Tämän tutkimuksen tavoitteena oli kuvata asukaslähtöisiä tekijöitä, jotka ovat yhteydessä palveluasumisessa asuvien iäkkäiden asumistyytyväisyyteen. Tutkimus oli poikkileikkauksena toteutettava kyselytutkimus. Tutkittavat olivat Uudenmaan alueen palveluasumisyksiköissä asuvia iäkkäitä (n = 842). Vastaajista 86 prosenttia oli tyytyväisiä nykyiseen asuinpaikkaansa. Korkeampi ikä, hyvät sosiaaliset suhteet ja mielen hyvinvointi olivat yhteydessä parempaan asumistyytyväisyyteen. Vastaavasti yksinäisyys ja masennuksen kokemus olivat yhteydessä huonompaan asumistyytyväisyyteen. Asumistyytyväisyys oli parempi, mikäli iäkäs itse oli saanut osallistua asuinpaikkansa valintaan. Vaikka iäkkäiden asumispalvelut näyttäytyvät julkisessa keskustelussa usein kielteisessä valossa, ovat iäkkäät asukkaat kuitenkin valtaosin tyytyväisiä asuinpaikkoihinsa. Asumistyytyväisyys on tärkeä asumispalveluiden laadun mittari ja sen edistämiseksi tulisi työskennellä. Older residents are satisfied with their service housing – which factors are associated with this? The aim of the study was to describe factors associated with residential satisfaction among older people living in assisted living facilities. The study was a cross-sectional postal survey. The participants were older residents (n = 842) living in assisted living facilities in the Uusimaa region. Eighty-six percent of respondents were satisfied with their current place of residence. Higher age, good social relationships, and mental well-being were associated with better residential satisfaction. Conversely, loneliness and experiencing depression were associated with poorer residential satisfaction. Residential satisfaction was also improved if the older person had been involved in choosing their place of residence. Although residential care of older people is often viewed negatively in public discourse, most older residents are satisfied with their current living arrangements. Residential satisfaction is an important measure of the quality of housing services and should be actively promoted.
Ikääntyneiden perhehoidosta on kehittymässä merkittävä osa vanhuspalveluja. Tutkittua tietoa puuttuu siitä, miten perhehoidon arki rakentuu ikääntyneiden hyvinvoinnin näkökulmasta sekä millaisia mahdollisuuksia ja esteitä ympäristö ja vuorovaikutus luovat heidän toiminnalleen. Tutkimuksen aineisto koottiin havainnoimalla yhdeksässä perhekodissa asuvan 39 ikääntyneen asukkaan arkea ja perhekodin ympäristöä. Lisäksi perhehoitajat kuvasivat omien havaintojensa perusteella asukkaan tyypillistä käyttäytymistä arjen tilanteissa. Aineisto analysoitiin ristiintaulukoimalla käyttäen χ²-testiä ja tuloksia täydennettiin laadullisilla muistiinpanoilla. Tulokset osoittivat perhehoidon vahvuuksiksi asukkaan kohtaamisen ja vuorovaikutuksen sekä iäkkään tavallista kotielämää muistuttavan ympäristön. Perhekodeissa oli eroja. Yleisimpiä haasteita olivat asukkaan autonomian toteutuminen sekä fyysisen aktiivisuuden vähäisyys. Asukkaalle erityisen hyvää oloa tuottaneet tilanteet liittyivät perhehoitajan ohjaamaan toimintaan ja vuorovaikutukseen, etenkin silloin, kun ne tukivat asukkaan identiteettiä. Perhehoidossa tavoitellaan mahdollisimman tavanomaista perheelämää. Tulokset vahvistavat käsitystä perhehoidon sopivuudesta myös ikääntyneelle, jonka kognitiivinen toimintakyky on heikentynyt. Tulevaisuudessa perhehoitoa kehitettäessä tulee huomioida ikääntyneen toimintakyvyn, perhehoitajan valmiuksien ja tavanomaisen perheelämän tasapainon löytäminen. Everyday life of older adults in a foster care home – an observational study on environment, interaction, and activities Adult foster care for aging adults is becoming a significant part of elderly services. However, there is a lack of research-based knowledge on how everyday life in adult foster care is implemented from the perspective of well-being of older adults, and what kinds of opportunities and obstacles the environment and social interactions create for their activities. The research data was collected by observing the daily lives of 39 elderly residents living in nine adult foster care homes, as well as the environment of these homes. Additionally, adult foster carers described the residents’ typical behavior in everyday situations based on their own observations. The data were analyzed quantitatively, and the results were supplemented with qualitative notes. The results highlight the strengths of adult foster care as the personal interaction of caregivers with residents and the home-like environment that resembles ordinary domestic life. Differences were found between the homes. The most common challenges were the realization of resident autonomy and the low level of physical activity. Situations that brought particular well-being to the residents were related to activities and interactions guided by the care providers, especially when these supported residents’ identities. Adult foster care aims to offer as ordinary family life as possible. The results reinforce the view that adult foster care is also suitable for elderly individuals with reduced cognitive abilities. In the future development of adult foster care, it is important to find a balance between the elderly person’s functional abilities, the adult foster carers’ competencies, and the characteristics of ordinary family life.
Muistisairauden alkuvaiheessa sairastuneella on monenlaisia tiedollisia ja sosiaalisia tarpeita, joihin palvelujärjestelmässä on pyritty vastaamaan erilaisilla toimintamalleilla ja tukimuodoilla. Toimintamalleja arvioivaa tutkimustietoa on kuitenkin ollut vasta vähän saatavilla. Tutkimuksen tavoitteena on tuottaa tietoa muistisairauteen sairastuneille suunnatun ryhmätoiminnan tuloksista, hyväksyttävyydestä ja toteutettavuudesta. Tuttavapiiri-ryhmätoiminta on tarkoitettu yksin asuville 60 vuotta täyttäneille henkilöille, jotka ovat saaneet hiljattain muistisairauksiin kuuluvan diagnoosin. Tutkimuksen aineistona ovat ryhmätoimintaan osallistuneilta kerätyt alku-, seuranta- ja palautekyselyt sekä ryhmätoiminnan ohjaajien kirjoittamat päiväkirja-aineistot. Ryhmätoiminnan tuloksia arvioitiin yksinäisyyden, osallisuuden ja turvallisuuden kokemuksissa havaittujen muutoksien sekä ryhmätoimintaan osallistumiseen liittyvien kokemuksien osalta. Tutkimuksen tuloksien mukaan yksinäisyydessä tai turvallisuudessa ei tapahtunut muutoksia ryhmätoimintaan osallistumisen aikana, mutta osallisuuden kokemus vahvistui. Ryhmätoimintaan osallistuneet kokivat keskeisinä hyötyinä sosiaalisen tuen sekä sairauden kanssa elämiseen liittyvät uudet oivallukset. Osallistumisesta kieltäytymisen tai osallistumisen keskeyttämisen taustalla oli heikko toimintakyky tai sairauden eteneminen, ryhmätoiminnan vaikea saavutettavuus tai kiinnostuksen ja motivaation puute. Ryhmätoiminnan toteutettavuuden kannalta keskeiset tekijät liittyivät osallistujien fyysiseen tai kognitiiviseen toimintakykyyn sekä ryhmätapaamisten sisältöihin ja toteutukseen. Evaluation of a group activities targeted at people with cognitive impairment - a mixed-method pilot study In the early stages of cognitive impairment, people have a wide range of informational and social needs, which the service system has sought to address through different types of support. However, there is a lack of research evaluating these approaches. The aim of this study is to provide knowledge on the outcomes, acceptability and feasibility of group activities for people with memory disorders. Tuttavapiiri group intervention is for people aged 60 and over living alone who have recently been diagnosed with some form of cognitive impairment. The data consists of baseline, follow-up and feedback surveys collected from group participants, and diary entries written by the group facilitators. The outcomes of the intervention were evaluated in terms of changes in loneliness, social inclusion and sense of security, and experiences of participation in the group activities. Results show that there were no changes in loneliness or sense of security during participation in the intervention, but the experience of social inclusion was strengthened. The main benefits experienced by the participants were social support and new insights into living with the memory disorder. Refusal or drop-out was due to poor functional ability or disease progression, difficult access to intervention, or lack of interest and motivation. The main factors affecting the feasibility of group activities were the physical or cognitive functioning of the participants and the content and delivery of the group sessions.
INTRODUCTION:Ischemic stroke (IS) remains a leading cause of global morbidity and mortality, necessitating novel therapeutic targets. MicroRNAs show promise in modulating post-stroke pathology, yet the role of miR-28-5p in IS remains unexplored. This study aimed to investigate miR-28-5p expression in IS and its clinical and mechanistic significance. METHODS:Serum miR-28-5p levels were quantified via qRT-PCR in 129 IS patients and 97 healthy controls. Kaplan-Meier (K-M) analysis and multivariate COX regression analysis evaluated the prognostic value of miR-28-5p in IS. In vitro, dual-luciferase assays validated the interaction between miR-28-5p and WNK3. Oxygen-glucose deprivation/reoxygenation (OGD/R)-treated HMC3 microglia were used to assess miR-28-5p/WNK3 axis in microglial polarization, oxidative stress, and inflammation. RESULTS:Serum miR-28-5p was significantly downregulated in IS patients, associated with elevated triglycerides, low-density lipoprotein cholesterol, reduced high-density lipoprotein cholesterol levels, and higher NIHSS scores. K-M analysis revealed a lower progression-free survival rate in IS patients with low miR-28-5p expression, and COX regression analysis confirmed miR-28-5p as an independent prognostic factor. In mechanism miR-28-5p directly targeted WNK3. Overexpression of miR-28-5p suppressed OGD/R-induced M1 polarization, oxidative stress (reduced malondialdehyde, elevated superoxide dismutase), and inflammatory cytokines (decreased TNF-α, IL-6, IL-1β, and increased IL-10), whereas WNK3 overexpression reversed these effects. CONCLUSION:MiR-28-5p served as a diagnostic biomarker and independent prognostic factor in IS. Its neuroprotection involved suppressing WNK3-mediated microglial M1 polarization, oxidative stress, and inflammation, highlighting its potential as a therapeutic target for IS.
Introduction: Optometrists, as primary eye care professionals working in the community, routinely provide consultations for older adults. Impaired vision significantly increases falls risk, positioning optometrists as important health service providers to address primary falls prevention. However, there is scarce evidence for how optometrists implement evidence-based falls prevention management. This study explored Australian community optometrists' understanding of falls prevention management and their perspectives on the barriers and enablers for implementing falls prevention management in their clinical practice. Methods: The study employed a qualitative descriptive design, using purposeful sampling to recruit Western Australian optometrists across metropolitan and rural primary eye care settings. Focus group discussions explored participants' knowledge of falls prevention, implementation experiences, and educational opportunities to improve implementation. Data were analyzed using inductive content analysis. Results: Four focus groups were conducted (N = 23, females = 12 and males = 11). Participants were predominantly early career optometrists (52% with 1-5 years of experience), 87% were aged under 40 and primarily practicing in metropolitan areas. The main category identified a substantial evidence-to-practice gap in optometrists' falls prevention management for older adults within primary eye care settings. Four generic categories contributed; perceived low levels of knowledge and awareness about falls prevention, sporadic integration into clinical practice, the need for an improved approach to collaboration within multidisciplinary teams, and hesitancy to undertake falls prevention management. Conclusion: Community optometrists had perceived low levels of knowledge about falls prevention and identified limited opportunities to implement falls prevention management. Suggestions to bridge this implementation gap included providing further education and promoting optometrists' engagement in multidisciplinary teams. Further research investigating how community optometrists can translate falls prevention evidence into practice is required.
Introduction: Falls are a serious problem for older adults, and as the number of older adults increases rapidly, the burden of falls is expected to continue rising. Reactive balance training is an important component of balance and fall-prevention exercise programmes in older people at elevated fall risk. Despite its effectiveness for improving reactive balance control and preventing falls, land-based RBT programs can be associated with increased risk of adverse events, including joint pain, fear, and anxiety that results in participants withdrawing from the program. A water environment could minimize the barriers associated with land-based RBT. The aim of this research was to determine the feasibility and preliminary effectiveness of aquatic reactive balance training (AquaReBal). Methods: Older adults (n = 12-15) will be recruited and will complete twelve sessions of AquaReBal over 6 weeks. Feasibility outcomes (fidelity, acceptability, adherence, safety) will be assessed throughout the study. Interviews with participants will be conducted post-training to understand participants' experiences with the intervention. Secondary outcomes related to falls - physical activity, psychological consequences, generic health-related quality of life, and reactive balance control - will be assessed pre- and post-training; however, given the small sample size, these measures will be treated as exploratory and are not powered to detect change with precision. Falls in daily life will be recorded throughout the study until 6 months post-training. Conclusion: Findings from this study will inform the feasibility and design of AquaReBal, contributing to the development of aquatic interventions for fall prevention in older adults.
INTRODUCTION:Walking speed is widely recognized as an informative indicator of physical capability in later life and is frequently used to evaluate mobility and functional health in older adults. Although the measurement of community walking speed (CWS) has been made possible using accelerometers, it is unclear whether discrepancies between laboratory walking speed (LWS) and CWS make a difference in predicting the incidence of future disabilities in older adults. Using data from the National Center for Geriatrics and Gerontology-Study of Geriatric Syndromes (NCGG-SGS), we examined whether LWS and CWS each independently predict incident disability. The discrepancy was defined as the difference between LWS and CWS, and we further analyzed the characteristics of older adults who exhibited such discrepancies. METHODS:Participants comprised 1,631 older adults (mean age = 70 years; 62.7% women). LWS was measured using a WalkWay device that measures the distribution of foot pressure during walking. CWS was derived using a model that estimated gait speed based on composite acceleration calculated from the mean triaxial acceleration within a single gait cycle. Participants were instructed to wear a triaxial accelerometer for at least 14 days. The incidence of disability was prospectively determined for 5 years. RESULTS:The Cox proportional hazards regression models revealed a statistically significant association between the z scores of LWS (hazard ratio [HR], 0.54; 95% confidence interval [CI], 0.41-0.72) and CWS (HR, 0.59; 95% CI, 0.41-0.83) and disability incidence. There were no statistically significant interactions between LWS and CWS for disability (HR, 1.00; 95% CI, 0.76-1.31). The area under the receiver operating characteristics curve of the LWS and CWS was 0.752 and 0.709, respectively. Regarding discrepancies between the fast LWS group and the fast CWS group, residual analysis showed that the fast LWS group had a higher proportion of women than the fast CWS group. CONCLUSION:LWS and CWS were found to be independently associated with disability. Further research must determine how CWS should be interpreted because participants who showed discrepancies between CWS and LWS did not exhibit a significant association with incident disability. Healthcare providers could use either CWS and LWS as a significant indicator in healthcare practice for older populations.
INTRODUCTION:In response to the rapidly growing elderly population, geriatric syndromes such as frailty, polypharmacy, and sarcopenia have gained significant attention due to their impact on aging-related health outcomes. To prevent functional decline, it is crucial to understand the relationship between physical performance and other potential confounding factors. This study aims to investigate how polypharmacy and other factors relate to physical performance. METHODS:This cross-sectional study included 445 participants aged over 20, surveyed via questionnaire. Polypharmacy was defined as the daily use of 8 or more pills. Body composition was assessed using bioelectrical impedance analysis, and physical performance was measured via the Time-Up-and-Go (TUG) and five times Sit-to-Stand (5xSTS) tests. RESULTS:The average age of participants was 64.22 years, with 11.0% on polypharmacy. The mean appendicular skeletal muscle mass index, TUG test, and 5xSTS test were 7.40 kg/m2, 8.29 seconds, and 9.33 seconds, respectively. Both physical performance tests correlated positively with age, low education, and polypharmacy and negatively with appendicular skeletal muscle mass index. Polypharmacy, low muscle mass, and lower educational levels were associated with poorer physical performance. CONCLUSION:These findings highlight the importance of early prevention strategies to address polypharmacy, muscle loss, and low education, all of which are potentially modifiable risk factors. Poorer physical performance was linked to polypharmacy, low muscle mass, and lower educational levels, suggesting a need for additional research into these contributing risk factors.
Introduction: With the growing population of older adults, predicting survival through clinical examinations has gained an increased interest. We aimed to evaluate the relationship between balance measures, such as postural sway and voluntary stepping performance and survival. METHODS:This study analyzed balance parameters, collected from previous studies conducted between 2005 and 2011, including postural sway, stabilogram diffusion analysis (SDA) in standing, and voluntary step execution. Cox proportional hazards regression analyses were performed to examine associations between balance parameters and mortality. RESULTS:Voluntary stepping performance, especially under dual-task (DT) condition, was associated with survival. Slower step initiation time was associated with higher mortality risk; with every 0.100 s increase, the survival hazard rate ratios decreased by 28%. Postural sway parameters, particularly increase in anterior-posterior sway velocity, demonstrated predictive ability but less effective than voluntary stepping test parameters. Among SDA measures, higher critical displacement tended to show an association with lower survival in older adults. CONCLUSION:These findings align with prior research regarding physical performance indicators, such as gait speed, to survival. Voluntary stepping under DT conditions extends this understanding by capturing both physical and cognitive functions, offering a more integrated survival assessment. Voluntary stepping performance, in DT conditions, may be a valuable predictor of survival in older adults. Incorporating DT-based assessments into clinical evaluations could improve survival prediction and guide early interventions targeting cognitive-motor health. Future studies should explore the longitudinal impact of voluntary stepping on survival, assessing whether cognitive-motor training for balance rehabilitation can enhance survival rates. .
Introduction: Cognitive impairment represents critical public health challenges in aging societies. This study investigated periodontitis, depression, and biological aging's triadic effects on cognition. Methods: Structural equation modeling (SEM) and relative weight analysis (RWA) were applied to analyze data from 2011 to 2014 National Health and Nutrition Examination Survey (NHANES) (N = 1,816). Cognitive function, periodontitis, depression, and biological age (PhenoAge) were assessed with covariates adjustment. Results: SEM revealed periodontitis severity, depressive symptoms, and PhenoAge advancement exhibited significant direct associations with lower cognitive performance after covariate adjustment. Simultaneously, biological aging partially mediated the influence of both depression and periodontitis on cognitive outcomes. RWA showed dominated cognitive variance, while periodontitis, depression, and PhenoAge contributed significantly. Conclusion: This supports triadic interdependencies where biological aging partially mediates the associations between periodontitis/depression and cognition. Prioritizing periodontal care and mental health may mitigate cognitive decline, especially in low-resource settings.
INTRODUCTION:Falls are a major cause of morbidity and mortality in older people, and type 2 diabetes mellitus (T2DM) has been identified as a key contributor. Another factor associated with increased fall risk is inappropriate medication use (IMU), which includes the use of inappropriate drugs or the omission of indicated ones. However, the independent and combined effects of T2DM and IMU on fall risk in older people remain unclear. METHODS:This prospective observational study was conducted among inpatients aged 65 years and older in the internal medicine department of a tertiary hospital between November 2022 and February 2023. Sociodemographic data, Turkish Inappropriate Medication Use in the Elderly (TIME-to-START/STOP) Criteria, and the Itaki Fall Risk Scale were collected through face-to-face interviews conducted by the researcher. The study population was divided into two groups: group 1 (patients without T2DM, n = 50) and group 2 (patients with T2DM, n = 58). The effects of the independent variables on fall risk were analyzed using a multivariable logistic regression model (backward Wald method, Nagelkerke R square 62.0%) in IBM SPSS Statistics 26.0. A p value <0.05 was considered statistically significant. RESULTS:T2DM and age were significant predictors of fall risk ([B = 2.775, p = 0.047, OR = 16.035]; [B = 0.137, p = 0.010, OR = 1.147]). Among participants with T2DM, females had higher risk of falls compared with males (B = 2.573, OR = 13.158, p = 0.043). At least one IMU was present in 75.0% of the cases per TIME-to-START. Fall risk was significantly higher in group 2 and in male participants who did not meet "2+" TIME-to-START criteria ([B = 2.077, OR = 8,000, p = 0.014]; [B = 2.118, OR = 8.316, p = 0.006]). IMU was not a significant fall risk predictor in either group according to TIME-to-STOP. Both T2DM and IMU identified by TIME-to-START were significant predictors of high fall risk in older people. In addition to T2DM, age, and IMU, living arrangement and history of falls were significant predictors. However, the primary focus was on the independent and combined effects of T2DM and IMU. CONCLUSIONS:Our study demonstrated that both T2DM and IMU identified by TIME-to-START were significant predictors of increased fall risk in older people. This risk was especially pronounced in patients with T2DM who also had multiple instances of inappropriate medication. These findings suggest that careful medication management is particularly important for fall prevention in older T2DM patients.
INTRODUCTION:The hemoglobin-to-red cell distribution width ratio (HRR), which has demonstrated better predictive ability than the red blood cell distribution width (RDW) and hemoglobin level, has not been used to predict orthopaedic surgical outcomes and may be a novel prognostic parameter for mortality. METHODS:This is a retrospective cohort study, providing a Level of Evidence III. In this single-center cohort study, data of 363 patients (aged ≥60 years) who underwent surgery for fragility hip fracture at our institution between January 2016 and December 2018 were retrospectively analyzed. Multivariable Cox proportional hazards and Kaplan-Meier survival curve analyses were performed to compare the high and low HRR and RDW groups, divided based on cutoff values. The power of mortality prediction over time was assessed by comparing Harrell's concordance index using the bootstrapping method. RESULTS:Among the 363 patients, the overall mortality was 48.48% (176/363), with a mean ± standard deviation of 4.31 ± 2.09 (0.02-7.44) years. The HRR was significantly associated with all-cause mortality after hip fracture surgery (hazard ratio: 0.989; 95% confidence interval: 0.978-0.999; p = 0.044). Moreover, during the follow-up period after 1 year, the HRR demonstrated the second-highest predictive ability for mortality among all laboratory parameters and indicators reflecting the general condition, and it remained unaffected by anemia status for up to 4 years. CONCLUSION:The HRR is proposed as a novel prognostic indicator for mid- to long-term survival after hip fracture surgery in older patients.
