Sleep Problems and Mobility Difficulties in Community-Dwelling Older Adults: Findings from the ELSI-Brazil Study

Background. Very few studies have assessed the impact of poor sleep and sleep medication use on the risk of falls among community-dwelling older adults. The objective of this study was to evaluate the association between sleep problems, sleep medication use, and falls in community-dwelling older adults. Methods. The study population comprised a nationally representative sample of noninstitutionalized older adults participating in the 2010 Health and Retirement Study. Proportion of adults reporting sleep problems, sleep medication use, and fall was calculated. Multiple logistic regression models were constructed to examine the impact of sleep problems and sleep medication use on the risk of falls after controlling for covariates. Results. Among 9,843 community-dwelling older adults, 35.8% had reported a fall and 40.8% had reported sleep problems in the past two years. Sleep medication use was reported by 20.9% of the participants. Older adults who do have sleep problems and take sleep medications had a significant high risk of falls, compared to older adults who do not have sleep problems and do not take sleep medications. The other two groups also had significantly greater risk for falls. Conclusion. Sleep problems added to sleep medication use increase the risk of falls. Further prospective studies are needed to confirm these observed findings.

The aim of this study was to provide global estimates of the prevalence of sleep quality and chronic diseases and to analyze the correlation between sleep and multimorbidity in community-dwelling older adults (≥65 years) in China. This is a cross-sectional study and a stratified multistage random sampling method was used to collect data on demographic characteristics, the Pittsburgh Sleep Quality Index (PSQI), and assessment of chronic conditions. Chi-squared tests, t-tests, Wilcoxon rank sum test and analysis of variance were used to test the correlation between sleep and multimorbidity. Of the 1,173 community-dwelling older adults enrolled, the mean total PSQI score was 7.25 ± 4.23. Of these, 588 (50.1%) had a total PSQI score >7 (with poor sleep quality) and 920 (78.4%) had chronic diseases. In addition, 43.8% (403/920) had a single chronic disease and 56.2% (517/920) had multimorbidity. A combination of two and three chronic conditions dominated the pattern of multimorbidity among community-dwelling older adults. Overall, the prevalence of poor sleep quality with multimorbidity among community-dwelling older adults in the community was 57.6% (298/517). The prevalence of poor sleep quality in older adults with multimorbidity was 1.30 times higher than in those without multimorbidity (RR = 57.6%/44.2% = 1.30). The prevalence of poor sleep quality increased with the number of chronic conditions, and women had a higher prevalence of poor sleep quality than men. T-test and analysis of variance showed statistically significant differences in all seven components of the PSQI between those with and without multimorbidity and different numbers of chronic conditions (p < 0.05). Community-dwelling older adults with multimorbidity were more likely to have sleep problems. The number of chronic conditions also had an additive effect on sleep problems, and women reported poorer sleep quality than men. One of the most challenging aspects of falling asleep was for participants with multimorbidity.

Prevalence and associated factors of potentially inappropriate medication in community-dwelling older adults in china: A meta-analysis

Worldwide prevalence of sleep problems in community-dwelling older adults: A systematic review and meta-analysis

Objectives. Dysphagia is a geriatric syndrome, which may lead to complications such as dehydration, malnutrition, aspiration, pneumonia, and a significant reduction in quality of life. The purpose of this study was to construct and validate a prediction model for dysphagia in community-dwelling older adults and provide an assessment tool for the prevention and control of dysphagia. Design. Cross-sectional study. Setting. The community-dwelling Chinese older adults. Participants. 3655 participants aged 65 years and older were involved, who were randomly divided into the training set and the validation set. Methods. Data were collected and analyzed from June 2022 to September 2022. Univariate and multivariate logistic regression analysis were used to identify independent risk factors for dysphagia. We applied R software to develop a nomogram model to predict dysphagia in community-dwelling older adults. The predictive value of the model was assessed by the area under the ROC curve (AUC), the calibration curve was used to evaluate the reliability of the nomogram model for predicting dysphagia in community-dwelling older adults. The model's clinical utility was further evaluated using a Decision Curve Analysis (DCA). Results. The incidence of dysphagia was 11.8% (320/3655). Maximum tongue pressure, number of molars, pneumonia, ADL, sarcopenia, age, neurological diseases, and rheumatic immune diseases were selected as risk predictors for dysphagia. The prediction model demonstrated fair discriminative ability with the AUC was 0.709 (95%CI: 0.679-0.739) in the training set and 0.693 (95%Cl: 0.640-0.747) in the validation set, the calibration is adequate, and the Hosmer and Lemeshow test showed p values of 0.163 and 0.415, respectively. The DCA curve of our model shows a positive clinical net benefit. Conclusions. The prediction model established in this study was of a certain predictive value for the risk of dysphagia in community-dwelling older adults. By estimating the likelihood of future outcomes or the onset of certain diseases, it can assist medical personnel in formulating preventive strategies, lessening the workload of nurses, and also diminishing the financial burden on patients, thereby enhancing their overall quality of life.

Anemia in Frailty

BackgroundAnxiety disorders in older adults have become a prominent public health problem due to their concomitant chronic conditions, reduced quality of life and even death. However, fewer studies have been conducted on differences in anxiety among older individuals in different aged-care models, and the interactive relationship between the influencing factors on anxiety remains unclear. The study aimed to examine the disparities in the prevalence of anxiety between community-dwelling and institutionalized older adults and related influencing factors.MethodsData were collected from the Anhui Healthy Longevity Survey (AHLS) and the Anhui Elderly Caring Social Organizations Survey (AECSOS). Data on demographic variables, lifestyle factors and health-related variables in 6968 older adults were used for analysis. Anxiety symptoms were evaluated using the Generalized Anxiety Disorder Assessment Scale (GAD-7). Binary logistic regression models and a Classification and Regression Tree model (CART) were utilized to examine the relationship between variables.ResultsThe prevalence of anxiety were 24.3% and 16.7% among community-dwelling older adults and institutionalized older adults, respectively. Several factors including age, gender, residence, education, income level, live alone, and number of chronic diseases showed a linkage with anxiety among community-dwelling older adults. For the institutionalized older adults, gender, residence, source of income, and number of chronic diseases exhibited a significant association with anxiety. We noted the interactive effect, suggesting that community-dwelling female older adults with an income level of less than 6500 RMB per year and reported chronic disease comorbidities had the highest likelihood of anxiety, and institutionalized female older adults with income sources such as pension, subsidy, family providing, and resident in rural areas have the greatest risk of experiencing anxiety.ConclusionsThis study has brought to light the higher risk of anxiety among community-dwelling older adults compared to institutionalized older adults. Targeted interventions are, therefore emphasized to address the negative impact of anxiety for populations at higher risk.

BACKGROUND: A recent study by Walton et al. (2004) showed that differential control demands within the same task were associated with differential activation of regions within the brain. We have demonstrated that cognitive function is associated with some types of physical function. In a clinical setting of nursing prevention in older adults, some physical performance tests related to cognitive function could be useful in identifying mild cognitive impairment in older adults. Objective: The purpose of this study was to develop a physical performance battery assessing cognitive function in community-dwelling older adults. METHODS: One hundred and seventy-nine community-dwelling older Japanese adults with a mean age of 74.1 ± 5.4 years were recruited. The participants were classified as having aging-associated cognitive decline (AACD) or a normal level of cognition, based on the Five-cognitive Function Test. The physical performance battery included a hand-operated peg board (X1), 4-way choice reaction time (X2), timed up and go (X3), and 5-repetition sit-to-stand (X4). An equation of the physical performance score (PPS) was developed using principal component analysis. Participants were divided into tertile levels (T1, T2, T3) according to the PPS. Multiple logistic regression was performed to evaluate whether the PPS was independently associated with AACD. The cut-off point to distinguish AACD from normal was identified by a receiver-operating characteristic curve. RESULTS: The following equation was developed: PPS = -0.037X1 - 0.002X2 - 0.211X3 - 0.119X4 + 5.846. In the logistic regression model, the odds ratios (95% confidence interval) of AACD compared with T1 were 0.61 (0.23-1.61), 0.27 (0.08-0.87) in T2 and T3, after adjusting age, sex, and education level. A PPS of 0.27 (AUC 0.75, 95%CI 0.66 - 0.84) was defined as an optimal cut-off point that maximized the sum of sensitivity and specificity (sensitivity 85%, specificity 59%). CONCLUSION: This physical performance battery should be a useful tool for assessing cognitive function in community-dwelling older adults.

BackgroundHypertension poses a serious health problem among Thai older adults which could subsequently lead to disability. However, little to no research has been conducted to understand modifiable risk factors of disability among community-dwelling older adults with hypertension in Thailand. In addition, sex is an important social determinant of health, but its role in disability among older adults with hypertension is less clear.ObjectivesThis study focused on community-dwelling older adults with hypertension in Thailand and investigated predictors of disability and examined sex differences in the risk factors that were associated with disability in this population.MethodsLongitudinal data were from the Health, Aging, and Retirement in Thailand (HART) survey (2015–2017; N = 916). The outcome variable was difficulty with the activity of daily living at follow-up. Potential risk factors included sociodemographic information, health behaviors/health status, and disability at baseline. Descriptive analysis and logistic regression analysis were employed to analyze the data.ResultsMost of the participants were female and between aged 60 and 69 years old. Being in an older age group (OR = 1.78, 95% CI: 1.07–2.97, p < 0.05), having more chronic conditions (OR = 1.38, 95% CI: 1.10–1.73, p < 0.01), experiencing obesity (OR = 2.02, 95% CI: 1.11–3.69, p < 0.05), and having disability at baseline (OR = 2.42, 95% CI: 1.09–5.37, p < 0.05) significantly predicted disability at 2 year follow-up among community-dwelling Thai older adults with hypertension. The effects of these risk factors on disability at follow-up did not differ by sex. However, different risk factors of disability were observed across sexes.ConclusionThe situations of disability among older adults with hypertension in Thailand are likely to aggravate due to the rapid aging of the population. Our analysis provided useful information regarding significant predictors of disability and sex-specific risk factors of disability. Tailored promotion and prevention programs should be readily available to prevent disability among community-dwelling older adults with hypertension in Thailand.

Association between residential greenness and depression symptoms in Chinese community-dwelling older adults

IDENTIFYING PROBLEMS DURING TRANSITIONS OF CARE AND REASONS FOR EMERGENCY DEPARTMENT UTILIZATION IN COMMUNITY-DWELLING OLDER ADULTS By Antoinette Bartolotta Coe, Pharm.D., Ph.D. A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy at Virginia Commonwealth University. Virginia Commonwealth University, 2015 Major Advisor: Director: Leticia R. Moczygemba, Pharm.D., Ph.D. Associate Professor, Department of Pharmacotherapy and Outcomes Science A mixed methods approach was used for this study. The setting was a low-income, subsidized housing apartment building for community-dwelling older and younger disabled adults identified as a health care hot spot due to high rates of ambulance use. The study purpose was to identify reasons for ED use and problems during transition from ED to home, predictors of zip code 23220 (health care hot spot) in emergent and non-emergent ED visits, and predictors of total ED costs in community-dwelling older adults living in a health care hot spot. Semi-structured interviews with residents who used the ED, an existing database from an interprofessional care coordination and wellness program for residents, and community-dwelling older adults’ electronic medical record and billing data from 2010-2013 ED visits from an academic medical center were used. The Gelberg-Andersen Behavioral Model for Vulnerable Populations was

Association between sleep problems and self-perception of health among community-dwelling older adults: Data from the 2019 national health survey

Elevated Natriuretic Peptide Levels and Cognitive Function in Community-dwelling Older Adults

Mobility is critical in maintaining independence in older adults. This study aims to systematically review the scientific literature to identify measures of mobility limitation for community-dwelling older adults. A systematic search of PubMed, CINAHL, and psycINFO, using the search terms "mobility limitation", "mobility disability", and "mobility difficulty" yielded 1,847 articles from 1990 to 2012; a final selection of 103 articles was used for the present manuscript. Tools to measure mobility were found to be either self-report or performance-based instruments. Commonly measured constructs of mobility included walking, climbing stairs, and lower extremity function. There was heterogeneity in ways of defining and measuring mobility limitation in older adults living in the community. Given the lack of consistency in assessment tools for mobility, a clear understanding and standardization of instruments are required for comparison across studies and for better understanding indicators and outcomes of mobility limitation in community-dwelling older adults.

BackgroundConsidering older adults are getting closer to the end-of-life and face death more directly. Attitudes to death not only affect the physical and mental health of older adults, but also affect their acceptance of hospice care, even the quality of death. This study aims to explore the status, influencing factors of attitudes toward death and demands of death education among the community-dwelling older adults in southwestern China.MethodsA cross-sectional survey was adopted to investigate 683 community-dwelling older adults in Chongqing, China. Non-parametric test and multiple linear regression analysis was used to explore the influencing factors of different attitudes toward death of older adults in community.ResultsThe multiple linear regression models showed that different dimensions of death attitudes were affected by one or more factors including number of diseases, discussion about life and death, marital status, and average income per month. And community-dwelling older adults have high level demand for death education.ConclusionsUnder the taboo culture of death in China, this study is one of the few studies on the attitudes toward death and the demands for death education of the community-dwelling older adults. This study contributes to enrich the global death studies and provide reference for the death education for older adults.