Religious Meaning System and Fear of Death in Older Adults: The Longitudinal Mediation Analysis of Wisdom and Meaning- Making

Light-intensity physical activity (LPA) is related to a reduced risk of all-cause death in older adults, but its effect on cardiovascular disease or death remains questioned. This meta-analysis aimed to quantify the association of LPA with the risk of cardiovascular disease and death in older adults. We conducted a literature search in electronic databases for prospective cohort studies assessing the relationship between LPA measured by accelerometers and the risk of cardiovascular disease and/or death in adults aged ≥60 years. Study-specific hazard ratios (HRs) and 95% confidence intervals (CIs) were pooled using a random effects model. Of the 518 articles identified, 5 prospective cohort studies were included. The mean body mass index of included participants was all over 25 kg/m2. Pooled results showed that the summary HR per 60 min/day higher of LPA was 0.90 (95% CI, 0.83-0.98; n = 3) for the risk of cardiovascular disease and 0.59 (95% CI, 0.49-0.72; n = 2) for cardiovascular death. Both the relationship of LPA with the risk of cardiovascular disease and cardiovascular death were linearly and inversely shaped. The HR for the risk of cardiovascular disease was greater for LPA than for moderate-to-vigorous physical activity (MVPA), in either equal time or equal amount scale (both Pinteraction < 0.01); but the HR for the risk of cardiovascular death was comparable between LPA and MVPA in both scales (both Pinteraction ≥0.20). Higher LPA is associated with a reduced risk of cardiovascular disease and death in older adults.

A transition model of fear of death in older adults is proposed, in which increased fear of death is predicted for elders in their late seventies or early eighties, evoked by the conflict or tension between the urge to survive and the awareness of limited survival time. This fear prompts coping efforts, with cognitive and emotional reorganization leading to decreased fear and increased acceptance of death. Study participants were 109 elders (ninety-three women and sixteen men; sixty-eight Whites and forty-one African-Americans) ranging in age from seventy to ninety-seven years (M=80.7 years; SD=6.9 years). In addition to earlier analysis showing increased fear of death in the transition period, qualitative analysis of open-ended interview protocols identified use of denial and suppression by younger participants, various coping strategies by those in their late seventies and early eighties, and increased acceptance of death by older participants. Evidence provides modest support of the model.

This study tested the hypothesis that level of resolution of Erikson's ego integrity versus despair crisis is inversely related to fear of death in older adults. Differences related to type of residence were also investigated. Fifty-one older adults ages 70 to 90 (11 males, 40 females) from a nursing home (N = 25) and an apartment complex (N = 26) completed measures of ego integrity and fear of death. Results of analyses of variance supported an inverse relationship between ego integrity and fear of death. This relationship was modified by type of residence indicating that among low integrity individuals, those living in the nursing home reported higher fear of death than those living in the apartment complex. No difference in fear of death in relation to residence type was obtained for high integrity individuals. If low ego integrity individuals lack a strong, internal support system they may be more dependent on external supports. It can be speculated that differences between independent and institutional environments in availability of effective psychological support sources and in inescapable evidence of the imminence of death, may make resolution of the ego integrity versus despair crisis more salient for the psychological well-being of institutionalized older adults. Programs providing ego integrity enhancement and enriched support systems seem indicated.

Undernutrition as a major risk factor for death among older Brazilian adults in the community-dwelling setting: SABE survey

Limited research exists on substance-related acute toxicity deaths (ATDs) in older adults (≥60 years) in Canada. This study aims to examine and describe the sociodemographic characteristics, health histories and circumstances of death for accidental ATDs among older adults. Following a retrospective descriptive analysis of all coroner and medical examiner files on accidental substance-related ATDs in older adults in Canada from 2016 to 2017, proportions and mortality rates for coroner and medical examiner data were compared with general population data on older adults from the 2016 Census. Chisquare tests were conducted for categorical variables where possible. From 2016 to 2017, there were 705 documented accidental ATDs in older adults. Multiple substances contributed to 61% of these deaths. Fentanyl, cocaine and ethanol (alcohol) were the most common substances contributing to death. Heart disease (33%), chronic pain (27%) and depression (26%) were commonly documented. Approximately 84% of older adults had contact with health care services in the year preceding their death. Only 14% were confirmed as having their deaths witnessed. Findings provide insight into the demographic, contextual and medical history factors that may influence substance-related ATDs in older adults and suggest key areas for prevention.

Anemia in Frailty

Mortality among older adults with opioid use disorders in the Veteran's Health Administration, 2000–2011

Attachment, depression, and fear of death in older adults: The roles of neediness and perceived availability of social support

Inflammatory biomarkers as predictors of hospitalization and death in community-dwelling older adults

Since the initial scientific statement on Secondary Prevention of Coronary Heart Disease (CHD) in the Elderly was published in 2002,1 several trends have continued that make an update highly appropriate. First, the graying of the US population and those of other industrialized countries has progressed unabated because more adults are surviving into their senior years. The number of Americans aged ≥75 years was estimated at 18.6 million in 2010, representing ≈6% of the population,2 and it is expected to double by 2050. The population aged ≥85 years is growing the most rapidly, with numbers expected to reach 19.5 million by 2040. In 2008, 67% of the 811 940 cardiovascular deaths in the United States occurred in people aged ≥75 years.3 In parallel to this increase in the older adult demographic, the number of Americans with CHD has increased to an estimated 16.3 million, more than half of whom are >65 years of age.3 Similarly, 7 million have had a stroke, the incidence of which approximately doubles with successive age decades after 45 to 54 years.3 Peripheral artery disease (PAD) affects 8 to 10 million Americans, the majority of whom are >65 years of age. Between 2015 and 2030, annual US costs related to atherosclerotic cardiovascular disease (ASCVD) are projected to increase from $84.8 billion to $202 billion.3 Moreover, given that ASCVD often undermines functional capacity and independence and increases reliance on long-term care, indirect expenses related to ASCVD are also expected to increase. Thus, the need for effective secondary prevention measures in the older adult population with known ASCVD has never been greater. Notably, the 2011 American Heart Association (AHA)/American College of Cardiology Foundation (ACCF) updated guidelines for secondary prevention of CHD broadened …

Although nonesterified fatty acids (NEFA) have been positively associated with coronary heart disease risk factors, limited and inconsistent data are available on the relation between NEFA and sudden cardiac death. Using a prospective design, we studied 4657 older men and women (mean age, 75 years) from the Cardiovascular Health Study (1992-2006) to evaluate the association between plasma NEFA and the risk of sudden cardiac death in older adults. Plasma concentrations of NEFA were measured using established enzymatic methods, and sudden death was adjudicated using medical records, death certificates, proxy interview, and autopsy reports. We used Cox proportional hazard models to estimate multivariable-adjusted relative risks. During a median follow-up of 10.0 years, 221 new cases of sudden cardiac death occurred. In a multivariable model adjusting for age, sex, race, clinic site, alcohol intake, smoking, prevalent coronary heart disease and heart failure, and self-reported health status, relative risks (95% confidence interval) for sudden cardiac death were 1.0 (ref), 1.15 (0.81-1.64), 1.06 (0.72-1.55), and 0.91 (0.60-1.38) across consecutive quartiles of NEFA concentration. In secondary analyses restricted to the first 5 years of follow-up, we also did not observe a statistically significant association between plasma NEFA and sudden cardiac death. Our data do not provide evidence for an association between plasma NEFA measured late in life and the risk of sudden cardiac death in older adults.

To determine empirically the diseases contributing most commonly and strongly to death in older adults, accounting for coexisting diseases. Longitudinal. United States. Twenty-two thousand eight hundred ninety Medicare Current Beneficiary Survey participants, a national representative sample of Medicare beneficiaries, enrolled during 2002 to 2006. Information on chronic and acute diseases was ascertained from Medicare claims data. Diseases contributing to death during follow-up were identified empirically using regression models for all diseases with a frequency of 1% or greater and hazard ratio for death of greater than 1. The additive contributions of these diseases, adjusting for coexisting diseases, were calculated using a longitudinal extension of average attributable fraction; 95% confidence intervals were estimated from bootstrapping. Fifteen diseases and acute events contributed significantly to death, together accounting for nearly 70% of death. Heart failure (20.0%), dementia (13.6%), chronic lower respiratory disease (12.4%), and pneumonia (5.3%) made the largest contributions to death. Cancer, including lung, colorectal, lymphoma, and head and neck, together contributed to 5.6% of death. Other diseases and events included acute kidney injury, stroke, septicemia, liver disease, myocardial infarction, and unintentional injuries. The use of methods that focus on determining a single underlying cause may lead to underestimation of the extent of the contribution of some diseases such as dementia and respiratory disease to death in older adults and overestimation of the contribution of other diseases. Current conceptualization of a single underlying cause may not account adequately for the contribution to death of coexisting diseases that older adults experience.

Terror management theory asserts that death fear (fear of annihilation) is buffered by self-esteem and beliefs in literal and symbolic immortality achieved through participation in the cultural system. The aims of this study were to determine how variables suggested by the theory were related to fear of death measures. Participants were 123 Black and 265 White elders aged 60 to 100 years; they were assessed on the Multidimensional Fear of Death Scale (MFODS), self-esteem, religiosity, locus of control, socioeconomic status, social support, and health. Regression analysis findings ( p <.05) offered partial support to the theory, with greater Fear of the Unknown (fear of annihilation) related to weaker religiosity, less social support, and greater externality; the effect of self-esteem was mediated by externality. Other predictors were related to an overall fear score based on the remaining 7 MFODS subscales. Findings are interpreted in terms of changing sources of self-esteem in old age.

Research suggests that death anxiety stems from fear of pain, worry about loved ones, and uncertainty about what comes after death. Understanding the relationship between coping styles and attitudes towards death in older adults may help identify individuals who need support with death anxiety. This study explored the relationships between coping styles (active, disengaged, social) and death anxiety (fear, avoidance). We used the Death Attitude Profile Revised and three subscales from the Brief Coping Orientation to Problems Experienced (COPE) Inventory. We conducted linear regressions to determine which coping styles were associated with fear of death and death avoidance. In post-hoc analyses, we investigated the role of spirituality-based coping as a two-item subscale from the active coping scale. All models controlled for age, sex, marital and educational status. The sample included 87 community-dwelling older adults (Mage=72.72 (SD=5.88); 56.32% female; 86.21% White). Higher levels of disengaged coping were significantly associated with greater fear of death and death avoidance (p < .05). Use of social support coping was significantly associated with less fear of death (β = -.10, p < .05). Spirituality-focused coping was associated with lower death avoidance (p < .05). Disengaged coping may indicate higher death anxiety, whereas spirituality and social support coping strategies may indicate lower death anxiety. Our findings have implications for identifying individuals in need of extra support during critical points in the healthcare process. They may also inform design and implementation of psychosocial interventions for communication about healthcare goals in the context of serious or terminal illness.

Introduction: With growing age, multiple chronic diseases may result in polypharmacy. Drugs that should be avoided in older adults are called potentially inappropriate medications (PIM). Beyond PIM, drug-drug interactions (DDI) are known to be related to adverse drug events. This analysis examines the risk of frequent falling, hospital admission, and death in older adults associated with PIM and/or DDI (PIM/DDI) prescription. Materials and methods: This post hoc analysis used data of a subgroup of the getABI study participants, a large cohort of community-dwelling older adults. The subgroup comprised 2120 participants who provided a detailed medication report by telephone interview at the 5-year getABI follow-up. The risks of frequent falling, hospital admission, and death in the course of the following 2 years were analysed by logistic regression in uni- and multivariable models with adjustment for established risk factors. Results: Data of all 2,120 participants was available for the analysis of the endpoint death, of 1,799 participants for hospital admission, and of 1,349 participants for frequent falling. The multivariable models showed an association of PIM/DDI prescription with frequent falling (odds ratio (OR) 1.66, 95% confidence interval (CI) 1.06-2.60, p = 0.027) as well as with hospital admission (OR 1.29, 95% CI 1.04-1.58, p = 0.018), but not with death (OR 1.00, 95% CI 0.58-1.72, p = 0.999). Conclusion: PIM/DDI prescription was associated with the risk of hospital admission and frequent falling. No association was found with death by 2years. This result should alert physicians to provide a closer look at PIM/DDI prescriptions.