Objective. To determine whether there is an association between subclinical hypothyroidism and glycemic control in older adults who received care at the “Centro Médico Naval” from 2010 to 2015. Methods. This retrospective analytical study analyzed a secondary database of the care of elderly in the study hospital. The sample was comprised of 1,385 older adults. To detect an association between variables, the Poisson regression with robust variance was used at a significance level of 95%. The analyses were carried out with the STATA 16 program. Results. Of the elderly 45.6% were between 71 and 80 years old; 58.4% were women and 43.8% had a normal body mass index. There was evidence of inadequate glycemic control in 8.1% and subclinical hypothyroidism in 15.2% of the elderly patients. Subclinical hypothyroidism was more frequent in the inadequate glycemic control vs. adequate glycemic control populations (41.1% vs. 13.0%). In the multivariance analysis, subclinical hypothyroidism (aPR = 2.22 95% CI [1.47–3.36]) was independent factor associated with inadequate glycemic control (p < 0.001). Conclusions. A significant association was detected between subclinical hypothyroidism and inadequate glycemic control in older adults who presented at the “Centro Médico Naval” from 2010 to 2015.
Introduction:Retirement resources are considered one of the key determinants of well-being and coping with the challenging situations of retirement courses. Therefore, due to the lack of a valid questionnaire for research and practice at the national level as well as international comparisons, this study was conducted to translate the original retirement resources inventory into Persian and assess the validity and reliability of the Persian version. Materials and Methods:The research employed a cross-sectional descriptive methodological approach, beginning with translating the questionnaire into Persian. Psychometric properties were evaluated through face, content, construct validity, and reliability tests. 335 participants were involved in assessing construct validity, while 30 participants contributed to the internal consistency test, and 20 took part in the test-retest reliability test. Data analysis was performed using SPSS Version 26 and AMOS 24 software. Results:The exploratory factor analysis (EFA) revealed eight components with eigenvalues greater than 1, accounting for 46.68% of the variance, with no questions being removed. Confirmatory factor analysis (CFA) indicated that all items had a factor loading above 0.3, resulting in a final model with 35 items and eight factors, supported by fit indices (χ 2/df = 1.95, TLI: 0.87, IFI = 0.88, RMSEA = 0.05, GFI: 0.85). Reliability measures showed Cronbach's alpha coefficients ranging from 0.71 to 0.83 and an intraclass correlation coefficient (ICC) of 0.93. Conclusion:The study concludes that the Persian version of the RRI, encompassing 35 items across eight dimensions, is a valid and reliable tool for the Iranian retiree population. This validated inventory can be utilized in future national and international studies, particularly experimental ones, to develop well-being and retirement adjustment programs, thereby aiding in understanding and supporting Iranian retirees.
Methods:All English studies published after 1989 with a controlled design, investigating PE in adults 65 years and over were considered if the study design compared PE to a nonexercise control group. Health-related outcomes included physical, cognitive, and psychological function. Studies that investigated cardiorespiratory disease and used designs like systematic review were excluded. Results and Discussion. Altogether, 57 studies were included of which 38 had data that were useable for meta-analysis. In the healthy aged, a significant benefit of multicomponent exercises (p=0.006, SMD = 1.40, CI = 0.41, 2.40) and tai chi (p=0.01, MD = 0.51, CI = 0.12, 0.91) on physical function was revealed, while strength exercise benefitted cognitive function (p=0.04, SMD = 0.86, CI = 0.03, 1.68). In frail older adults, there was a significant benefit of multicomponent exercises on physical function (p < 0.0001, SMD = -10.85, CI = 5.66, 16.04) and mental health (p=0.0002, SMD = -0.39, CI=-0.18, 0.59). Strength exercise had a significant benefit on activity of daily living (ADL) (p < 0.0003, SMD = 15.78, CI = 7.28, 24.28). Conclusion:The substantial disparity of research in the field of exercise in older adults renders synthesis of the evidence problematic. However, it appears that multicomponent exercise is the most suitable approach for both healthy and frail older adults although the benefit may be reflected in different health outcomes.
Background Intrinsic capacity (IC) is conceptualized by World Health Organization (WHO) with a focus on healthy aging. Identifying impairment could help in making a person-centred plan for the care of older adults. Objectives Establish the prevalence of IC among community-dwelling older adults age >60, the prevalence of impairment in each domain, and identify factors associated with an impairment in IC. Methods This cross-sectional observational study in the community setting included 1000 older adults aged 60 years and above in two-year study period. The 6 domains of IC including cognition, locomotor capacity, psychological, vitality, hearing, and vision were derived from the comprehensive geriatric assessment. The IC composite score was calculated based on these domains, and a higher IC score indicated greater IC. Results During the study period, 1000 older adults, with the median age of 66.5 (IQR-63-73) were included, and 629 (62.9%) were women. Only in 157 (15.7%) community-dwelling older adults, all 6 domains were intact. Impairment in one, two, and three domains was seen in 442 (42.2%), 305 (30.5%), and 91 (9.1%), respectively. The most prevalent impaired domain was locomotor (593, 59.3%), followed by vision (441, 44.1%), hearing (193, 19.3%), cognition (106, 10.6%), mood (38, 3.8%), and vitality (37, 3.7%). The factors associated with lower IC included increasing age (β-coefficient −0.01, 95% CI: −0.02 to −0.01, p value = 0.002), impaired activities of daily living (β-coefficient −0.13, 95% CI: −0.49 to −0.18, p value <0.001), and chronic neurologic illness (β-coefficient −0.10, 95% CI: −0.77 to −0.18, p value = 0.001). Conclusions In conclusion, we found that impairment in IC was frequent in community-dwelling older adults, and it is associated with age, presence of chronic neurologic illness, and declining functionality. The adoption of IC should be seen as an opportunity to disseminate geriatric care in our healthcare systems which lack the necessary attention to the needs of older persons.
Objectives. To verify the prevalence of frailty in patients hospitalized with acute exacerbation of COPD; to compare two frailty assessment methods: Edmonton Scale and the Fried Frailty Phenotype, and to associate frailty with functioning in these patients. Methods. Patients hospitalized due to an acute exacerbation of COPD were included. The assessment of pulmonary function, frailty, and functioning was performed. Frailty assessment was performed by the Edmonton Scale and Fried Frailty Phenotype. Individuals were classified into “frail,” “pre-frail” and “non-frail.” Functioning was evaluated by the one sit-to-stand test. Results. Thirty-five individuals were included (17 male, 69 ± 9 years; FEV1/FVC 47 ± 10%; FEV1 34 (24–52) % predicted). Participants scored 3 (3-4) points on the Edmonton Scale and 7 (5–9) points on the Fried Frailty Phenotype. According to the Fried model, 17% were considered prefrail and 83% frail and in the Edmonton scale, 20% were classified as nonfrail, 29% prefrail, and 51% frail. There was a positive moderate correlation between the two methods (r = 0.42; p=0.011); however, there was no agreement between them (p=0.20). This probably occurs because they assess the same construct, i.e., frailty; however, they are different in their components. There was a negative and moderate correlation between the Fried Frailty Phenotype and functioning (r = −0.43; p=0.009). Conclusion. Most hospitalized individuals with exacerbated COPD with severe and very severe airflow limitation are frail and the assessment methods correlate, but there is no agreement. Additionally, there is association between frailty and functioning in this population.
Worldwide, the number of old adults will peak in the coming decades. Relying solely on the chronological age to make treatment decisions and shape general or specific societal and medical considerations may reinforce ageism and lead to flawed reasoning. Defining physiological age using biological markers is not yet reliable, and an approach based on comorbidities without considering their impact on quality of life is inadequate. A multidimensional approach with strong integration of functionality is presented here to draw a real-world aging approach, easily accessible, clinically relevant, and of societal value.
Background:Frailty refers to a decline in an elderly person's physical, psychological, and social functioning, making them sensitive to stressors. Because frailty is caused by a variety of factors, including certain demographic characteristics, understanding the mediating factors that affect frailty in the elderly is critical.Purpose:To provide evidence about the relationship between depression, well-being, social activity, physical performance, and frailty among older adults.Materials and Methods:The study used secondary data from Taiwan's Long-term Study of Aging (n = 7,622), excluding people with severe dementia. The chi-square test and Spearmen's coefficient correlation were used to assess the relationship between the demographic variables and frailty. Nonparametric bootstrapping analysis was used to test whether depression, well-being, and social activity are parallel mediators of the relationship between physical performance and frailty. This study was approved by Fu Jen Catholic University (FJU-IRB No. C110040).Results:The overall frailty prevalence was 13.9%. We calculated a mean score and standard deviation for each measurement in this study. The correlation found low-to-moderate positive and negative statistically significant correlations between the variables. A significant, moderately negative relationship was found between physical performance and frailty that correlated with three potential mediating factors. The path indicated that lower physical performance scores and higher depression scores are more likely to be associated with frailty.Conclusion:Older adults who are depressed are more likely to become frail. Adults who are more socially active and report greater well-being are less likely to become frail. Therefore, further research should design and test a comprehensive intervention for older adults in community settings that addresses all three factors, aimed at increasing well-being and social activity while also treating depression.
OBJECTIVE:This study aims to investigate an association between body postures and autonomic nervous system (ANS) responses through analysis of short-term heart rate variability (HRV) data obtained through electrocardiography.METHODS:Forty older individuals were recruited to form the sample. HRV measurements were taken in three positions-sitting, supine, and standing-and compared.RESULTS:Results demonstrated statistically significant differences in the HRV parameters used to examine the parasympathetic nervous system (PNS) and the sympathetic nervous system (SNS), specifically in the measurements obtained from the sitting position and the supine position (P < 0.001 for PNS and P = 0.011 for SNS). The differences in these parameters were, however, negligible between the sitting and the standing positions. Moreover, the ANS responses obtained in the sitting position were strongly and positively correlated with those in the standing position (r = 0.854 for PNS and r = 0.794 for SNS). These results suggested that the PNS and SNS parameters obtained while sitting were likely to be affected by orthostatic hypotension in much the same way as those in the standing position, as compared to the supine position.CONCLUSIONS:As such, sitting may not be the best position for older individuals in the assessment of their autonomic responses, whereas the supine position is recommended as the baseline posture in the old-age population. These findings are useful for future research in clinical settings that require accuracy in the ANS responses as determined by the HRV measurements.
BACKGROUND:Frailty potentially influences clinicians' decision making on treatment provided they can select the appropriate assessment tools. This study aims to investigate the difference between the FRAIL scale and the Clinical Frailty Scale (CFS) in assessing frailty among community-dwelling older adults attending the General Medical Clinic (GMC) in Seberang Jaya Hospital, Penang, Malaysia. METHODS:The medical records of 95 older patients (age ≥ 65) who attended the GMC from 16 December 2019 to 10 January 2020 were reviewed. Frailty was identified using the FRAIL scale and the CFS. Patient characteristics were investigated for their association with frailty and their difference in the prevalence of frailty by the FRAIL scale and CFS. RESULTS:The CFS identified nonsignificant higher prevalence of frailty compared to the FRAIL scale (21/95; 22.1% vs. 17/95; 17.9%, ratio of prevalence = 1.235, p=0.481). Minimal agreement was found between the FRAIL scale and the CFS (Kappa = 0.272, p < 0.001). Three out of 5 components of the FRAIL scale (resistance, ambulation, and loss of weight) were associated with frailty by the CFS. Higher prevalence of frailty was identified by the CFS in those above 70 years of age. The FRAIL scale identified more patients with frailty in ischaemic heart disease patients. CONCLUSION:Patient characteristics influenced the choice of the frailty assessment tool. The FRAIL scale and the CFS may complement each other in providing optimized care to older patients who attended the GMC.
Osteosarcopenic obesity (OSO) describes the concurrent presence of obesity, low bone mass, and low muscle mass in an individual. Currently, no established criteria exist to diagnose OSO. We hypothesized that obese individuals require different cut-points from standard cut-points to define low bone mass and low muscle mass due to their higher weight load. In this study, we determined cutoff values for the screening of osteosarcopenia (OS) in obese postmenopausal Malaysian women based on the measurements of quantitative ultrasound (QUS), bioelectrical impedance analysis (BIA), and functional performance test. Then, we compared the cutoff values derived by 3 different statistical modeling methods, (1) receiver operating characteristic (ROC) curve, (2) lowest quintile of the study population, and (3) 2 standard deviations (SD) below the mean value of a young reference group, and discussed the most suitable method to screen for the presence of OS in obese population. One hundred and forty-one (n = 141) postmenopausal Malaysian women participated in the study. Bone density was assessed using calcaneal quantitative ultrasound. Body composition was assessed using bioelectrical impedance analyzer. Handgrip strength was assessed using a handgrip dynamometer, and physical performance was assessed using a modified Short Physical Performance Battery test. ROC curve was determined to be the most suitable statistical modeling method to derive the cutoffs for the presence of OS in obese population. From the ROC curve method, the final model to estimate the probability of OS in obese postmenopausal women is comprised of five variables: handgrip strength (HGS, with area under the curve (AUC) = 0.698 and threshold ≤ 16.5 kg), skeletal muscle mass index (SMMI, AUC = 0.966 and threshold ≤ 8.2 kg/m2), fat-free mass index (FFMI, AUC = 0.946 and threshold ≤ 15.2 kg/m2), broadband ultrasonic attenuation (BUA, AUC = 0.987 and threshold ≤ 52.85 dB/MHz), and speed of sound (SOS, AUC = 0.991 and threshold ≤ 1492.15 m/s). Portable equipment may be used to screen for OS in obese women. Early identification of OS can help lower the risk of advanced functional impairment that can lead to physical disability in obese postmenopausal women.
Nasogastric tube feeding is an essential way of delivering enteral nutrition when the oral route is insufficient or unsafe. Malnutrition is recognised as a reversible factor for sarcopenia and frailty. It is therefore crucial that malnutrition is treated in older inpatients who have dysphagia and require enteral nutrition. Despite five National Patient Safety Alerts since 2005, “Never Events” related to nasogastric feeding persist. In addition to placement errors, current practice often leads to delays in feeding, which subsequently result in worse patient outcomes. It is crucial that tube placement is confirmed accurately and in a timely way. Medical advancements in this area have been slow to find a solution which meets this need. In this paper, we provide an updated review on the current use of feeding nasogastric tubes in the older population, the issues associated with confirming correct placement, and innovative solutions for improving safety and outcomes in older patients.
Aging is a natural process that affects all systems of the human organism, leading to its inability to adapt to environmental changes. Advancing age has been correlated with various pathological conditions, especially cardiovascular and cerebrovascular diseases. Carotid artery (CA) is mainly affected by age-induced functional and morphological alterations causing atheromatous disease. The evolvement of biomedical sciences has allowed the elucidation of many aspects of this condition. Symptomatic carotid disease (CD) derives from critical luminar stenosis or eruption of an atheromatous plaque due to structural modifications of the vessels, such as carotid intima-media thickening. At a histologic level, the aforementioned changes are mediated by elastin fragmentation, collagen deposition, immune cell infiltration, and accumulation of cytokines and vasoconstrictors. Underlying mechanisms include chronic inflammation and oxidative stress, dysregulation of cellular homeostatic systems, and senescence. Thus, there is an imbalance in components of the vessel wall, which fails to counteract exterior stress stimuli. Consequently, arterial relaxation is impaired and atherosclerotic lesions progress. This is a review of current evidence regarding the relationship of aging with vascular senescence and CD. A deeper understanding of these mechanisms can contribute to the production of efficient prevention methods and targeted therapeutic strategies.
Objectives. This study seeks to determine the prevalence of chronic diseases and analyze the association between multimorbidity and all-cause mortality by sex. Methods. This is a 16-year longitudinal study of follow-up. We used sample data of the SABE (Health, Well-Being and Aging) study cohort and mortality data obtained through the Mortality Information Improvement Program of the City of São Paulo (PRO-AIM) from the 2000–2016 period. Survival analysis was performed using Cox proportional hazard models. Results. Hypertension (HT) was the most prevalent disease in older adults (52.93%), followed by musculoskeletal disorders (MSDs) (27.09%), cardiovascular diseases (CD) (17.79%), diabetes mellitus (DM) (16.95%), mental disorders (MD) (15.43%), and respiratory diseases (RD) (9.72%). The highest mortality rate in women was observed in the combination of HT/MSDs/DM/MD (HR = 6.15, 95% CI = 2.32, 16.32), while in men was in the combination of HT/CD/MSDs/DM (HR = 5.72, 95% CI = 1.72, 19.06). Conclusion. Similar to previous studies carried out in developed countries, we found that all-cause mortality increased as diseases are added to an individual. Women and men presented different mortality patterns according to multimorbidity. Therefore, we suggest that additional longitudinal studies should be performed in order to analyze mortality by sex.
Background . In the sub-Saharan African, region of the world with a fast growing aging population and where the use of herbal products is very common, there is a paucity of data on medication consumption patterns among elderly people. The objective of this study was to assess the prevalence of polypharmacy and its associated factors among community-dwelling elderly in Lomé, Togo, in 2017. Methods . A cross-sectional study was conducted from March to June 2017 in Lomé, Togo among people aged 60 years and older. The Respondent Driven Sampling method was used to recruit participants. Data on socio-demographic characteristics and medication consumption patterns, including the use of medicinal plants and dietary supplements, were collected using a standardized questionnaire during a face-to-face interview at participants’ home. Descriptive and binary logistic regression analyses were performed. Results . A total of 370 participants with median age 65 years, (IQR: 62–71) were enrolled in the study. Almost three elderly in five (57.6%) were multimorbid (had two or more chronic diseases). Conventional drugs (78.4%), medicinal plants (14.3%) and other dietary supplements (9.5%) were used by participants. The prevalence of polypharmacy was 22.7% (95% CI: 18.5–27.3%). Concurrent use of conventional drugs and medicinal plants or other dietary supplements was observed among 17.0% of participants and 67.3% reported self-medication. Multimorbidity (aOR = 4.55; 95% CI: [2.42–8.54]) and female sex (aOR = 1.86; 95% CI: [1.00–3.47]) were associated with polypharmacy. Conclusion . One elderly in five uses five or more medications in Togo. Further studies are needed to assess drug-drug interactions and herb-drug interactions among this population.
Background. Variation in the prevalence of sarcopenia is related to the skeletal muscle index cutoff points applied. The objective of this pilot study was to examine the recruitment process for testing different sarcopenia definitions (ASMI cutoffs) in older Mexican adults. It explored whether the prevalence of sarcopenia decreased by applying ethnic- and gender-specific, DXA-derived appendicular skeletal muscle index (ASMI)-cutoff points in the definitions, as well as some associated factors in a sample of community-dwelling older Mexican people. Methods. This is a pilot feasibility study that included a convenience sample of 217 community-dwelling older adults. Volunteers underwent DXA measurements and an assessment of functional status based on hand grip strength and physical performance. Six definitions were formed based on the 2010 EWGSOP criteria, but using different cutoff points for each of the three components, including regional cutoff points for ASMI derived from young Mexican adults. Several risk factors for sarcopenia were also assessed. Results. The prevalence of sarcopenia varied according to the different definitions applied. The lowest level was found with the definition that applied regional ASMI-cutoff points (p<0.01). The sarcopenic older adults had significant lower body weight, fat mass, and fat-free mass (FFM) than the nonsarcopenic subjects. The risk of sarcopenia increased with age and low FFM (p<0.001). Conclusion. The present study demonstrates the feasibility of the main study, and our data support the notion that using regional ASMI cutoff points resulted in a low prevalence of sarcopenia. Therefore, it is preferable to estimate the prevalence of this condition using ethnic- and gender-specific cutoff points and to explore associated factors such as low FFM.
Studies conducted in nursing homes/hospitals have shown that organizational culture plays an important role in care delivery and group culture leads to better quality of care. To explore the organizational culture and care delivery in adult day services (ADS) centers in Taiwan, we used both quantitative and qualitative research methods. Quantitative data from the Competing Values Framework (CVF) assessment showed that the group culture was dominant at all three centers. Qualitative data from observation and staff interviews uncovered both group and nongroup cultural elements. The group cultural elements, such as flexible management, teamwork environment, and sharing the same values, contributed to good care; however, the nongroup cultural elements, such as the staff-centered view, hierarchy, and conflicts within the leadership, led to negative staff-staff and staff-clients interactions. Further research is needed to untangle the complexity between quality care delivery and organizational culture.
BACKGROUND:Age-related sarcopenia is associated with physical decline, including poor functional capacity, lack of physical activity, problems with activities of daily living, and disability. However, little is known about the association between mental health problems and cognitive function in older adults with sarcopenia. Therefore, this study explored community-dwelling older adults' sarcopenia prevalence and related associations with depression, cognitive performance, and physical activity.METHODS:This cross-sectional study included 330 community-dwelling older adults (66.85 ± 5.54 years, 76.06% female). Based on the Asian Working Group for Sarcopenia guidelines, gait speed, muscle mass, and handgrip were assessed. All participants responded to a set of questionnaires (e.g., Global Physical Activity Questionnaire, cognitive assessment, and depression scale). Logistic regression analysis and multivariate logistic regression were used to determine independent predictors for sarcopenia.RESULTS:Overall, 16.1% of the participants were identified as having sarcopenia. Further, advanced age (i.e., mean age ≥ 70 years; odds ratio: 4.67), high depression scores (odds ratio: 2.09), mild cognitive impairment (odds ratio: 0.22), and low physical activity levels (odds ratio: 1.96) were significant associated risk factors for sarcopenia after adjusting for age, sex, and educational level.CONCLUSIONS:Sarcopenia can lead to adverse health outcomes (i.e., depressive symptoms, cognitive decline, and low physical activity) in older adults.
The care of the older adult requires an interprofessional approach to solve complex medical and social problems, but this approach is difficult to teach in our educational silos. We developed an interprofessional educational session in response to national requests for innovative practice models that use collaborative interprofessional teams. We chose geriatric fall prevention as our area of focus as our development of the educational session coincided with the development of an interprofessional Fall Risk Reduction Clinic. Our aim of this study was to evaluate the number and type of students who attended a pilot and 10 subsequent educational sessions. We also documented the changes that occurred due to a Plan-Do-Study-Act (PDSA) rapid-cycle improvement model to modify our educational session. The educational session evolved into an online presession self-study didactic and in-person educational session with a poster/skill section, an interprofessional team simulation, and simulated patient experience. The simulated patient experience included an interprofessional fall evaluation, team meeting, and presentation to an expert panel. The pilot session had 83 students from the three sponsoring institutions (hospital system, university, and medical university). Students were from undergraduate nursing, nurse practitioner graduate program, pharmacy, medicine, social work, physical therapy, nutrition, and pastoral care. Since the pilot, 719 students have participated in various manifestations of the online didactic plus in-person training sessions. Ten separate educational sessions have been given at three different institutions. Survey data with demographic information were available on 524 participants. Students came from ten different schools and represented thirteen different health care disciplines. A large-scale interprofessional educational session is possible with rapid-cycle improvement, inclusion of educators from a variety of learning institutions, and flexibility with curriculum to accommodate learners in various stages of training.
Background . The rise in an ageing population has resulted in an increase in the prevalence of aortic stenosis. With the advent and rapid expansion in the use of transcatheter aortic valve replacements (TAVRs), patients with severe aortic stenosis, traditionally thought too high risk for surgical intervention, are now being treated with generally favourable results. Frailty is an important factor in determining outcome after a TAVR, and an assessment of frailty is fundamental in the identification of appropriate patients to treat. Objective . The objective of the study was to identify if the psoas muscle area is associated with frailty in TAVR patients and outcome after intervention. Method . In this prospective study, we measured outcomes of 62 patients who underwent TAVR procedures against the psoas muscle area and the Reported Edmonton Frail Scale (REFS). Our aim was to assess if psoas muscle assessment can be used as a simple method to predict frailty in our population group. Results . A total of 60 patients met the study criteria. Mean psoas-lumbar vertebral index was 0.61, with a lower value in the frail group. There was not a statistically significant correlation between the psoas measures, REFS score (indicative of frailty), and mortality. However, there was a statistically significant relationship between the psoas size and REFS score (p=0.043). Conclusion . Psoas assessment can be useful in providing additional information when planning for patients to undergo a TAVR and can be used as a screening tool to help identify frail patients within this high-risk group.
