing disease. The programs include 10 leading health indicators that reflect major health problems, which concern OA. Exercise and physical activity are among the most important factors affecting health and longevity, but exercise adherence is a significant hindrance in achieving health goals in the OA. Exercise adherence in OA is a multifactorial problem encompassing many biopsychosocial factors. Factors affecting adherence in the OA include socioeconomic status, education level, living arrangements, health status, pacemakers, physical fitness, and depression. Improving adherence could have a significant impact on longevity, quality of life, and health care costs.

Development of a Model on Determinants of Malnutrition in Aged Persons: A MaNuEL Project.

Abstract: In older persons, the origin of malnutrition is often multifactorial with a multitude of factors involved. Presently, a common understanding about potential causes and their mode of action is lacking, and a consensus on the theoretical framework on the etiology of malnutrition does not exist. Within the European Knowledge Hub "Malnutrition in the Elderly (MaNuEL)," a model of "Determinants of Malnutrition in Aged Persons" (DoMAP) was developed in a multistage consensus process with live meetings and written feedback (modified Delphi process) by a multiprofessional group of 33 experts in geriatric nutrition. DoMAP consists of three triangle-shaped levels with malnutrition in the center, surrounded by the three principal conditions through which malnutrition develops in the innermost level: low intake, high requirements, and impaired nutrient bioavailability. The middle level consists of factors directly causing one of these conditions, and the outermost level contains factors indirectly causing one of the three conditions through the direct factors. The DoMAP model may contribute to a common understanding about the multitude of factors involved in the etiology of malnutrition, and about potential causative mechanisms. It may serve as basis for future research and may also be helpful in clinical routine to identify persons at increased risk of malnutrition.

Prevalence and Incidence of Atrial Fibrillation and Other Arrhythmias in the General Older Population: Findings From the Swedish National Study on Aging and Care.

Abstract: Aim: To study the prevalence and cumulative incidence of arrhythmias in the general population of adults aged 60 and older over a 6-year period. Study Design and Setting: Data were taken from the S...

Patterns of Marijuana Use and Health Impact: A Survey Among Older Coloradans.

Abstract: Access to recreational and medical marijuana is common in the United States, particularly in states with legalized use. Here, we describe patterns of recreational and medical marijuana use and self-reported health among older persons using a geographically sampled survey in Colorado. The in-person or online survey was offered to community-dwelling older persons aged above 60 years. We assessed past-year marijuana use including recreational, medical, or both; methods of use; marijuana source; reasons for use; sociodemographic and health factors; and self-reported health. Of 274 respondents (mean age = 72.5 years, 65% women), 45% reported past-year marijuana use. Of these, 54% reported using marijuana both medically and recreationally. Using more than one marijuana method or preparation was common. Reasons for use included arthritis, chronic back pain, anxiety, and depression. Past-year marijuana users reported improved overall health, quality of life, day-to-day functioning, and improvement in pain. Odds of past-year marijuana use decreased with each additional year of age. The odds were lower among women and those with higher self-reported health status; odds of use were higher with past-year opioid use. Older persons with access to recreational and medical marijuana described concurrent use of medical and recreational marijuana, use of multiple preparations, and overall positive health impacts.

Determinants of Seasonal Influenza Vaccine Uptake Among the Elderly in the United States: A Systematic Review and Meta-Analysis:

Abstract: Background: Despite the availability of a universal influenza vaccination program in the United States and Canada, seasonal influenza vaccine (SIV) uptake among the elderly remains suboptimal. Understanding the factors that determine SIV uptake in this important population subgroup is essential for designing effective interventions to improve seasonal influenza vaccination among the elderly. We evaluated the determinants of SIV uptake in the elderly in the United States and Canada. Methods: We systematically searched relevant bibliographic databases and websites from 2000 to 2017 for population-based clinical trials or observational studies conducted in community-based elderly individuals in the United States or Canada, irrespective of health status. Two reviewers independently screened the identified citations for eligibility using a two-stage sifting approach to review the title/abstract and full-text article. We gathered data on determinants of uptake (any vaccine receipt) and adherence (receipt of vaccine in more than one season) to seasonal influenza vaccination. Where possible, we pooled the data using inverse variance methods to minimize the variance of the weighted average. Results: Five cross-sectional studies on SIV uptake (none on adherence) from the United States met our eligibility criteria. Being older (pooled odds ratio [POR] = 1.44, 95% Confidence Interval [CI] = 1.11, 1.86); White (POR = 1.33, 95% CI = [1.10, 1.64]); and having higher income (POR = 1.06, 95% CI = [1.04, 1.09]); and health insurance (POR = 1.40, 95% CI = [1.25, 1.55]) were associated with increased SIV uptake. Conclusion: Older, ethnically White, higher income elderly individuals with access to health insurance coverage and a regular health care provider have higher SIV uptake in the United States. There was limited evidence for other socioeconomic and health-related determinants. Further studies are needed to provide an evidence base for planning more effective influenza vaccination programs in the United States.

Cognitive Function and Digital Device Use in Older Adults Attending a Memory Clinic.

Abstract: This study investigated cognitive function in relation to the use of a computer and a touchscreen device among older adults attending a memory clinic. The entire sample (n = 323) was categorized into four profiles, according to the frequency of digital device use (either daily or non-daily usage). Results showed that on a daily basis, 26% of the sample used both a computer and a touchscreen device, 26.9% used only a computer, 7.1% used only a touchscreen device, and 39.9% used neither type of digital device. There were significant group differences on age, education, and clinical diagnosis (p < .001). Non-daily users of digital devices had significantly lower performance, compared with daily users of both types of digital device, on measures of global cognitive function, processing speed, short-term memory, and several components of executive function (p < .001). Falling behind with regard to the use of digital devices might reflect underlying poor cognitive capacities.

An Exploration of Virtual Reality Use and Application Among Older Adult Populations.

Abstract: Despite increased research on virtual reality (VR) platforms in recent years, there are very few studies that specifically examine its application within a gerontological context. This study examines the usability, preferences, and application considerations of a mobile VR platform by individually interviewing community-dwelling older adults both before and after trying the Samsung Gear VR. Participants were asked to self-select and view short VR videos (30 s-3 min) that were filmed within the local community (e.g., walking path and art museum). Semi-structured interview questions explored participant perceptions of using the device and was followed with two focus group sessions. Thematic analysis was employed when reviewing observational notes and transcribed audio recordings. Ten adults (aged 63-89) participated and themes identified include (a) usability, (b) video subject matter preferences, and (c) application. These themes highlighted both the challenges and opportunities of VR use among a wide range of older populations and provided greater insight with its exploration and application in future studies. This included potential use among those older adults who have notable functional limitations, such as those who are immobile, or reside within a care facility.

Advancing long-term care science through using common data elements: candidate measures for care outcomes of personhood, well-being, and quality of life

Abstract: To support the development of internationally comparable common data elements (CDEs) that can be used to measure essential aspects of long-term care (LTC) across low-, middle-, and high-income countries, a group of researchers in medicine, nursing, behavioral, and social sciences from 21 different countries have joined forces and launched the Worldwide Elements to Harmonize Research in LTC Living Environments (WE-THRIVE) initiative. This initiative aims to develop a common data infrastructure for international use across the domains of organizational context, workforce and staffing, person-centered care, and care outcomes, as these are critical to LTC quality, experiences, and outcomes. This article reports measurement recommendations for the care outcomes domain, focusing on previously prioritized care outcomes concepts of well-being, quality of life (QoL), and personhood for residents in LTC. Through literature review and expert ranking, we recommend nine measures of well-being, QoL, and personhood, as a basis for developing CDEs for long-term care outcomes across countries. Data in LTC have often included deficit-oriented measures; while important, reductions do not necessarily mean that residents are concurrently experiencing well-being. Enhancing measurement efforts with the inclusion of these positive LTC outcomes across countries would facilitate international LTC research and align with global shifts toward healthy aging and person-centered LTC models.

Understanding user involvement in research in aging and health

Abstract: User involvement in research is advocated as an avenue for efficient societal developments. In this article, we identify potentials, problems, and challenges related to research on aging and health ...

Understanding Contextual Differences in Residential LTC Provision for Cross-National Research: Identifying Internationally Relevant CDEs.

Abstract: Long-term care (LTC) reflects a growing emphasis on person-centered care (PCC), with services oriented around individuals' needs and preferences. Addressing contextual and cultural differences acro ...

Do Race and Everyday Discrimination Predict Mortality Risk? Evidence From the Health and Retirement Study.

Abstract: Everyday discrimination is a potent source of stress for racial minorities, and is associated with a wide range of negative health outcomes, spanning both mental and physical health. Few studies ha...

Current Engagement in Advance Care Planning in Japan and Its Associated Factors.

Abstract: Using the Ministry of Health, Labour and Welfare national data on perspectives toward medical care at the end of life, this study examined the current status of engagement in advance care planning (ACP) activities among physicians and nurses in Japan and associated factors. Only 28.7% of physicians and 27.6% of nurses answered that they were engaging their patients/clients in ACP. Multinomial regression analysis revealed that more frequent involvement in caring for dying patients was associated with ACP engagement for both physicians and nurses. Increased years of clinical practice experience and working in a hospital were associated with decreased likelihood of nurses' ACP engagement. Completion of training designed to promote patient self-determination at the end of life was associated with both physicians' and nurses' ACP engagement. It is recommended that health care professionals be encouraged to complete such training to promote patients' autonomy through ACP.

Toward Comprehensive Medicine: Listening to Spiritual and Religious Needs of Patients:

Abstract: Although great progress has been made in medicine, the spiritual and religious needs of patients have been slow to be acknowledged as a core principle of professional practice and care at end of life. Spiritual care, once regarded as the sole province of chaplains, has recently become increasingly recognized as part of a holistic management approach and the responsibility of all health care professionals. Almost two decades after the appearance of first recommendations, doctors still find it difficult to initiate discussions on religion and spirituality with their patients. In a local survey we conducted among junior doctors and nursing staff, only 2% of doctors would regularly enquire, whereas more than 50% never asked about religion. It appears that doctors are generally poorly prepared to tackle this issue, both during their medical student years and later as trainees. We present a case study that illustrates the intricacies of trying to deliver comprehensive care to an elderly patient with a potentially life-ending condition where the cultural, personal, and religious opinion of the relatives have played an important role in the patient's management. We then discuss the results of our survey and explore the literature as to why doctors, in particular, tend not to enquire about the religion and spirituality of their patients.

Older Women’s Experiences of Aging and Health: An Interpretive Phenomenological Study:

Abstract: Objective: This interpretive phenomenological study explored older Irish women's experiences of aging and health related issues. Method: Data were collected using in-depth interviews with 23 older women (coresearchers). Data analysis followed the "Vancouver school of doing phenomenology" framework and included a meta-synthesis of individual case constructions. Results: "Retaining autonomy within a process of adaptation and continued engagement" describes the essential meaning of coresearchers' experiences. Four themes were identified: "Being in control: Balancing needs and supports," "Navigating a changing world," "Being connected and involved," "Trying to stay well." Discussion: Gender shapes older women's experience of aging, health, and ill health. Three major factors moderate their experience: autonomy and control, proactivity and adaptability, and staying engaged with life. The study concludes that aging, gender, and health are intrinsically linked and collectively shape older women's experience. This is an important consideration when planning gender-appropriate health care services for older women.

Person-Centered Dementia Care in China: A Bilingual Literature Review.

Abstract: We conducted a bilingual literature review of the existing studies focusing on person-centered dementia care in China. We synthesized key findings from included articles according to three overarching themes: Chinese cultural relevance of person-centered care (PCC), perceived needs for PCC for older adults in China, implementation and measurement of PCC in China, and person-centered dementia care model. We also drew on frameworks, theories, and other contents from the examined articles to develop a person-centered dementia care model with specific relevance to China. The model is a good starting point to help us operationalize globally relevant core principles of PCC in the specific sociocultural context of China. The framework will be informed by more empirical studies and evolve with the ongoing operationalization of PCC. Although PCC is a new concept and has not been vigorously or systematically studied in China, it is attracting increasing attention from Chinese researchers. More empirical studies are needed to link PCC to measurable outcomes, enrich the framework for applying PCC, and construct assessment and evaluation systems to facilitate the provision of PCC across countries and cultures. Global consortia and collaborations with multidisciplinary expertise to develop a PCC common data infrastructure that is internationally relevant for data sharing and comparison are needed.

Association Between Public Transportation Use and Loneliness Among Urban Elderly People Who Stop Driving.

Abstract: Aim: To examine the association between public transportation use and loneliness in urban elderly who stop driving. Methods: In this cross-sectional study, we assessed 31 community-dwelling older adults who had stopped driving. Public transportation use was assessed by using frequency and divided into two groups. The users group was participants who used public transportation more than once a week and the nonusers group was participants who used public transportation less than once a week. Loneliness was measured using the Japanese version of the UCLA Loneliness Scale version 3 (UCLA.LS.ver3), with a higher score indicating greater loneliness. The independent t test was used to compare the UCLA.LS.ver3 scores between users and nonusers group. A multiple linear regression model was used with the UCLA.LS.ver3 score as the objective variable and public transportation use as the explanatory variable. Results: The UCLA.LS.ver3 score was significantly higher in the nonusers group than in the users group (nonusers group: 12.7 ± 1.9; users group: 10.1 ± 2.9, p = .017). After adjustments, public transportation use was significantly associated with lower loneliness (β = -2.55, p = .029). Conclusion: Public transportation use might have important role to prevent loneliness in older adults who stop driving.

Assessment of Comorbidity and Use of Prescription and Nonprescription Drugs in Patients Above 65 Years Attending Family Medicine Outpatient Clinics

Abstract: Background and aim: Aging is often accompanied by chronic diseases, comorbidity, and polypharmacy. Use of prescription/nonprescription drugs, and over-the-counter (OTC) drugs seen frequently in the...

In Vivo Imaging of Molecular Clearance From Human Entorhinal Cortex: A Possible Method for Preclinical Testing of Dementia.

Abstract: Accumulation in the brain of metabolic waste products such as amyloid-β and hyperphosporylated tau (tau) is a hallmark of dementia (e.g., Alzheimer’s disease). One possible underlying mechanism is ...

Closing the Gap in Hospice Utilization for the Minority Medicare Population

Abstract: Background: Medicare spends about 20% more on the last year of life for Black and Hispanic people than White people. With lower hospice utilization rates, racial/ethnic minorities receive fewer hospice-related benefits such as lesser symptoms, lower costs, and improved quality of life. For-profit hospices have higher dropout rates than nonprofit hospices, yet target racial/ethnic minority communities more through community outreach. This analysis examined the relationship between hospice utilization and for-profit hospice status and conducted an economic analysis of racial/ethnic minority utilization. Method: Cross-sectional analysis of 2014 Centers for Medicare & Medicaid Services (CMS), U.S. Census, and Hospice Analytics data. Measures included Medicare racial/ethnic minority hospice utilization, for-profit hospice status, estimated cost savings, and several demographic and socioeconomic variables. Results: The prevalence of for-profit hospices was associated with significantly increased hospice utilization among racial/ethnic minorities. With savings of about $2,105 per Medicare hospice enrollee, closing the gap between the White and racial/ethnic minority populations would result in nearly $270 million in annual cost savings. Discussion: Significant disparities in hospice use related to hospice for-profit status exist among the racial/ethnic minority Medicare population. CMS and state policymakers should consider lower racial/ethnic minority hospice utilization and foster better community outreach at all hospices to decrease patient costs and improve quality of life.

Engaging Older Adults With Parkinson’s Disease in Physical Activity Using Technology: A Feasibility Study:

Abstract: Parkinson's disease (PD), a progressive neurodegenerative disorder, presents unique and daily challenges. Living with PD may limit one's physical activity and negatively affect quality of life (QOL). No studies were identified that utilized online technology to promote health in this population. The purposes of this study were to (a) assess the feasibility of an intervention that requires wearing a physical activity tracker and participating in an online support group, and (b) examine the effect of this intervention on the self-efficacy for physical activity and QOL of older adults with PD. A 12-week longitudinal pretest/posttest design was used to assess physical activity, engagement in an online support group, self-efficacy, and QOL. A postintervention questionnaire was used to capture the participants' (n = 5) experience using the physical activity tracker and an electronic tablet to engage in an online support group. The sample size of this feasibility study precluded robust quantitative analysis of QOL or self-efficacy. Findings from the open-ended questionnaire suggest technology was challenging for most participants, yet it did provide social support. Teaching effective interventions to promote self-management for increasing physical activity, and consequently improving QOL, is recommended. While technology can assist, older persons with PD may experience technological challenges.

Integration of Geriatrician Consultation for Trauma Admissions May Benefit Patient Outcomes.

Abstract: Objective: Geriatric admissions to trauma centers have increased, and in 2013, our center integrated geriatrician consultation with the management of admitted patients. Our goal is to describe our experience with increasing geriatric fall volume to help inform organized geriatric trauma programs. Method: We retrospectively analyzed admitted trauma patients ≥65 years old, suffering falls from January 1, 2006, to December 31, 2017. We examined descriptive statistics and changes in outcomes after integration. Results: A total of 1,335 geriatric trauma patients were admitted, of which 1,054 (79%) had suffered falls. Falls increased disproportionately (+280%) compared with other mechanisms of injury (+97%). After 2013, patient discharge disposition to skilled nursing facility decreased significantly (-67%, p < .001), with a concomitant increase in safe discharges home with outpatient services. Regression analysis revealed association between integration of geriatrician consultation and outcomes. Discussion: Geriatrician consultation is associated with optimized discharge disposition of trauma patients. We recommend geriatrician consultation for all geriatric trauma activations.

Illness Management in Older Lesbian, Gay, Bisexual, and Transgender Couples: A Review.

Abstract: More openly sexually and gender diverse people are aging into later life across the world as generational transitions occur. People identifying many different ways beyond cisgender and heterosexual are diverse with respect to many other characteristics and sociopolitical locations across the globe and may thus experience a wide array of health journeys both individually and as partners in intimate relationships. In this review article, we summarize the major contributions of and ongoing gaps in existing studies about such couples' experiences of chronic disease management in later life. We focus on three key groups of findings from prior research about the health of older sexually and/or gender diverse couples: care practices, unmet needs, and diverse resources. We outline priorities for future research within and across these topic areas and in varied locations, with unique recommendations for scholars in both academic and clinical settings. These recommendations support greater integration of such populations, topics, and needs in existing discourse on aging and late life. Likewise, recommendations from this review illuminate potential best practices for engaging and serving these elders in both academic and applied settings.

Identification of Frailty in Primary Care: Feasibility and Acceptability of Recommended Case Finding Tools Within a Primary Care Integrated Seniors' Program.

Abstract: Background: Case finding for frailty is recommended as part of routine clinical practice. We aimed to test feasibility and acceptability of three recommended case finding tools in primary care as part of an integrated seniors' program. Method: Program of Research to Integrate Services for the Maintenance of Autonomy-7 (PRISMA-7), 4-m walk test, and electronic frailty index (eFI) were used as frailty case finding tools for a target population of community-dwelling seniors ≥65 years of age enrolled in a seniors' program within an academic primary care clinic in Alberta, Canada. Feasibility was measured by percent completion rate and requirements for training/equipment/space/time, and acceptability by health care providers was measured using focus groups. Results: Eighty-five patients underwent case finding and 16 health care providers participated in the focus groups. Completion rate for PRISMA-7, 4-m walk test, and eFI was 97.6%, 93%, and 100%, respectively. No special training or equipment was required for PRISMA-7; brief training, equipment, and space were required for 4-m walk test. Both tools took less than 5 min to complete. Despite eFI requiring 10 to 20 min/patient chart, providers found it less intrusive. Conclusion: Despite feasibility of the tests, acceptance was higher for tools with minimal clinic interruption, low requirements for resources, and those with added benefit.

Physical Activity and Brain Health: An Analysis of Messages From Organizations and Caregiver Perceptions.

Abstract: Growing research suggests regular physical activity as a strategy for reducing risk of Alzheimer's disease (AD); however, there is little research available regarding public messages about the connection between physical activity and brain health. This study aimed to (a) examine the volume and content of regular physical activity and brain health messages being distributed by national organizations, and (b) explore how informal caregivers perceive and comprehend brain health messages. Methods included (a) a content analysis of 155 online documents related to physical activity and aging that were located on national physical activity organizations' websites, and (b) a thematic analysis of transcripts and observer notes from two focus groups with 10 informal caregivers recruited at a support organization for AD caregivers in the southeastern United States. Content analysis results revealed limited information about the physical activity and brain health connection. Focus group results revealed that caregivers had limited exposure to information about the physical activity and brain health connection and were concerned about the credibility of this information. Further research is needed regarding brain health and physical activity messages and the potential benefits of collaboration among physical activity organizations, researchers, and health care professionals in delivering consistent and credible messages to the public.

The Impact of Leadership and Psychosocial Work Environment on Recipient Satisfaction in Nursing Homes and Home Care.

Abstract: This study examines the association between nursing assistants' assessment of leadership, their psychosocial work environment, and satisfaction among older people receiving care in nursing homes and home care. Cross-sectional surveys were conducted with nursing assistants (n = 1,132) and people receiving care (n = 1,535) in 45 nursing homes and 21 home care units. Direct leadership was associated with the psychosocial work environment in nursing homes and home care. Furthermore, better leadership was related to higher satisfaction among nursing assistants and older people in nursing homes. Thus, indirect leadership had no effect on recipients' satisfaction in either nursing homes or home care. The path analysis showed an indirect effect between leadership factors and recipient satisfaction. The findings suggest that the psychosocial work environment of nursing assistants and recipient satisfaction in nursing homes can be increased by improving leadership.

What Matters at the End of Life: A Qualitative Study of Older Peoples Perspectives in Southern Denmark.

Abstract: What matters at the end of life (EOL) among the older population in Denmark is poorly investigated. We used focus groups and in-depth interviews, to identify perspectives within the EOL, along with what influences resuscitation, decision making, and other treatment preferences. We included eligible participants aged ≥65 years in the Region of Southern Denmark. Five focus groups and nine in-depth interviews were conducted, in total 31 participants. We found a general willingness to discuss EOL, and experiences of the process of dying were present among all participants. Three themes emerged during the analysis: (a) Being independent is crucial for the future, (b) Handling and talking about the EOL, and (c) Conditions in Everyday Life are Significant. Life experiences seemed to affect the degree of reflection of EOL and the decision-making process. Knowing your population of interest is crucial, when developing an approach or using an advance care plan from another setting.

Memory and Confusion Complaints in Visually Impaired Older Adults: An Understudied Aspect of Well-Being.

Abstract: Objective: To determine the prevalence of cognitive (memory or confusion) complaints in older adults with visual impairment (VI). Method: We assessed the relationship between VI (corrected visual a...

Prevalence and Patterns of Health Care Use Among Poor Older People Under the Livelihood Empowerment Against Poverty Program in the Atwima Nwabiagya District of Ghana.

Abstract: In spite of the growing literature on prevalence and patterns of health care use in later life globally, studies have generally overlooked subjective standpoints of vulnerable Ghanaian older people obstructing the achievement of the United Nations' health-related Sustainable Development Goals. We examined the prevalence and patterns of health care use among poor older people in the Atwima Nwabiagya District of Ghana. Cross-sectional data were obtained from an Aging, Health, Lifestyle and Health Services Survey conducted between June 1 and 20, 2018 (N = 200). Chi-square and Fisher's exact tests were carried out to estimate the differences between gender and health care utilization with significant level of less than or equal to 0.05. Whereas, 85% of the respondents utilized health care, females were higher utilizers (88% vs. 75%) but males significantly incurred higher health care expenditure. The majority utilized health services on monthly basis (38%) and consulted public health care providers (77%). While 68% utilized services from hospitals, most sourced health information from family members (54%) and financed their health care through personal income (45%). The study found that the Livelihood Empowerment Against Poverty grant played a little role in reducing health poverty. Stakeholders should review social programs that target poor older people in order to improve their well-being and utilization of health care.

The Impact of a Cycled Lighting Intervention on Nursing Home Residents: A Pilot Study.

Abstract: Purpose:Achieving adequate levels of illumination to stimulate the circadian system can be difficult in a nursing home. The aim of this study was to examine the impact that a 4-week cycled lighting...