management in the individual context of the elderly among care teams and networks for dignified living is one of practical-theoreticaland ethical challenges for residential care facilities.Palliative care was defined by World Health Organization (WHO) as an approach improving the quality of life of individuals and their families who are facing problems associated with life-threatening illness, whether physical, psychological, social, or spiritual [4].Furthermore, essential attributes of ageing-based palliative care models identified by policy were communication and coordination between providers, skill enhancement, and capacity to respond rapidly to individuals' changing needs and preferences over time [5].Nursing home deaths and Advance Care Planning (ACP) provided advance directive care have been concerned especially during Covid-19 and beyond to promote an appropriate death with meaningful as possible for both the elderly and the family members [6].ACP has been confirmed as a crucial intervention in improving communication, and care satisfaction as well as reduced staff distress through decision-making proceses [7,8].Certainly, ACP strengthens the iterative process of discussion, decision-making, and documentation related to end-of-life [9].Thus, ACP has been confirmed for improving quality of end-of-life care and patient and family satisfaction, and reduces stress, anxiety, and depression in surviving relatives [10].Besides, Case Management (CM) was the element consistently reported in palliative care models for studies provided evidence for effectiveness on health outcomes [5,11].CM has been shown the benefits on providing counseling and palliative care [12,13].Integrating CM into palliative care is a logical, feasible, and effective strategy to improve the care of seriously ill patients [14].Regarding literature, case managers under CM concept, as patient advocates, are perfectly positioned to facilitate the necessary palliative care or end-of-life care conversation, including advance care planning, and securing the essential legal documents that clearly note the patient and support system wishes and care goals [13].Counseling is one of the most common components providing
In the current care scenario of the COVID-19 pandemic, older oncology patients are especially vulnerable and find themselves facing a double threat. On the one hand, the risk of contracting an infection that we still know little about facilitated by immunosuppression and potentially aggravated by the antineoplastic treatment toxicity, co-morbidities, and the cancer severity [1]. On the other, the neoplastic disease itself, along with the risk of losing an opportunity because of the reduction of medical cancer care, due to the limitation or re-allocation of resources [2]. Therefore, one priority aspect is establishing the individual risk associated with the neoplasm and the treatment, in the context of each type of oncological patient [3]. Although cancer is assumed to be an adverse prognostic factor in patients with COVID-19 and in older persons, there is still uncertainty and a lack of robust evidence. Recommendations have surged concerning therapeutic decisions in oncology patients, and the records of cancer patients with COVID. Nevertheless, the real impact of therapeutic decisions in clinical practice remains unknown, especially in the older patient group as well as the evolution of this population group.
Statistics about potential side effects of COVID-19 vaccination are of questionable reliability; adverse effects may be missed, ascribed to other causes or obfuscated. Under these circumstances, the role of theoretic argumentation based on patho physiological and biochemical mechanisms increases. For example, effects of the spike protein (SP) observed in COVID-19 patients can be expected to occur to some extent also after injections of vaccines containing SP (inactivated viral vaccines) or nucleic acids inducing the synthesis of SP by cells. SP can damage vascular endothelial cells by down regulating angiotensinconverting enzyme 2 (ACE2) and consequently inhibiting mitochondrial function [10]. SARS-CoV-2 uses ACE2 as a cellular receptor, which may lead to the ACE2 degradation and angiotensinII-mediated lung injury in COVID-19 [11]. SP is presented to the immune system inducing immune reactions and binds to ACE2 receptors on platelets activating them [11]. The endothelial damage together with the platelet activation would result in thromboses and thrombocytopenia wholly expressed in the entity known as vaccineinduced thrombotic thrombocytopenia [12]. Of note, D‐dimer level is usually high in patients with postvaccinal clotting disorders [12,13]. Thrombosis and thrombocytopenia may be caused not only by SP but also by adenoviral vectors in vaccines [14]. The vectors elicit cellular and humoral immune responses, bind to circulating platelets, inducing their activation and aggregation. There is evidence in favor of synergistic effects of SP and adenoviral vector in vaccines. These mechanisms may explain the comparatively high prevalence of thromboses and thrombocytopenia following application of adenoviral vector-based anti-SARS-CoV-2 vaccines e.g. cerebral and splanchnic vein thrombosis, pulmonary embolism and disseminated intravascular coagulation [14]. Moreover, SP has been shown in vitro to enter cell nuclei and to impair DNA repair [15], which may have far-reaching consequences to be studied in future. Letter to the Editor
Careof creating a special diaper for the frail older adults suffering from urinary incontinence to prevent complications arising from overnight and persistent wetting of the perineal region is thus appealing.Previously, we had reported the creation of an absorbent, antiseptic, antiperspirant and deodourant diaper containing traditional Chinese herbs, Mori Follium, Fraxini Cortex and Calamine.Mori Follium and Fraxini Cortex are herbs traditionally used in oral concoction as antiperspirant, whereas Calamine is a traditional Chinese medicinal herb commonly used topically as antipruritics.These three herbs, mixed in the ratio 1:1:1 were integrated into the diaper, and tested in two different clinical trials.The first of which utilized a convenient sweating assessment machine, Sudoscan for evaluation of sweat gland function.Sudoscan acts by measuring the ability of the sweat glands to release chloride ions (i.e.chloride conductance in microsiemens µS ) in response to an electrical stimulus on the palms and soles (areas with the highest sweat gland density) as a biomarker to assess sweat gland function [7,8].In the clinical study, volunteers were allowed to soak their feet inside herbal extracts water bath [7,9,10].Sweat gland activities of the soles of the healthy volunteers were then assessed before and after the bath.It was reported that 84.6 % of the volunteers experienced a 15.3 % sweat reduction after the 15-minute herbal bath.The second pilot clinical trial was conducted in the dependent or disabled elderly using the innovative herbal extract impregnated diapers [11].The dependent or disabled elderly were required to wear the herbal extract containing diapers in their Rehabilitation Home overnight continuously for six hours, for 5 consecutive days.Feedback and questionnaires were acquired from these dependent elderly and their carers, and results were compared with their feedback of wearing the control diaper alone without the
Ageism or old age is a very old concept and refers to negative stereotypes and prejudicial attitudes toward old age and how these are reflected in psychological and social problems.Ageism has been identified as the third major form of discrimination in our society after racism and sexism; (Stallard) (Craig) [16,17].Robert Butler coined in 1969 the term "ageism" to refer to the set of negative attitudes towards the elderly, social stereotypes, of prejudice and discrimination, maintained by the population to the detriment of
this older aged population suffers from alcoholism. If prolonged, cognitive impairments in the elderly can lead to irreversible deficits that can have a dramatic impact on their quality of life. In order to prevent the adverse effects of alcohol dependence, it’s imperative that elderly patients receive proper screening and treatment for substance abuse disorder [7]. This paper will discuss commonly seen cognitive deficits caused by alcohol abuse and their various treatment options.
INTRODUCTION:Older women often experience various types of stressors, including the death of a spouse and associated financial stress (often with a lack of social support), emotional stress due to factors such as caregiving and being single, and the challenges of the aging process. These circumstances could produce or aggravate anxious symptomatology that can in turn compound the negative effects of aging. A brief scale of perceived stress that is not confounded with health status and covers multiple culturally relevant potential stressors is needed for quick use in busy medical settings.AIM:To assess the reliability and the validity of an original stress scale designed to measure perceptions of stress beyond health status in a non-clinical convenience sample of community-dwelling older women.METHOD:In this cross-sectional pilot investigation, via conducting item-total correlations and correlational tests of validity, we studied the psychometric properties of our measure using data from volunteer older subjects (mainly low-income and from non-Caucasian backgrounds). The domains covered by the nine items of the tool were selected based on a literature review of common stressors experienced by older adults, especially by older women. Data were collected face-to-face using a demographic list, a well-established depression measure, a brief posttraumatic stress disorder (PTSD) screener, and our 9-item stress tool. Primary outcomes: reliability and validity of the scale of older women's non-medical stress. Secondary outcomes: demographic characteristics of the sample and correlations between stress items.RESULTS:Based on our sample of older women (N=40, mean age 71 years), good internal consistency between the items of the stress scale was found (Cronbach's a=.66). The findings of the data analyses also revealed that our psychometric tool has good convergent validity with the PTSD screener (r=.53). Moreover, in contrast with most other stress tools, it has strong discriminant validity (r=.11) with a well-validated depression scale.CONCLUSION:Our results suggest that this new measure is psychometrically strong. Future research directions encompass using larger samples, ideally including older men with the modification of the scale's name, as well as validating this tool against more measures. Clinical implications of our findings are briefly discussed.
Background: Physical function is a cornerstone of geriatric medicine.Impairment in physical function may threaten one's ability to live independently and is associated with multiple negative health outcomes.Although Chinese people is one of the fastest growing populations in the world, there is a limited understanding of the epidemiology of physical function impairment in the global Chinese aging population.Methods: Researchers used the PRISMA statement and performed a comprehensive online search to highlight the global epidemiology of physical function impairment of Chinese older adults in terms of prevalence, incidence, risk and protective factors, and health consequences.Search items include Chinese, older adult, Asian elderly,
Background:The number of older adults with Alzheimer's disease (AD) has been steadily increasing and is likely to triple by 2050.Parallel increases in AD and informal AD caregivers who experience their own physical and cognitive challenges will result in the need for tools that can help both populations track their cognitive health easily, both in the clinic and at home.Methods: DANA, a tablet-based, FDA-cleared computerized cognitive assessment tool, was used over 90 days among seven caregiver-AD patient dyads in-clinic and at home to assess DANA's sensitivity in detecting mild cognitive impairment and dementia as well as its feasibility in the home and clinic.Results: DANA is sensitive to certain differences in cognitive performance between AD patients and caregiver.Most subtests were found to be feasible for in-home use among both patients and caregivers.
BACKGROUND:Perceived stress influences the health and well-being of older adults. This study aims to examine the association between the expectation and the receipt of filial piety and perceived stress among U.S Chinese older adults. METHODS:Data were drawn from the PINE study, a population-based study of Chinese older adults aged 60 and above in the greater Chicago area. Perceived stress was assessed by the PSS-10 and was the dependent variable. Independent variables were the expectation and the receipt of filial piety examined in six domains. Negative Binomial Regression and Multivariable Logistic Regression analyses were conducted. RESULTS:Of the 3,159 Chinese older adults interviewed, the mean age was 72.8 (SD=8.3) and 58.9% were female. Compared with older adults who received a high level of filial piety, older adults who received a medium level of filial piety were 1.57 (1.29-1.93) times more likely to perceive stress as high, and older adults who received a low level of filial piety were 2.74 (2.26-3.33) times more likely to perceive stress as high, after controlling for the potential confounding variables. The expectation of filial piety was not significantly associated with perceived stress. CONCLUSION:A low level of filial piety receipt may be a risk factor for perceived stress. Our findings suggest incorporating cultural contributors into the analyses of perceived stress.
A series of studies has defended higher body mass index (BMI) of the elderly as preventive, but the obesity may play an important role in the development of other diseases, such as, fasting hyperglycemia that may progress to diabetes and in contrast, decreased physical activity plays an important role in the onset of chronic diseases in the elderly. The aim of this study was to investigate the relationship between obesity, measured by body mass index (BMI) and the physical activity level, assessed by the IPAQ as risk factors for fasting hyperglycemia in older people. Methods: 803 elderly volunteers who participate in the project EPIDOSO II from the Center for the Study of Aging Federal University of São Paulo was part of the research. This is a prospective cohort study assessing the elderly in the SP. This elderly population is evaluated by many health professionals through medical, physical, nutritional and psychological evaluations. It is also performed blood exams for the measurement of fasting glucose. Laboratory results were related to body mass index and physical activity level of each individual. The results showed that obesity and decreased physical activity can lead to changes in fasting glucose. This study makes us rethink the tolerance of a higher BMI in the elderly population, proving the relationship of metabolic risk with increasing BMI and low International Physical Activity Questionnaires (IPAQ).
Growing number of older adults is one the most significant sociodemographic changes in the United States in the next few decades.Advancing age is associated with increased incidence of cancer and other age-related health conditions.It is common that older cancer patients have concurrent conditions and comorbidities that may affect treatment decisions, prognosis and overall survival.Assessment and care for older cancer patient is more complex than caring for younger patient.Comprehensive Geriatric Assessment (CGA) is a useful method for assessing older patients with cancer.CGA is a multidisciplinary evaluation designed to assess and manage elderly patient's medical, psychosocial, and functional capabilities.In this paper we will review domains of CGA and their impact on older cancer patient's outcome.
Background: Both behavioral and psychological symptoms of dementia and the use of atypical antipsychotics among nursing home residents with dementia are epidemic.However, the evidence from systematic reviews and randomized controlled trials for the benefits of using atypical antipsychotics in this population is conflicting and inconsistent.This study examines the evidence from randomized controlled trials for the use of atypical antipsychotics to treat nursing home residents with behavioral and psychological symptoms of dementia.Methods: PubMed, Cochrane review, the National Clinical Guideline Clearinghouse, previously published systematic reviews, and a search of references were used to find eligible randomized controlled trials on use of atypical antipsychotics to treat NH residents with behavioral and psychological symptoms of dementia.Inclusion and exclusion criteria were pre-defined.The papers were independently reviewed by two investigators.Risk of bias, applicability, and heterogeneity were assessed based on previously published methods.Results: Among 1469 citations, the 12 trials met the inclusion criteria.The variability of the diagnostic criteria and outcome measurements, as well as that of these verity of dementia and behavioral and psychological symptoms of dementia, prohibited meta-analysis of the selected 12 original studies.Among the total 4352 enrolled subjects across the 12 trials, age ranged from 77 to 84 years old.Seventy two percent of participants were female, and 64% of participants completed the trials.Mean duration of the 12 trials varied from six to 12 weeks.Four out of the 12 trials (33%) showed positive results.The BPSD reduction varied from 7% to 72%.Risk of bias included low concealment (58%) and high attrition rate (20-42%).The strict exclusion criteria and low recruitment fractions (69%) among the 12 trials reduced the applicability of the trials.Additionally, there was significant clinical heterogeneity and methodological diversity across the 12 trials. Conclusions:There is limited and inconsistent evidence to demonstrate the efficacy of atypical antipsychotics in the treatment of behavioral and psychological symptoms of dementia in nursing home residents.In addition, there are concerns about risk of bias, applicability, clinical heterogeneity, and methodological diversity among the 12 trials.We are less confident in the intervention effects of atypical antipsychotics on BPSD, and therefore do not recommend routinely prescribing atypical antipsychotics.
Background: Australia is a multicultural country that consists of a diverse population. It can be difficult to provide equal healthcare services across all ethnicities due to cultural disparities. This is seen amongst Australian Chinese to under-utilize healthcare services such as palliative care. Objective: This study aimed to explore the Australian Chinese’s understanding of palliative care service and on their end-of-life care preferences so that suitable support and services that are culturally appropriate could be delivered to them. Methods: Participants were recruited from two Chinese cancer support group organizations in Sydney to complete a self-reported questionnaire on their understanding of palliative and end-of-life care preferences. 41 Chinese participants were recruited from four support group sessions. Results: Seven themes were explored. The majority of participants understood the role of palliative care and would accept the service. They favored being informed about the nature of their condition even during advanced stages. Many preferred making decisions for their own treatment but highly valued the advice from doctors and family members. Most participants were open to discuss issues related to death and dying and the need for interpreter services was highlighted. They viewed that nutrition and hydration as necessity during end-of-life and many believed in a combined regimen of western and alternative therapy to treat their condition. Conclusion: This study shows that Australian Chinese understand the role of palliative care. Changes in perception in areas such as disclosure of the truth of a disease and openness in discussing issues related to death and dying are highlighted. Traditional Chinese values still play a role in shaping their attitudes regarding decision-making and hydration and nutrition during end-of-life care. Further research to explore the generalisability of these results is warranted.
Aim: Depression in patients after hip fracture has adverse effects on patient outcomes.This study aimed to identify the prevalence of perioperative depression and the risk factors which predispose patients undergoing emergency hip surgery to perioperative depression. Methods:A cross-sectional study was conducted in hip fracture survivors in an orthogeriatric unit in Western Australia, from 2005 to 2008.Patients were categorized as depressed if Geriatric Depression Scale (GDS) score was five or above.Linear regression was used to analyze the association between age and GDS.Modifying effect of dementia was examined using likelihood ratio test.Results: Depression was present in 18.3% of 1127 patients within two weeks after hip fracture.Mean age was 81.2 years.Prevalence of perioperative depression was highest in the old-old (24.1%) and in patients with pre-existing dementia (64.8%).Advancing age, prefracture institutionalization, use of gait aids, poor physical status, and dementia were associated with higher GDS scores, but not gender or perioperative delirium.The association between increasing depressive symptoms and advancing age was significant in patients without dementia but not in patients with dementia.Conclusions: Depressive symptoms were common during perioperative care for emergency hip surgery.Depression was highly prevalent in patients with dementia after hip fracture regardless of their age.Pre-morbid patient factors may help to identify those patients at risk for depression and should be addressed to optimize rehabilitation participation and outcomes.
Depression and dementia are common comorbidities among Nursing Home (NH) residents.Antidepressants are widely used in this vulnerable population.However, the evidence for anti-depressant use, including from randomized controlled trials, systematic reviews, and evidence-based clinical practice guidelines, is inconsistent and conflicting.Additionally, antidepressants are associated with multiple adverse effects.Long-term care providers often need to deal with requests from patients' families, nursing staff, and colleagues to prescribe antidepressants, while following recommendations from pharmacists and regulations from the Center for Medicare and Medicaid Service (CMS) and Federal Drug Administration (FDA) not to prescribe or to discontinue antidepressants.It is difficult for long-term care providers to decide whether they should prescribe antidepressants and meet regulations and quality of care standards based on the few Randomized Controlled Trials (RCTs).A large randomized control study to examine the efficacy of antidepressants among depressed NH residents with dementia is urgently needed.We propose a practical step-wise approach to prescribe antidepressants for this vulnerable population.
Introduction:The aging of the population will bring with it an increase in the number of individuals with dementia living in the community.This will result in a greater demand on family caregivers and the long term care system to deliver care that is consistent with patient needs across the dementia trajectory, and requires a thorough understanding of an individual's care needs as they change over the disease course.This study compares the unmet care needs of community dwelling persons with dementia across the stages of the dementia.Methods: Cross sectional analyses were conducted using in-home assessment data collected from 254 community residing persons with dementia and their informal caregivers.Results and Discussion: Most unmet needs for patients in the early stage of disease were in the domains of safety and basic education about disease processes.Patients with moderate stage disease had the highest level of unmet needs in the domains of supervised daytime activities and caregiver's management of neuropsychiatric behaviors.Individuals with severe or end stage disease had the highest level of unmet needs in the domain of emotional distress and the caregiver's need for caregiver emotional support and respite.Reasons for unmet needs may be a consequence of a lack of knowledge about the disease process and a lack of psychosocial support resources.At all levels were evolving needs for information on the changing disease course and the need for meaningful activities.These results provide a basic overview of unmet needs by disease stage from which to build palliative care interventions for persons with dementia living at home and their family caregivers.
Introduction: Lack of knowledge of end-of-life care pathway (EOLCP) and misconceptions about opioid use are detrimental to providing quality care to patients with life-limiting diseases. This study aims to use the mixedmethod to assess the level of specialty trainees’ perceptions regarding EOLCP and symptom management in the Australian context. Methods: A total of 31 accredited college trainees in surgery, obstetrics and gynaecology, emergency medicine, anaesthesia as well as physician trainees who had been rotated to palliative care were recruited for the questionnaire. A total of 12 subjects were recruited for the individual interview. Results and Discussion: Both quantitative and qualitative data suggested that participants showed a basic understanding of EOLCP and symptom control. Most participants were generally comfortable with opioid use. They were able to recognize the priorities of end-oflife care and common opioid-related side effects. However, additional education on probability of serious side effects related to opioids, opioid rotation, opioid dosage calculation and prophylactic medications, were suggested. Large-scale studies should be conducted to explore the adequacy of end-of-life care education within specific specialty, other potential factors on practice of EOLCP and opioid use, as well as more effective education strategies in the Australian context.
Introduction:During the last few months of life patients often suffer from significant psychological and physical distress.Studies in the past have found that the amount of tests conducted on a patient tends to increase as death approaches.In many cases the tests performed on a patient in the last few months of life were unnecessary, causing needless discomfort.This study focuses on the number and necessity of tests conducted in the last week of life of a terminal cancer patient.Methods: This study was conducted at Liverpool Hospital, a university teaching hospital located in New South Wales, Australia.Data from deceased cancer patients referred to palliative care for consultation was collected retrospectively from electronic medical records and patient clinical notes.A standard data extraction form was developed to collect patient characteristics, tests ordered, patient progress and symptoms over a period of 7 days up until death.Two palliative care specialists not involved with care of these patients then independently evaluated the need and outcome of each test.These specialists were aware that the patients had all died.Results: 33 patients were included in the study over a period of 3 months.A total number of 1051 tests were conducted over a combined total of 231 in-hospital days.The average number of tests conducted during the last 7 days prior to death per patient was 31.85.On average 65.16% of tests conducted were assessed as unnecessary, 28.80% neutral and 6.04% necessary per patient.The most frequent test category ordered was blood chemistry (41.19%) followed by complete blood count (28.83%) and coagulation (10.47%) tests.In total, combined over all 33 patients, 69.27% of the tests were deemed unnecessary, 25.21% neutral and 5.52% necessary Conclusion: End of life cancer patients are subjected to frequent and often unnecessary tests and investigations.Much improvement can be made in hospital systems and clinician education in order to increase the quality of patient care.Our study prompts clinicians to evaluate the necessity and benefit of diagnostic tests conducted on end of life cancer patients before performing them and provides recommendations for improvement.
A 78 year old Caucasian, bed-bound, nursing home female, presented with non-tender, violaceous, indurated plaques of the skin of her anterior left thigh. Patient’s past medical history was significant for coronary artery disease, atrial fibrillation, diabetes mellitus type II, and stroke with left hemiplegia. On physical examination of her thigh, a 5X8 cm diffuse dusky red, woody hard, hematoma-like plaque was noted without inguinal lymphadenopathy or leg edema (Figure 1). Laboratory studies (comprehensive metabolic panel, complete blood count, and, coagulation factors) were unremarkable. Initial assumption was the lesions were hematomas, possibly secondary to trauma and heat packs were applied for patient comfort.
