Status Of Older People Research Articles

Association of body indices with mortality in older population: Japan Specific Health Checkups (J-SHC) Study.

Obesity indices reflect not only fat mass but also muscle mass and nutritional status in older people. Therefore, they may not accurately reflect prognosis. This study aimed to investigate associations between a body shape index (ABSI), body mass index (BMI), and mortality in the general older population. This nationwide observational longitudinal study included individuals aged between 65 and 74 years who underwent annual health checkups between 2008 and 2014. Exposures of interest were ABSI and BMI, and the primary outcome was all-cause mortality. Association between the ABSI and BMI quartile (Q1-4) and mortality was assessed using Cox regression analysis. A restricted cubic spline was also used to investigate nonlinear associations. The missing values were imputed using multiple imputation by chained equations. Among 315,215 participants, 5074 died during a median follow-up period of 42.5 (interquartile range: 26.2-59.3) months. Compared with ABSI Q1, ABSI Q3 and Q4 were associated with increased risk of mortality, with the adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) of 1.13 (1.05-1.22) and 1.23 (1.13-1.35), respectively. Compared with BMI Q3, BMI Q1 and Q2 were associated with an increased risk of mortality, with aHRs and 95% CIs of 1.51 (1.39-1.65) and 1.12 (1.03-1.22), respectively. The impacts of these indices were greater in male than in female. The heatmap of the aHR for mortality by continuous ABSI and BMI showed that higher ABSI was consistently associated with higher mortality risk regardless of BMI, and that the combination of low BMI and high ABSI was strongly associated with increased mortality risk. High ABSI and low BMI are additively associated with the risk of all-cause mortality in the general older population in Japan. Combination of ABSI and BMI is useful for evaluating mortality risk in older people.

The impact of frailty on the use of social services, medication and mortality risk: a cross-sectional study

BackgroundFrailty is a common condition in older people, and its prevalence increases with age. With an ageing population, the adverse consequences of frailty cause an increasing appeal to the health care system. The impact of frailty on population level is often assessed using adverse health outcomes, such as mortality and medication use. Use of community nursing services and services offered through the Social Support Act are hardly used in assessing the impact of frailty. However, these services are important types of care use, especially in relation to ageing in place. In this cross-sectional study, we aimed to assess the impact of frailty on use of Social Support Act services, use of community nursing services, medication use, and mortality.MethodsWe used a frailty index, the FI-HM37, that was based on data from the Dutch Public Health Monitor 2016, for which respondents ≥ 65 years of age were included (n = 233,498). The association between frailty, the use of Social Support Act services, community nursing services and medication use was assessed using the Zero Inflated Poisson (ZIP) regression method. Survival analysis using Cox proportional hazards regression was conducted to estimate the hazard ratios for the association between frailty and mortality.ResultsThe ZIP regression with a final sample size of 181,350 showed that frailty affected care use even after correcting for several covariates mentioned in the literature. For each unit increase in frailty index (FI) score, the relative probability of using zero Social Support services decreased with 7.7 (p < 0.001). The relative chance of zero community nursing services decreased with 4.0 (p < 0.001) for each unit increase in FI score. Furthermore, for each unit increase in FI score, the likelihood of zero medication use decreased with 2.9 (p < 0.001). Finally, for each unit increase in FI score, the mortality risk was 3.8 times higher (CI = 3.4–4.3; p < 0.001).ConclusionsWe demonstrated that frailty negatively affects the use of Social Support Act services, the use of community nursing services, medication use, and mortality risk. This study is the first to demonstrate the impact of frailty on Social Support Act services and community nursing services in the Netherlands. Findings emphasize the importance of frailty prevention for older people and public health policy.

Feasibility of Monitoring Heart and Respiratory Rates Using Nonwearable Devices and Consistency of the Measured Parameters: Pilot Feasibility Study.

As Japan is the world's fastest-aging society with a declining population, it is challenging to secure human resources for care providers. Therefore, the Japanese government is promoting digital transformation and the use of nursing care equipment, including nonwearable devices that monitor heart and respiratory rates. However, the feasibility of monitoring heart and respiratory rates with nonwearable devices and the consistency of the rates measured have not been reported. In this study, we focused on a sheet-type nonwearable device (Safety Sheep Sensor) introduced in many nursing homes. We evaluated the feasibility of monitoring heart rate (HR) and respiratory rate (RR) continuously using nonwearable devices and the consistency of the HR and RR measured. A sheet-type nonwearable device that measured HR and RR every minute through body vibrations was placed under the mattress of each participant. The participants in study 1 were healthy individuals aged 20-60 years (n=21), while those in study 2 were older adults living in multidwelling houses and required nursing care (n=20). The HR was measured using standard methods by the nurse and using the wearable device (Silmee Bar-type Lite sensor), and RR was measured by the nurse. The primary outcome was the mean difference in HR and RR between nonwearable devices and standard methods. The mean difference in HR was -0.32 (SD 3.12) in study 1 and 0.04 (SD: 3.98) in study 2; both the differences were within the predefined accepted discrepancies (<5 beats/min). The mean difference in RR was -0.98 (SD 3.01) in study 1 and -0.49 (SD 2.40) in study 2; both the differences were within the predefined accepted discrepancies (3 breaths/min). HR and RR measurements obtained using the nonwearable devices and the standard method were similar. Continuous monitoring of vital signs using nonwearable devices can aid in the early detection of abnormal conditions in older people.

Quality of Life of Older People Living with COPD in Nepal

Background: Chronic Obstructive Pulmonary Disease (COPD) is one of the most common chronic health conditions in older people and is increasingly becoming a major public health concern. Objectives: The study aims to assess the quality of life among older patients living with COPD. Methods: A hospital-based cross-sectional study was conducted from February 2017 to July 2018 in a tertiary care hospital in Kavre, Nepal. A total of 220 patients aged 60 years and above were the respondents. Quality of Life (QOL) of participants was assessed through a widely used shorter version of ST George’s Respiratory Questionnaire (SGRQ-C). The mean and Pearson correlation coefficients were used while analysing the data. Results: The mean total score for all domains of QOL was 68.57 (SD=18.66). The mean QOL scores for symptom, activity, and impact domains were 70.51 (SD=±22.37), 68.12 (SD=±23.42), and 68.19 (SD=±20.32) respectively, which suggested marked impairments in QOL in all SGRQ-C domains. The factors significantly related to the overall QOL of COPD patients in this study were: gender, education, type of family, and economic status. Conclusion: Nepalese older patients with COPD had poor quality of life. Older patients with COPD had an impaired QOL in all three components of symptom, activity, and impact domains. There should be some initiation on how the QOL of older patients with COPD can be improved.

A multicomponent personalized prevention program in the primary care setting: a randomized clinical trial in older people with noncommunicable chronic diseases (Primacare_P3 study)

BackgroundMulticomponent interventions based on a comprehensive geriatric assessment (CGA) could promote active aging and improve health status in older people with Noncommunicable Chronic Diseases (NCDs), but conflicting evidences are available.AimTo evaluate the efficacy of a CGA-based multicomponent personalized preventive program (PPP) in reducing unplanned hospitalization rates during 12-month follow-up in community-dwelling older people with NCDs.Materials and methodsIn this randomized clinical trial (RCT), 1216 older adults recruited by 33 general practitioners (GPs) will be randomly allocated to intervention group (IG) or usual care control group (CG). The IG will receive a multicomponent PPP developed on the findings of the CGA-based Multidimensional Prognostic Index short-form (Brief-MPI), including structured interventions to improve functional, physical, cognitive, and nutritional status, to monitor NCDs and vaccinations, and to prevent social isolation. Participants in the CG will receive usual care. Brief-MPI, resilience, and health-related quality of life will be assessed after 6 and 12 months. Moreover, saliva samples will be collected at baseline in IG to measure biomarkers of oxidative stress, inflammatory cytokines, and oral microbiome.Expected resultsThe CGA-based PPP might reduce unplanned hospitalization rates and potentially institutionalization rates, emergency department (ED) and unplanned GP visits, and mortality. Further outcomes explored in the IG will be the adherence to PPP, resilience, health-related quality of life, and multidimensional frailty as assessed by the Brief-MPI.ConclusionsResults will suggest whether the CGA-based multicomponent PPP is able to improve specific outcomes in a primary care setting.Trial registrationClinicalTrials.gov; identifier: NCT06224556; Registered January 25, 2024.

Resection of the extra vertebral portion of the filum terminale plus sphincterectomy. Case Report

Introduction: Constipation is a gastrointestinal disorder that causes less frequent bowel movements, difficult stools, pain, and stiffness. Acute constipation can cause intestinal obstruction and may even require surgery. The pathogenesis is multifactorial and focuses on genetic predisposition, socioeconomic status, low fiber consumption, lack of sufficient fluid intake, lack of mobility, changes in hormonal balance, side effects of medications or body anatomy. Chronic constipation is a complex condition in older people characterized by difficulty defecating. In this sense, this situation is closely related to the patient's quality of life and the consumption of health resources. Clinical Case: male patient who reports chronic constipation for a year, presents for 24 hours a clinical condition characterized by vomiting of food content on 4 occasions, reports abdominal distension accompanied by flatulence and dyspepsia, during hospitalization an episode of hematochezia versus rectal bleeding is evident. Evolution: Chronic Constipation is diagnosed and Resection Technique of the extravertebral portion of the filum terminalis plus posterior internal sphincterectomy is used. Conclusions: The Resection Technique of the extravertebral portion of the filum terminalis plus posterior internal sphincterectomy has demonstrated excellent benefits in the management of pediatric patients with chronic constipation.

Mild cognitive impairment predicts the onset of Sarcopenia: a longitudinal analysis from the English Longitudinal Study on Ageing

BackgroundMild cognitive impairment (MCI) and sarcopenia are two common conditions in older people. It is not widely known if MCI could predict the onset of sarcopenia. Therefore, we aimed to investigate whether MCI could predict the occurrence of sarcopenia in a population of older adults.MethodsIn the ELSA (English Longitudinal Study on Ageing), MCI was defined as the absence of dementia, preserved functional capacity and low performance in three objective cognitive tests. Sarcopenia was diagnosed as having low handgrip strength and low skeletal muscle mass index during follow-up. The longitudinal association between MCI at the baseline and incident sarcopenia was assessed using a multivariable logistic regression model, reporting the data as adjusted odds ratios (OR) and 95% confidence intervals (95%CI).Results3,106 participants (mean age of 63.1 years; 55.3% males) were included. People with MCI reported significantly lower mean handgrip strength values and Skeletal Mass Index (SMI), as well as a higher prevalence of obesity at baseline. At baseline, 729 people had MCI and during the ten years follow-up period, 12.1% of the initial population included had sarcopenia. On multivariate analysis, adjusted for 18 potential confounders, the presence of MCI (OR = 1.236; 95%CI: 1.090–1.596, p = 0.01) significantly predicted the onset of sarcopenia during follow-up.ConclusionThe presence of MCI at baseline was associated with a higher incidence of sarcopenia at ten-years follow-up, demonstrating a likely role of MCI as a predictor of the onset of sarcopenia in older people.

Alterations in regulators of the renal-bone axis, inflammation and iron status in older people with early renal impairment and the effect of vitamin D supplementation.

Chronic kidney disease (CKD) leads to alterations in fibroblast growth factor 23 (FGF23) and the renal-bone axis. This may be partly driven by altered inflammation and iron status. Vitamin D supplementation may reduce inflammation. Older adults with early CKD (estimated glomerular filtration rate (eGFR) 30-60ml/min/1.73 m2; CKDG3a/b; n = 35) or normal renal function (eGFR >90ml/min/1.73 m2; CKDG1; n = 35) received 12,000, 24,000 or 48,000IU D3/month for 1year. Markers of the renal-bone axis, inflammation and iron status were investigated pre- and post-supplementation. Predictors of c-terminal and intact FGF23 (cFGF23; iFGF23) were identified by univariate and multivariate regression. Pre-supplementation, comparing CKDG3a/b to CKDG1, plasma cFGF23, iFGF23, PTH, sclerostin and TNFα were significantly higher and Klotho, 1,25-dihydroxyvitamin D and iron were lower. Post-supplementation, only cFGF23, 25(OH)D and IL6 differed between groups. The response to supplementation differed between eGFR groups. Only in the CKDG1 group, phosphate decreased, cFGF23, iFGF23 and procollagen type I N-propeptide increased. In the CKDG3a/b group, TNFα significantly decreased, and iron increased. Plasma 25(OH)D and IL10 increased, and carboxy-terminal collagen crosslinks decreased in both groups. In univariate models cFGF23 and iFGF23 were predicted by eGFR and regulators of calcium and phosphate metabolism at both time points; IL6 predicted cFGF23 (post-supplementation) and iFGF23 (pre-supplementation) in univariate models. Hepcidin predicted post-supplementation cFGF23 in multivariate models with eGFR. Alterations in regulators of the renal-bone axis, inflammation and iron status were found in early CKD. The response to vitamin D3 supplementation differed between eGFR groups. Plasma IL6 predicted both cFGF23 and iFGF23 and hepcidin predicted cFGF23.

Effects of Regular Exercise on the Biochemical, Oxidative, and Inflammatory Profiles and Quality of Life in Older Spaniards with Metabolic Syndrome.

Metabolic syndrome increases the risk of developing diabetes and cardiovascular disease. The regular practice of physical activity is a crucial factor for healthy aging and for controlling and preventing chronic diseases. To assess the effects of regular physical activity on the biochemical and inflammatory profiles, as well as the quality of life of older adults diagnosed with metabolic syndrome. Participants (aged 55-70 years; living in the Balearic Islands, Spain) were divided into two groups (n = 50 each) according to the degree of physical activity measured by metabolic equivalents of task (METs). Anthropometric parameters, blood pressure, biochemical and hematological parameters, and inflammatory biomarkers were measured. Beck Depression Inventory and adherence to the Mediterranean diet questionnaires, as well as the Dietary Inflammatory Index, chair test, health-related quality of life (HRQoL), and Rapid Assessment of Physical Activity, were also determined. The characterization of the patients was similar in both groups, showing a homogeneous sample. The group with the highest METs experienced a decrease in depression and an increase in the intensity of physical activity. Adherence to the Mediterranean diet and HRQoL physical dimensions increased in participants with the highest METs, also showing a decrease in glycemia and glycosylated hemoglobin values. Inflammatory biomarkers, including tumor necrosis factor alpha, interleukin-6, interleukin-1β, and osteoprotegerin, decreased in patients practicing more physical activity. High levels of physical activity are related to a healthier lifestyle, characterized by high adherence to the Mediterranean diet, decreased depressive behavior, oxidative stress, and inflammatory status in older people with metabolic syndrome.

How our population is aging. Factors associated with the functional capacity of older adults in Bucaramanga-Colombia: The ARENA Study

Introduction. As a demographic aging result, societies have experienced effects such as the increase of functional limitations in older adults and high demand for social and health care. The objective is to analyze factors associated with the functional level of daily life activities and socio-family risk factors of older adults in an urban population in Bucaramanga-Colombia. Methodology. Analytical cross-sectional secondary data study. 196 older adults were studied after excluding individuals with incomplete records. The Barthel and the Lawton Index were used for functional status, and Socio-Family Assessment Scale for social risk. The STATA software was used for doing the logistic regression that helped to determine association between variables. Results. Above half of older adults presented functional limitations when performing daily life activities (59.69%). The prevalence of a socio-family risk was 47.45%. Functional limitation was associated with age, cognitive dysfunction and falls risk. Discussion. The study demonstrated lower scores in the Barthel Index and high scores in risk and social problematic situations compared to other studies. Moreover, results support that high blood pressure is a risk factor for functional limitations situations. Conclusion. It is important to continue interventions about health status in older people to identify risk factors, such as cognitive dysfunction, high Falls risk and chronic diseases control.

Prevalence of sarcopenia in Africa: a systematic review and meta-analysis of observational studies

BackgroundExisting literature suggests that sarcopenia is a highly prevalent condition in older people. However, most studies to date reporting data on its prevalence have been mainly carried out in Western countries, while data on sarcopenia in Africa is scarce. With this systematic review and meta‐analysis, we aimed to determine the prevalence of sarcopenia in African countries and to explore potential factors that could explain higher or lower prevalence of this condition in Africa.MethodsMajor databases for studies reporting data on sarcopenia in African countries were searched from inception to June 2023. We conducted a meta-analysis of the prevalence [and 95% confidence intervals (95% CIs)] of sarcopenia in Africa, applying a random effect model. Several sensitivity and meta-regression analyses were run.ResultsAmong 147 articles initially screened, six articles (with seven cohorts) including a total of 10,656 participants were included. Mean age of participants was 66.9 years, and the majority were female (58.1%). The weighted prevalence of sarcopenia in the selected countries of Africa was 25.72% (95%CI: 18.90–32.55). This outcome was characterized by a high heterogeneity (I2 = 99%) and by publication bias. Among the factors investigated, sarcopenia was lower when assessed using only one anthropometric measure, or in South Africa.ConclusionSarcopenia is a prevalent condition in Africa and thus research regarding this topic is a public health priority. Future studies that cover African countries for which data are not available and using standardized criteria are needed.

2051 How representative are UK-based trials investigating lifestyle interventions for diabetes mellitus: a systematic review

Abstract Background Type 2 Diabetes mellitus (T2DM) is the most common long-term metabolic condition in older people. In the UK, half of all diabetic patients are over 65 and prevalence reaches 10% in over 75s. Lifestyle interventions reduce diabetic complications and can achieve remission, however, there are concerns over the generalisability of these findings to the diabetic population, particularly elderly, complex patients, and those from ethnic minorities. This systematic review quantifies the disparity between diabetes clinical trial cohorts and the UK diabetic population. Method This is a systematic review of UK-based randomised control trials (RCTs) of non-pharmaceutical interventions in adults with T2DM. Data was collected on characteristics of participants included in these studies, including age, sex, ethnicity, socioeconomic status and education of participants. Results Our search strategy identified 5437 results, of which 161 met the criteria for full-text screening. After full-text screening and de-duplication, 80 RCTs were included in our analysis. Of 80 studies, 60% (48/80) reported a mean participant age under 60. Only 40 (50%) reported participant age range; of these the maximum participant age was under 65 in 20% and under 75 in 60%. Where the mean age of participants was over 60, 56% (18/32) restricted participation by comorbidities. Almost all of these precluded anyone with pre-existing CVD (17/18), one third precluded any comorbidities, and 5/18 precluded hypertensive patients. Only 26% of studies reported the ethnicity of participants. These cohorts were not representative of the UK diabetic population, with underrepresentation of Asian ethnic groups in 90% of trials. Conclusions Representation of elderly patients with comorbidities and those belonging to ethnic minority groups is severely limited in UK based T2DM RCTs of lifestyle interventions. Failure to include a representative population in clinical trial cohorts risks guidance that is not generalisable to the UK diabetic population, potentially exacerbating existing health inequities.

Assessment Tools for Detecting Malnutrition among Elderly in Shelter Homes: A Systematic Review

Assessing nutritional status in older people is essential to screen for malnutrition and identify the individuals requiring nutritional intervention for a better quality of life and longer life expectancy. This review aimed to investigate malnutrition and the role of nutritional assessment tools among older people in Malaysia. We systematically reviewed the publications from 2000 to 2019 using PubMed/MEDLINE and Scopus databases, recovering 15 original articles published until January 2022. This systematic review was conducted from May to September 2022. Two reviewers were involved in the process of the selection of articles and data extraction. Only research papers on malnutrition among older people in institutionalized settings in Malaysia were included. Four articles related to malnutrition in older people in old folk homes in Malaysia were included in this review. The tools with the most significant evidence were Mini Nutritional Assessment (MNA) and Nutritional Health Checklist (NHC) in residential care for the elderly. It was found that the incidence of malnutrition among the elderly in old folk homes in Malaysia ranged from 12.3% to 17.4%. Meanwhile, 40.4% to 57.7% of the population are documented to be at risk of malnutrition. NA and DETERMINE NHC were found to be most suitable for use in residential care due to their high sensitivity and specificity. A subsequent study is proposed to build and implement a scoring system to rate screening tools based on the validity, suitability, and practicability of the tools to help with malnutrition screening research and clinical practice in Malaysia and internationally.

Impact of Adverse Health Conditions on Clinical Outcomes of Older People with Atrial Fibrillation: Insights from a Prospective Cohort Study.

To evaluate the impact of adverse health conditions, including multimorbidity, frailty, malnutrition, cognitive impairment, and polypharmacy, on clinical outcomes in older people with atrial fibrillation (AF). This prospective cohort study focused on patients aged 65 years and older with AF. They were admitted to the hospital between September 2018 and April 2019 and followed up for 1 year. We evaluated these participants for adverse health conditions including multimorbidity, frailty, malnutrition, cognitive impairment, and polypharmacy. The primary clinical outcome measured was a combination of all-cause mortality or rehospitalization. 197 older patients (≥65 years) with AF (mean age, 77.5±7.1 years; 57.4% men) were enrolled. During 1-year follow-up, Primary endpoint events (all-cause mortality or rehospitalization) occurred in 82 patients (41.6%). Compared with the non-event group, the Charlson comorbidity index (CCI) was higher (2.5±1.9 vs 1.7±1.3, p=0.004), more heart failure (32.9% vs 17.4%, p=0.01) and chronic kidney disease (17.1% vs 7.0%, p=0.03), with lower systolic blood pressure (125.3±18.3 mmHg vs 132±17.9 mmHg, p=0.005) in the event group. On multivariate Cox regression showed that the CCI was associated with a higher odds ratio of the composite outcome of all-cause mortality and rehospitalization (HR: 1.26; 95% CI: 1.02-1.56, p=0.03). Other adverse health conditions showed no significant association with the composite outcome of all-cause mortality and rehospitalization. Among adverse health conditions in older people with AF, multimorbidity appears to be a significant determinant of adverse clinical outcomes. ChiCTR1800017204; date of registration: 07/18/2018.

CVD incidence and mortality among people with diabetes and/or hypertension: Results from the English longitudinal study of ageing.

Diabetes and/or hypertension are the most common conditions in older people, and also related to higher cardiovascular disease (CVD) incidence and mortality. This study aims to explore the risk of CVD incidence and mortality among older people with diabetes and/or hypertension over a 16 years follow-up period and investigates the role of depression and obesity in these relationships. 6,855 participants aged 50+ from the English Longitudinal Study of Ageing (ELSA). The main exposure is having diabetes and/or hypertension at baseline (2002/2003) compared to not having, but excluded those with coronary heart disease (CHD) and/or stroke (CVD). Survival models are used for CVD incidence and mortality up to 2018, adjusted for socio-demographic, health, health behaviours, cognitive function, and physical function characteristics. 39.3% of people at baseline had diabetes and/or hypertension. The risk of CVD incidence was 1.7 (95%CI: 1.5; 1.9) higher among people with diabetes and/or hypertension compared to those without and was independent of covariates adjustment. People with diabetes and/or hypertension were also 1.3 (95%CI: 1.1; 1.8) times more likely to die from CVD than those without. We did not find evidence for an elevated risk of CVD incidence and mortality among people with obesity nor among those with depression. In order to effectively reduce the risk of CVD incidence and mortality among older people, treatment as well as management of hypertension and diabetes should be routinely considered for older people with diabetes and/or hypertension.

Severe Impairment Rating Scale (SIRS) in assessing patients with severe dementia in Chinese Community

AbstractBackgroundLike other advanced countries, Hong Kong is facing the challenges of an aging population, reduced fertility, and increasing longevity. Most older people who diagnosed with moderate to severe dementia would need institutional care. Nevertheless, the current instruments available in the Chinese population are having flooring effects in measuring the functional conditions for this specific group of population.MethodThis study aims to validate the 14‐item Chinese Severe Impairment Rating Scale (C‐SIRS), as an instrument designed to measure functional condition of older people with moderate and severe dementia. The development of this validation study was under classical test theory to examine and test (1) the degree of clarity, understandability, and relevance (i.e. content validity), (2) the test‐retest reliability score of SIRS, (3) the degree of the inter‐relatedness among SIRS items like internal consistency, and (4) the correlation between SIRS score and the functional measures by Hong Kong Montreal Cognitive Assessment (HK‐MoCA) and Modified Barthel Index 100 (MBI‐100).ResultWhen assessing the relevance and sensitivity of the question with the universal agreement calculation method, the scale‐level content validity index (S‐CVI/UA) of C‐SIRS received relevance ratings of “almost agree” or “absolutely agree” by all the experts. The Fleiss' kappa showed that there was moderate agreement between the panellists’ judgements, with at least 8 years of experience, κ = .326 (95% CI, .319 to .343), p &lt; .001. 105 older people with moderate to severe dementia recruited from nursing home were enrolled in the validation, the C‐SIRS had a high level of internal consistency, as determined by a Cronbach’s alpha of 0.99 with F = .005, p = .831. The SIRS shows significant correlation with both cognitive, as measured by MoCA (with r = .337, p &lt; .001), and functional measures as measured by MBI (with r = .64, p &lt; .01).ConclusionC‐SIRS is sensitive in measuring the functional condition in older people with moderate to severe dementia. Moreover, C‐SIRS is easier to administrate with shorter time required. Further study should help by investigating the sensitivity of C‐SIRS to assess the change over a longer period of time.

Europe’s demography and what to do about it

Among the EU’s challenges, demography is probably the least conspicuous. This does not, however, mean that it is unimportant—quite the contrary. While in the past, it was visible only in population statistics, in the 2020s the lack of a labour force has become obvious to anyone with an interest in the European welfare state and the EU’s competitiveness. Population ageing, caused by increasing longevity and persistently low birth rates, cannot be addressed by encouraging women to have more children or by bringing in non-EU migrants. These methods are ineffective, and often resented. Instead, the key to improving the state of the EU’s demographic and economic prospects lies in increasing labour participation rates. This can be done by pushing up the statutory retirement age and creating the right conditions for older people, women, minority groups and diasporas to enter the world of work. While the latter measures are also not easy to implement, they are still more politically and socially viable than boosting immigration and birth rates.

Conditions for older people in post-sentence preventive detention

ZusammenfassungLebensältere Personen stellen einen beachtlichen Anteil der in Sicherungsverwahrung Untergebrachten. Zudem blicken Untergebrachte häufig auf Lebensläufe, die altersbedingte Einschränkungen begünstigen, zurück. Da Vollzugsgesetze keine besonderen Vorgaben für den Umgang mit älteren Untergebrachten vorsehen, obliegt es den einzelnen Einrichtungen, entsprechende Angebote zu schaffen. In vorliegendem Artikel wird die Alterszusammensetzung von Sicherungsverwahrten dargestellt und ein Überblick über die in den Einrichtungen bestehenden Maßnahmen und Angebote für ältere Untergebrachte gegeben. Die Daten stammen aus einer jährlichen Stichtagserhebung durch die Kriminologische Zentralstelle (KrimZ) und einer in diesem Rahmen durchgeführten Abfrage bei den Einrichtungen der Sicherungsverwahrung. Das Durchschnittsalter bei Antritt der Sicherungsverwahrung ist über 47 Jahre. Im Jahr 2022 waren die Untergebrachten im Durchschnitt etwa 55 Jahre; mehr als ein Viertel waren über 60 Jahre alt. Elf Einrichtungen haben Angaben gemacht. Es ist festzustellen, dass bisher kein einheitlicher Stand beim Umgang mit den besonderen Bedarfen von älteren Untergebrachten existiert. Mögliche Reaktionen auf die Bedürfnisse Älterer sind bestimmte bauliche Maßnahmen (n = 10) und Anpassungen in der Ausstattung (n = 10) sowie das Zurückgreifen auf spezielles Personal (n = 4) oder Schulungen für Mitarbeitende (n = 1). Außerdem können Maßnahmen der Gesundheitsversorgung (n = 8) und spezifische Behandlungsangebote für körperliche (n = 5) und geistige Fitness (n = 7) die Situation älterer Untergebrachter verbessern. Eine Schaffung systematischer Strukturen zum Umgang mit älteren Personen in Sicherungsverwahrung würde die Einrichtungen mit dieser Aufgabe nicht allein lassen und gleichzeitig eine menschenwürdige Unterbringung der Sicherungsverwahrten garantieren.

Examining the Nonstationary Spatial Association Between International Migration and Vulnerable Older People Living Alone in Mexico

Research on the intersection of migration and ageing is becoming increasingly relevant as older populations grow in developing countries. Understanding the challenges faced by older people, who are often left behind due to their vulnerable position, is essential for policy-making. This research examines the geographical variation in the impact of international migration on the living alone status of older people in Mexico, particularly those most at risk. The following municipal-level information was obtained from the 2020 Census: international migration, living alone, receipt of remittances, and disability. Using geographically weighted regressions, we found geographical variations in the association between international migration and living alone or being more vulnerable. Controlling for socio-demographic factors, in the southern states international migration is associated with a reduction in the proportion of adults living alone and greater vulnerability due to disability or lack of support from other households. This relationship holds for both men and women. However, in some border regions the proportion of older adults living alone and experiencing greater vulnerability increases with increasing migration, especially for women.

005 Association between prescription drugs and vaccines commonly prescribed to older people and bullous pemphigoid: a UK population-based study

Abstract Bullous pemphigoid (BP) is the most common autoimmune blistering skin disease, manifested by painful itching of the skin and mucous membranes. Despite high mortality, poor quality of life and increasing incidence in older people, BP can be overlooked due to its rarity in the general population. The cause of BP is unknown, but there are reports of drug-induced BP and remission after the withdrawal of suspected drugs. Systematic reviews have found prescription drugs such as gliptins and loop diuretics to be associated with BP. However, previous studies did consider multiple drug exposures and had selected populations. Our UK population-based study aimed to determine whether drugs/vaccines prescribed between 1998 and 2021 for common conditions in older people are associated with BP. We conducted a population-based nested case–control study using the UK Clinical Practice Research Datalink (representing 8% of the UK population). Each person with BP (case) was matched by age, sex and general practice to up to five controls at the diagnosis time of their case. Multivariable conditional logistic regression was used to determine adjusted odds ratios (aOR) of developing BP within 1 year of taking at least one prescription for the following therapeutic groups: antibiotics, antidiabetics and insulin, antihypertensives, antithrombotics, lipid modifiers, analgesics, dementia drugs, antiepileptics, antipsychotics, antidepressants and influenza vaccine. Where possible, we report results for classes of drugs or subclasses. The results were adjusted for multiple exposures and corrected for multiple testing. We also explored potential confounders: ethnicity, deprivation, stroke, Parkinson disease and dementia. Six months of antibiotics prescriptions before the BP diagnosis was excluded to account for treating undiagnosed BP symptoms. We identified 16 844 patients with BP and 79 493 controls (mean age 76 years; 44% male). The drugs associated with an increased risk of BP were penicillinase-resistant penicillins [aOR 2.6, 95% confidence interval (CI) 2.4–2.8]; macrolides (aOR 1.5, 95% CI 1.4–1.7); gliptins (aOR 2.8, 95% CI 2.4–3.3); centrally acting anticholinesterases (aOR 2.3, 95% CI 2.0–2.7); N-methyl-D-aspartate receptor antagonists (aOR 2.2, 95% CI 1.7–2.9); antiepileptics (aOR 2.4, 95% CI 2.3–2.6); influenza vaccine (aOR 1.4, 95% CI 1.4–1.5) and loop diuretics (aOR 1.3, 95% CI 1.2–1.4). Reduced BP risk was associated with nonsteroidal anti-inflammatory drugs (aOR 0.8, 95% CI 0.8–0.9) and opioids (aOR 0.8, 95% CI 0.8–0.9). Potential confounders did not affect odds ratio estimates. All P values were &amp;lt; 0.001. No association was found for broad-spectrum penicillins, lipid-modifying drugs, anticoagulants, beta blockers, calcium channel blockers and potassium-sparing diuretics with another diuretic. Clinicians need to be aware of BP risk in older people following administration of penicillinase-resistant penicillins, gliptins, dementia and epilepsy drugs, in order to recognize BP early and consider withdrawal of the suspect drug.