Teleconsultation for chronic disease management among community-dwelling older adults: A call for innovation

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

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.

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.

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

Elevated Natriuretic Peptide Levels and Cognitive Function 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.

High Prevalence of Physical Frailty Among Community-Dwelling Malnourished Older Adults–A Systematic Review and Meta-Analysis

The digital divide is apparent not only between older and younger generations but also within the older adult population itself. Identifying digital literacy profiles among older adults is crucial for developing targeted strategies to narrow this divide. This study aimed to identify profiles of digital literacy among community-dwelling older adults and to examine factors associated with these profiles. Data were collected from community-dwelling older adults in South Korea through a nationwide cross-sectional survey that assessed digital literacy and related factors. Digital literacy was evaluated across 3 domains: information and communication (9 items), content creation and management (4 items), and safety and security (9 items). Latent profile analysis was used to identify profiles of digital literacy among community-dwelling older adults, and multinomial logistic regression was used to identify predictors of profile membership. A total of 1016 older adults completed structured questionnaires (average age 68, SD 6.5 years; 486/1016, 47.8% men). Three digital literacy profiles were identified (P<.001): "low level" (346/1016, 34.1%), "middle level" (374/1016, 36.8%), and "high level" (296/1016, 29.1%). With the "middle-level" digital literacy group as the reference group, older adult participants (odds ratio [OR] 1.11, 95% CI 1.07-1.15) with less than a middle school education (vs with a college degree or higher; OR 7.22, 95% CI 2.31-22.54), who needed help with one of the 10 instrumental daily activities (vs ≥2 activities; OR 3.06, 95% CI 1.11-8.40) and who did not engage in in-person social activities (OR 1.81, 95% CI 1.07-3.07), were more likely to be in the "low-level" group. Women were less likely to be in the "high-level" digital literacy group than men (OR 0.45, 95% CI 0.25-0.80). Participants with less than a college education were also less likely to be in the "high-level" group, with those having less than a middle school education showing the lowest OR (OR 0.17, 95% CI 0.07-0.41). Those who had never worked (OR 0.23, 95% CI 0.06-0.90) and those not engaging in regular physical exercise (OR 0.58, 95% CI 0.40-0.84) were also less likely to be in the "high-level" digital literacy group. Participants with greater social support were more likely to be in the "high-level" digital literacy group (OR 1.70, 95% CI 1.22-2.37). These findings underscore the characteristics linked to lower digital literacy and suggest a tailored approach to meet the needs of diverse groups of older adults in a digitalizing society. To promote digital literacy among older adults, potential strategies include improving access to and guidance for using digital devices, specifically designed for this demographic, as well as promoting social support and encouraging participation in social activities.

Observational cohort study of highly functioning community-dwelling older adults to assess their sarcopenic status, leisure physical activity, and quality of life over 12-months

Effects of comorbid physical frailty and low muscle mass on incident disability in community-dwelling older adults: A 24-month follow-up longitudinal study

Sarcopenia's high prevalence in older adults with cardiovascular disease (CVD) suggests that the risk of comorbidity in sarcopenia might also be increased during the at-risk phase of CVD. However, the relationship between CVD risk and sarcopenia has not been elucidated. Therefore, the purpose of this cross-sectional study was to investigate the association between CVD risk and sarcopenia in community-dwelling Japanese older adults. The participants in this cross-sectional study included 14 923 community-dwelling Japanese older adults (mean age 73.2 ± 5.6 years). The present study estimated the CVD risk using the revised World Health Organization risk chart, and classified CVD risk into "low" (<10%) and "mid-high" (≥10%). Assessments of sarcopenia, muscle mass, muscle strength and gait speed were measured based on the clinical definitions. Among the participants, 654 people (4.4%) had sarcopenia, and 4857 (32.6%) had CVD mid-high risk. A multiple logistic model showed that the CVD mid-high risk was associated with sarcopenia (odds ratio [OR] 1.55, 95% confidence interval [CI] 1.28-1.89). In addition, CVD mid-high risk was associated with low muscle mass (OR 1.74, 95% CI 1.50-2.01), low muscle strength (OR 1.25, 95% CI 1.14-1.37) and slow gait speed (OR 1.17, 95% CI 1.07-1.27) in the adjusted model. Among community-dwelling older adults, high or moderate CVD risk was associated with an increased risk of sarcopenia. Our findings could help identify older adults with a future high risk for sarcopenia. Geriatr Gerontol Int 2024; 24: 1328-1334.

Falls are a leading cause of disability. Previous studies have identified various risk factors for falls. However, contemporary novel research is needed to explore these and other factors associated with falls among a diverse older adult population. This study aims to identify the factors associated with falls among hospitalized and community-dwelling older adults. Cross-sectional data from the 'Appropriate care paths for frail elderly people: a comprehensive model' (APPCARE) study were analyzed. The study sample consisted of hospitalized and community-dwelling older adults. Falling was assessed by asking whether the participant had fallen within the last 12 months. Multivariable logistic regression models were used to evaluate associations between socio-demographic characteristics, potential fall risk factors and falls. The sample included 113 hospitalized (mean age = 84.2 years; 58% female) and 777 community-dwelling (mean age = 77.8 years; 49% female) older adults. Among hospitalized older adults, loneliness was associated with an increased risk of falls. Associations between female sex, secondary education lever or lower, multimorbidity, a higher score on limitations with activities of daily living (ADL), high risk of malnutrition and falling were found among community-dwelling participants. The results of this study confirm the multi-factorial nature of falling and the complex interaction of risk factors. Future fall prevention programs could be tailored to the needs of vulnerable subpopulations at high risk for falls.