Age-related Physiological Changes Research Articles

Functioning of Older Adults in Low and Middle Income Countries: A Literature Review

The global population of older adults is rising, with the fastest surge in low and middle income countries (LMIC). Physical functioning determines independence in living. Therefore, it is critical to understand the functioning of older adults in LMIC. Extensive literature informs the functioning profile of older adults in developed nations; however, functioning of older adults in developing nations remains understudied. Physical functioning profile of older adults varies across the world due to differences in socio-demographic and economic factors alongside age-related physiological changes. The present study reviews the functioning profile, factors affecting physical functioning and health related quality of life (H-RQoL), and influence of physical co-morbidities on functioning of older adults in LMIC. Literature search was conducted in PubMed, Google Scholar, CINHAL, and Cochrane database. Eighteen cross-sectional, longitudinal, prospective cohort studies from Asia, Africa, North, South America, and Turkey were included. Most studies focused on singular domain of function. Hand-grip strength, lower extremity muscle strength, balance, and cognition were the most affected variables. Most older adults required partial assistance in bathing and housekeeping, and complete assistance in dressing. Individuals aged ≥ 75 years demonstrated greater limitation in activities of daily living (ADL). Older adults with cognitive impairment were at greater risk of functional decline. Low income, arthritis, and diabetes were major factors responsible for limitation in ADL and poor H-RQoL. Clinicians, researchers, and policymakers can use the present findings to plan culturally suitable rehabilitation programs to impart good health and well-being to older adults, which is central to the attainment of health-related sustainable development goals set forth by the United Nations.

Aspiration pneumonia.

The growing population of older people worldwide represents a great challenge for health systems. The elderly are at increased risk of infectious diseases such as pneumonia, which is associated with increased morbidity and mortality related mainly to age-related physiological changes in the immune system (immunosenescence), the presence of multiple chronic comorbidities, and frailty. In pneumonia, microaspiration is recognized as the main pathogenic mechanism; while macroaspiration which refers to the aspiration of a large amount of oropharyngeal or upper gastrointestinal content passing through the vocal cords and trachea into the lungs is identified as “aspiration pneumonia”. Although there are strategies for the prevention and management of patients with pneumonia that have been shown to be effective in older people with pneumonia, more research is needed on aspiration pneumonia, its risk factors and outcomes, especially since there are no specific criteria for its diagnosis and consequently, the studies on aspiration pneumonia include heterogeneous populations.

Median Effective Dose of Dexmedetomidine Inducing Bradycardia in Elderly Patients Determined by Up-and-Down Sequential Allocation Method.

Purpose: When dexmedetomidine is used in elderly patients, high incidence of bradycardia is reported. Given age-related physiological changes in this population, it is necessary to know the safety margin between the loading dose of dexmedetomidine and bradycardia. Therefore, we conducted this study to investigate the median effective dose (ED50) of dexmedetomidine causing bradycardia in elderly patients.Methods: Thirty patients with ages over 65 years undergoing elective general surgery were enrolled. The Dixon and Massay sequential method were applied to determine the loading dose of dexmedetomidine, starting from 1.0 µg/kg. The dose for the follow-up subjects increased or decreased according to the geometric sequence with the common ratio 1.2, based on the 'negative' or 'positive' response of the previous subject. Positive mean that the subject developed bradycardia during the test. Hemodynamic data including heart rate and systolic blood pressure were recorded. The level of sedation was assessed with the Observer Assessment of Alertness and Sedation Scale (OAA/S).Results: Bradycardia occurred in 13 patients (43.3%). The ED50 of dexmedetomidine causing bradycardia was 1.97 µg/kg (95% CI, 1.53-2.53 µg/kg). OAA/S scores at 10 min after the beginning of the dexmedetomidine infusion and 10 min after the termination of dexmedetomidine administration showed no significant differences between the positive and negative groups (P > 0.05).Conclusion: The ED50 of dexmedetomidine causing bradycardia in our cohort was higher than clinical recommended dose. A higher loading dose appears acceptable for a faster onset of sedation under careful hemodynamic monitoring.Trial registration: ChiCTR 15006368.

Telemedication Reviews to Optimize Medication Prescription for Older People in Nursing Homes.

Introduction: Older people living in nursing homes (NH) are at a higher risk of preventable drug-related adverse events because of age-related physiological changes, polypathology, and polypharmacy. NH residents are particularly exposed to potentially inappropriate medications (PIMs). Many strategies have been developed to improve the quality and the safety of drug prescription in NH, including medication reviews (MRs). Methods: In the context of the application of telemedicine, we developed and are currently implementing a novel hospital expert-based MRs through tele-expertise (or "telemedication review," telemedication reviews hereafter [TMR]) in French NH residents. The impact of these TMR on unplanned hospitalizations 3 months after implementation is assessed. TMR consider all available sociodemographic, clinical, biological, and pharmaceutical data pertaining to the patient and are performed in accordance with their health care objectives. Results: The preliminary results for the 39 TMRs performed to date (September 2021) showed that a total of 402 PIMs were detected, and all residents had at least one PIM. We also present the feasibility and the usefulness of this novel TMR for NH, illustrating these preliminary results with two concrete TMR experiences. Among the 39 TMR performed, the average acceptance rate of expert recommendations made to general practitioners (GP) working in NH was ∼33%. Discussion and Conclusions: The success of this novel TMR depends on how the proposed prescription adjustments made by the hospital expert team are subsequently integrated into health care practices. The low acceptance rate by GP highlights the need to actively involve these professionals in the process of developing TMR, with a view to encouraging them to act on proposed adjustments.

Age-Related Alterations of Hyaluronan and Collagen in Extracellular Matrix of the Muscle Spindles.

Background: Muscle spindles (MSs) play a crucial role in proprioception and locomotor coordination. Although the elasticity and viscosity of the extracellular matrix (ECM) within which MSs are embedded may play a key role in MS function, the impact of aging on ECM components is unclear. The aim of the current study was to investigate the age-related physiological changes of the ECM and to verify if these could be due to alterations of the environment directly surrounding MSs. Methods: Hematoxylin Eosin and picrosirius-red staining was carried out; collagen types I (COLI) and III (COLIII) were assessed, and biotinylated hyaluronan binding protein (HABP) immunohistochemical analysis was undertaken to evaluate alterations of the ECM in the intramuscular connective tissue (IMCT) of the hindlimbs of C57BL/6J male mice. Assessments were carried out on 6-week-old (Group A), 8-month-old (Group B), and 2-year-old (Group C) laboratory mice. Results: The capsule’s outer layer became progressively thicker with aging (it was 3.02 ± 0.26 μm in Group A, 3.64 ± 0.31 μm in Group B, and 5.81 ± 0.85 μm in Group C). The collagen in IMCT around and within the MSs was significantly higher in Group C, but there were no significant differences between Groups A and B. The MS capsules and continuous IMCT were primarily made up of COLI and COLIII. The average optical density (AOD) values of COLI in IMCT surrounding MS were significantly higher after aging (p < 0.05), but there were no significant differences in COLIII in the three groups (p > 0.05). HA was present in IMCT and filled the MSs capsule. The AOD of HABP of MS showed that there were lower HA levels in Group C with respect to Group A (p = 0.022); no significant differences were noted neither between Groups A and B nor between Groups B and C (p > 0.05). Conclusion: Age-related collagen accumulation and lower HA in the ECM in which the MSs were embedded may probably cause more stiffness in the ECM in vivo, which could help to partly explain the peripheral mechanisms underlying the age-related decline in functional changes related to MSs.

Life-Space Constriction in Aging Adults

Community-dwelling aging adults desire to maintain independence and prevent or delay a sequela of declining function and ultimate frailty. Early indicators of potential declines in function and frailty, such as life-space constriction (LSC), are important to identifying early. The purpose of this study was to examine factors associated with LSC and the influence of these factors and LSC on function and frailty. A cross-sectional study using a convenience sample of community dwelling persons 55 and older living in the South was conducted. Results indicated most participants (N = 72) were female (69%; n = 50) and half were White (53.5%; n = 38). LSC explained 34% variance in function (F = 3.805 (8, 59); p = .001) when environmental supports (social network), challenges (driving time it took the participant to get to the nearest full-service grocery store) and individual factors were controlled for. There was a significant difference between Black and White participants with environmental challenges (p = .001) and function (p = .001). Individual factors included challenges (age-related physiological changes, disease burden, and mental health limitations) and buoy (assistive devices), these explained 22% variance in self-reported frailty (F= 3.099 (6, 65); p = .01). Number of assistive devices was the only significant predictor of self-reported frailty.

Preoperative evaluation of geriatric patients undergoing liver transplantation.

As the population of the world is aging the number of geriatric patients undergoing liver transplantation (LT) is also increasing. They pose a unique challenge for the caregivers, as they have age-related physiological changes, multiple comorbidities and cirrhosis-related pathologies. Twenty-two percent of patients who undergo LT are older than 65 years. Many patients suffer from nonalcoholic steatohepatitis (NASH), hepatocellular carcinoma and hepatitis-C virus. Incidence of NASH tends to increase with age, obesity, diabetes and metabolic syndrome. Elderly patients require comprehensive cognitive, cardiac and pulmonary evaluation prior to LT. Cirrhotic cardiomyopathy, hepatopulmonary syndrome, portopulmonary hypertension and frailty are of specific concern. Proportion of elderly patients who are undergoing LT continues to increase. These patients require comprehensive cardiopulmonary and frailty evaluation. Consensus-based practice advisories need to be developed to standardize preoperative evaluation of geriatric patients awaiting LT.

Serum testosterone and its binding globulin during senescence

Purpose: The aim of this work is to analyze age-related changes in providing tissues with steroid hormones (androgens [A], mainly testosterone [T]) by means of specific steroid transport protein of the blood (testosterone-binding globulin, [TeBG]) and to propose new informative approach for reliable early diagnostics of impending hypogonadism in elderly men. Methods: Methods are analytical. Results and conclusions: Authors develop new approach for assessment of age-related physiological changes in supply of steroids (in particular T) by specific transporting them testosterone-binding globulin (TeBG). This work substantiates the following statements: a) existing common beliefs about circulating A (including ‘exchangeable’ and ‘free’ testosterone levels – [Texch], [Tfree]) do not match their true state of affairs concerning presence, interaction, interchange and transmission of А into target cells; b) blood pool of ‘ТeBG-Т-ТeBG’-complex should correctly be called the ‘functional Т-dimer’ (FTD); c) venous blood FTD-content ‘mirrors’ the ‘potentially active’ (bioavailable) testosterone molecules conc. ([Tact]) in arterial blood (i. e. which capable to be transferred into target cells from capillaries, [Tact] = [FTD] ); d) age-dependent rise in circulation of ‘nonfunctional’ TeBG-molecules (ТеBGnf) caused by accumulation with age the ‘senescence factor’ which inhibits needed FTD-formation; e) [FTD]- measurements can be useful for early diagnosis of impending hypogonadism in elderly men

Sex-related pharmacokinetic differences with aging.

The proportion of women increases with advanced age, but older women are often underrepresented in clinical trials. Therefore, little is known about the combined effect of sex- and age-related physiological changes on drug pharmacokinetics. We compiled clinical studies, which investigated sex-related pharmacokinetic differences both in older and young women and men. The ratio women/men was calculated for various pharmacokinetic parameters across adulthood to assess sex-related differences in drug pharmacokinetics with aging. The contribution of body weight and drug characteristics to sex-related pharmacokinetic differences were explored using analysis of variance. We found 67 studies reporting the pharmacokinetics for 56 drugs both in older and young women and men. Median peak concentration (Cmax) (interquartile range (IQR)) and drug exposure (AUC) (IQR) were 22% (8-41%) and 20% (0-39%) higher in women compared with men whereas time to peak concentration (tmax), apparent volume of distribution (VdF) and elimination half-life (t1/2) were not significantly different. Body weight and the drug main elimination pathway contributed to sex-related differences in Cmax and AUC. Relative to men, women had a modest increase in Cmax with increasing age (r = 0.19, p = 0.04). Conversely, sex-related differences in AUC remained constant with increasing age. The pharmacokinetic differences between women and men were modest and, with the exception of Cmax, remained constant with increasing age. The higher plasma concentration might be correlated to more adverse events in older women and thus, drug treatment should be started on the lower recommended dosage when appropriate particularly for drugs characterized by a narrow therapeutic index.

Is There a Difference in Unmet Supportive Care Needs Between Older and Younger Outpatients Receiving Chemotherapy?

Objective: This study investigated whether there was a difference in unmet supportive care needs between older and younger cancer patients who receive chemotherapy. Background: Physiological, physical, cognitive, and social functions, which play a key role in coping with cancer, are impaired due to aging. Age-related physiological changes and psychosocial factors and comorbid medical conditions make some of the needs of older cancer patients unique and complex. At the heart of meeting these needs lies the concept of supportive care. First step of meeting their needs is to determine these needs. Study Design and Methods: The study was conducted in the Daytime Treatment Unit of the oncology hospital of a university in Ankara, Turkey. The study sample consisted of 93 patients aged 65 years or older and 93 patients under 65 years of age. Both groups were similar in terms of sex, cancer type, and chemotherapy protocols. Data were collected using a Patient Information Form and Supportive Care Needs Scale-Short Turkish Version and analyzed using descriptive statistics, Mann-Whitney U test, Kruskal-Wallis H test, and Bonferroni correction. Results: Participants had a median total score of 1.92. Their "daily life needs" and "sexuality needs" subscale scores were highest and lowest, respectively. Older patients had lower median total scores than younger patients. Younger patients had higher median "health care and information needs" and "sexuality needs" subscale scores than older patients. Conclusion: Elderly patients reported fewer unmet needs than younger patients. This may be due to age-related cultural factors as they may have difficulty expressing their needs. Implications: Results suggest to focus on the fact that patients' needs change with age and that they have difficulty expressing their needs.

Characterizing the Heterogeneity of Aging: A Vision for a Staging System for Aging.

Introduction: Older adulthood encompasses several decades of change and heterogeneity. Primary care providers need a geriatric comprehensive vision for defining older adult subpopulations.Methods: Using PubMed and Google searches, we reviewed the literature on epidemiology of age-related physiological changes, age-related diseases and geriatric syndromes, functional state, and emotional and social changes. We divided old age into strata based on chronological age and strata based on functional state, disease burden, and geriatric syndromes.Results: We describe 4 chronological-age strata beginning at age 60, and 4 functional-age strata based on frailty according to a modified clinical frailty scale. We provide clinical considerations and anticipatory guidance topics for each of the age strata and functional strata.Conclusion: Chronological age, functional status, chronic disease burden and geriatric syndromes, and life expectancy are all important domains that impact clinical care and appropriate anticipatory guidance for individual older adults. Better knowledge for differentiating subpopulations of older adults may improve clinical care, reduce medical overuse, improve personalized anticipatory guidance, and focus on the impact of functional state on the quality of life.

The Benefits of a Muscle-Sparing Below Knee Amputation in the Elderly Population.

It is well accepted that good muscle coverage of the bones at the end of a below knee amputation (BKA) stump is preferable, for both weight bearing and protection against prosthesis failure. Elderly patients often have atrophy of the leg musculature secondary to age-related physiological changes and decreased use. These patients often have poor coverage and bulk in their stumps after the standard BKA. We propose a selective muscle-sparing approach to these patients, utilizing selective removal of muscle bundles with regard to their blood supply and fascial planes. The surgical method technique along with outcomes of patients undergoing the procedure is presented here. A retrospective chart review was performed to identify patients who had undergone a muscle-sparing BKA from March 2008 to October 2017 by a single surgeon. Estimated blood loss, operative time, and perioperative and postoperative complications were assessed. Forty-six patients greater than 60years of age underwent muscle-sparing BKA procedures. Complete healing was seen in 30 (65%) patients, while 7 (15%) were lost to follow-up and 9 (20%) required conversion to an above knee amputation (AKA). Intraoperative outcomes in our series were notable for an average estimated blood loss (EBL) of 84.3ml, lower than the traditional BKA (average EBL 150-500ml), with comparable operative times averaging 131 minutes and as short as 85 minutes (skin incision to dressing). No patients in the cohort required postoperative blood transfusions (day 0-4), significantly less than the reported 3-7ml/kg body weight blood requirements in similar patient populations. The muscle-sparing BKA technique should be considered in elderly patients, where the normally bulky posterior calf muscle mass is lacking. The selective removal of muscle bundles with regard to their blood supply leaves maximum coverage of the bone with decreased potential hematoma formation and blood loss.

Early diagnosis and prevention of acute kidney injury in elderly patients after urgent abdominal surgery

Due to the rapidly aging of the population, the number of elderly patients is boosting. Elderly patients are a special cohort of patients due to their typical physiological and anatomical age-related changes, fragility, and comorbidity. One of the threatening perioperative complications is acute kidney injury (AKI), which is associated with a longer hospital stay, increased short-term and long-term mortality. Despite constant efforts to standardize the determination of AKI using serum creatinine, this method has several disadvantages, which makes the search for other diagnostic criteria for kidney damage urgent. Recently, the determination of biomarkers (lipocalin-2, interleukin-18, cystatin C), which can be useful in the early diagnosis of AKI, has become increasingly popular. Even though the filtration capacity of the kidneys is the only factor determining the serum cystatin C concentration, this marker is the most valuable. The use of ultrasound for the early diagnosis of AKI is also considered promising. Several studies show that the renal resistance index and semi-quantitative assessment of renal blood flow work are well for diagnosing persistent AKI. The high mortality rate and the lack of special treatment increase the need for AKI prevention in the elderly, the main one of which is careful clinical monitoring with timely correction of hypovolemia and hypotension. With invasive procedures, the risk of AKI can be reduced by maintaining mean arterial pressure &gt; 80 mmHg and hematocrit &gt; 30 %, as well as providing adequate oxygenation and volume restoration. Prescription of drugs should be individualized by adjusting doses based on the glomerular filtration rate and the patient’s age. However, the question of specific drug prevention of AKI remains open. Several studies have confirmed the renoprotective properties of dexmedetomidine in cardiac surgery, and some positive effects of pentoxifylline for the treatment of renal pathology are also described in the literature. This review explores the topic of AKI in elderly patients undergoing abdominal surgery and focuses on the early diagnosis and prevention of this syndrome.

Age-related changes in physiology in individuals with bipolar disorder

BackgroundIndividuals with bipolar disorder have a reduced life expectancy and may experience accelerated biological ageing. In individuals with bipolar disorder and healthy controls, we examined differences in age-related changes in physiology. MethodsUK Biobank recruited more than 500,000 participants, aged 37–73, between 2006 and 2010. Generalised additive models were used to examine associations between age and grip strength, cardiovascular function, body composition, lung function and heel bone mineral density. ResultsThe main dataset included 271,118 adults (mean age = 56.04 years; 49.60% females). We found statistically significant differences between cases and controls for grip strength, blood pressure, pulse rate and body composition, with standardised mean differences of up to -0.24 (95% CI -0.28 to -0.19). Evidence of differences in lung function, heel bone mineral density or arterial stiffness was limited. Case-control differences were most evident for age-related changes in cardiovascular function (both sexes) and body composition (females). Differences did not uniformly narrow or widen with age and differed by sex. For example, the difference in systolic blood pressure between male cases and controls was -1.3 mmHg at age 50 and widened to -4.7 mmHg at age 65. Diastolic blood pressure in female cases was 1.2 mmHg higher at age 40 and -1.2 mmHg lower at age 65. LimitationsAnalyses did not distinguish between bipolar disorder subtypes. Results may not generalise to other age groups. ConclusionsDifferences between bipolar disorder cases and controls were most evident for cardiovascular and body composition measures. Targeted screening for cardiovascular and metabolic health in middle age is warranted to potentially mitigate excess mortality.

Prolonged caloric restriction ameliorates age-related atrophy in slow and fast muscle fibers of rat soleus muscle

Aging causes loss of skeletal muscle mass and function, which is called sarcopenia. While sarcopenia impairs the quality of life of older adults and is a major factor in long-term hospitalization, its detailed pathogenic mechanism and preventive measures remain to be identified. Caloric restriction (CR) suppresses age-related physiological and pathological changes in many species and prolongs the average and healthy life expectancy. It has recently been reported that CR suppresses the onset of sarcopenia; however, few studies have analyzed the effects of long-term CR on age-related skeletal muscle atrophy. Thus, we investigated the aging and CR effects on soleus (SOL) muscles of 9-, 24-, and 29-month-old ad libitum-fed rats (9AL, 24AL, and 29AL, respectively) and of 29-month-old CR (29CR) rats. The total muscle cross sectional area (mCSA) of the entire SOL muscle significantly decreased in the 29AL rats, but not in the 24AL rats, compared with the 9AL rats. SOL muscle of the 29AL rats exhibited marked muscle fiber atrophy and increases in the number of muscle fibers with a central nucleus, in fibrosis, and in adipocyte infiltration. Additionally, although the decrease in the single muscle fiber cross-sectional area (fCSA) and the muscle fibers' number occurred in both slow-type and fast-type muscle fibers, the degree of atrophy was more remarkable in the fast-type fibers. However, CR suppressed the muscle fiber atrophy observed in the 29AL rats' SOL muscle by preserving the mCSA and the number of muscle fibers that declined with aging, and by decreasing the number of muscle fibers with a central nucleus, fibrosis and denervated muscle fibers. Overall, these results revealed that advanced aging separately reduces the number and fCSA of each muscle fiber type, but long-term CR can ameliorate this age-related sarcopenic muscle atrophy.

Impact of Hearing Aid Use on Falls and Falls-Related Injury: Results From the Health and Retirement Study.

Falls are considered a significant public health issue and falls risk increases with age. There are many age-related physiologic changes that occur that increase postural instability and the risk for falls (i.e., age-related sensory declines in vision, vestibular, somatosensation, age-related orthopedic changes, and polypharmacy). Hearing loss has been shown to be an independent risk factor for falls. The primary objective of this study was to determine if hearing aid use modified (reduced) the association between self-reported hearing status and falls or falls-related injury. We hypothesized that hearing aid use would reduce the impact of hearing loss on the odds of falling and falls-related injury. If hearing aid users have reduced odds of falling compared with nonhearing aid users, then that would have an important implications for falls prevention healthcare. Data were drawn from the 2004-2016 surveys of the Health and Retirement Study (HRS). A generalized estimating equation approach was used to fit logistic regression models to determine whether or not hearing aid use modifies the odds of falling and falls injury associated with self-reported hearing status. A total of 17,923 individuals were grouped based on a self-reported history of falls. Self-reported hearing status was significantly associated with odds of falling and with falls-related injury when controlling for demographic factors and important health characteristics. Hearing aid use was included as an interaction in the fully-adjusted models and the results showed that there was no difference in the association between hearing aid users and nonusers for either falls or falls-related injury. The results of the present study show that when examining self-reported hearing status in a longitudinal sample, hearing aid use does not impact the association between self-reported hearing status and the odds of falls or falls-related injury.

Can exercise be used as a protective agent against disease severity in COVID-19 and as treatment during subsequent rehabilitation?

In a matter of months, COVID-19 has spread worldwide, and it has affected not only human lives but also the socioeconomic structure. Disease severity increases with the presence of other factors such as age, diabetes, and hypertension. Exercise has been shown to control blood pressure and blood sugar level; it enhances the immune system and age-related physiological changes. Given its ability to control all of these factors, exercise can be used as a protective agent against disease severity in COVID-19 and as treatment during subsequent rehabilitation.

Lifetime depression and age-related changes in body composition, cardiovascular function, grip strength and lung function: sex-specific analyses in the UK Biobank.

Individuals with depression, on average, die prematurely, have high levels of physical comorbidities and may experience accelerated biological ageing. A greater understanding of age-related changes in physiology could provide novel biological insights that may help inform strategies to mitigate excess mortality in depression. We used generalised additive models to examine age-related changes in 15 cardiovascular, body composition, grip strength and lung function measures, comparing males and females with a lifetime history of depression to healthy controls. The main dataset included 342,393 adults (mean age = 55.87 years, SD = 8.09; 52.61% females). We found statistically significant case-control differences for most physiological measures. There was some evidence that age-related changes in body composition, cardiovascular function, lung function and heel bone mineral density followed different trajectories in depression. These differences did not uniformly narrow or widen with age and differed by sex. For example, BMI in female cases was 1.1 kg/m2 higher at age 40 and this difference narrowed to 0.4 kg/m2 at age 70. In males, systolic blood pressure was 1 mmHg lower in depression cases at age 45 and this difference widened to 2.5 mmHg at age 65. These findings suggest that targeted screening for physiological function in middle-aged and older adults with depression is warranted to potentially mitigate excess mortality.

Usage of Health Information Websites: A Systematic Review of Older Adults’ Preferences for Web Features

Background : Online health information have a role in enhancing health in older adults. However, age-related physiological changes and non-senior friendly websites proved to be a challenge for older adults. Research investigating older adults’ preferences of features in health information websites is limited. Thus, in this review, we aim to summarize older adults’ preferences regarding the design and content of health websites. Methods : Medline, CINAHL, Cochrane Library, Scopus, Journal of Medical Internet Research (JMIR), and Google Scholar were searched for relevant articles, using key words ‘older adults’, ‘internet’, ‘health information’ and ‘usability’. The methodological quality of included studies was evaluated using the McMaster critical appraisal tools (quantitative and qualitative versions). Individual study design, participants’ characteristics, and identified preferences for health website features were extracted and summarized narratively. (PROSPERO registration number: CRD42018096281) Results : Five studies (3 qualitative, 2 quantitative) were included in this review. The quality appraisal score ranged from 32% to 83%. The preferences of older adults were grouped into three domains: web presentation factors, web navigation factors and health information preferences. The results highlight older adults have specific preferences when engaging with online content. Conclusion : This review suggests that readable text, simple design, consistent layout and straightforward web navigation are the preferred priorities for a health information website for older adults. Implications for practice : Findings from this review may be useful to healthcare professionals and developers to understand older adults’ preferences pertaining to web design and contents in health websites specifically designed for this population. DOI : http://dx.doi.org/10.17576/JSKM-2021-1902-13

Physiologically Based Pharmacokinetics Model in Pregnancy: A Regulatory Perspective on Model Evaluation.

Physiologically based pharmacokinetics (PBPK) modelling is widely used in medicine development and regulatory submissions. The lack of clinical pharmacokinetic data in pregnancy is widely acknowledged; therefore, one area of current interest is in the use of PBPK modelling to describe the potential impact of anatomical and physiological changes during pregnancy on the medicine's pharmacokinetics. PBPK modelling could possibly represent a predictive tool to support the medicine benefit–risk decision and inform dose adjustment in this population and also to investigate medicine levels in the foetus to support the risk assessment to the foetus. In the context of regulatory application, there are, however, a number of considerations around model evaluation, and this should be tailored to the model purpose, in order to inform the confidence in the model for the intended application. A number of gestational age-related physiological changes are expected to alter the pharmacokinetics of medicines during pregnancy, and there are uncertainties on some parameters; therefore, well-qualified models are needed to improve assurance in the model prediction before this approach can be used to inform with confidence high-impact decisions as part of regulatory submissions.