Death In Older People Research Articles

Cardiovascular risk factors and all-cause mortality in older age (15-year cohort study)

Cardiovascular diseases (CVD) occupy a leading position in the structure of all-cause mortality. Prospective and interventional studies have identified the major risk factors for CVD and shown their associations with the risk of cardiovascular outcomes and all-cause death. The impact on the individual risk of death may vary by age, sex, study design, and may be population-specific. We aimed to study the contribution of major CVD risk factors to the 15-year risk of all-cause death in the Russian (Siberian) population cohort aged 45–69 years.Material and methods. A random population sample (men and women 45–69 years old, n = 9360) was examined at baseline in 2003–2005 (Novosibirsk, Russian branch of the HAPIEE project) and re-examined twice in 2006–2008 and 2015–2018. Current analysis included individuals without baseline CVD (n = 8087), the average follow-up period – 15.6 (SD 0.69) years. The fatal events were registered based on death certificates from the Population Registration Bureau (ZAGS), and using the data received at serial examinations and postal interview. We analyzed the association between CVD risk factors and all-cause death using multivariate Cox regression.Results. In a cohort aged 45–69, in the adjusted model, 15-year risk of all-cause death was positively associated with age (HR = 1.08; 95 % CI 1.07–1.09), male sex (HR = 1.46; 95 % CI 1.24–1.71), hypertension (HT) (HR = 1.39; 95 % CI 1.25–1.55), smoking (HR = 2.37; 95 % CI 2.08–2.70), high WHR (HR = 1.19; 95 % CI 1.06–1.33), and type 2 diabetes (T2DM) (HR = 1.52; 95 % CI 1.34–1.73), and it was negatively associated with elevated total cholesterol (TC) or LDL-C in blood. In age- and sex-adjusted model, the risk was additionally associated with high triglycerides (HTG), obesity and elevated fasting plasma glucose (FPG). In men, the risk of death was independently associated with age, HT, smoking, low HDL-C, high WHR, and T2DM. In women, the risk of death was independently associated with age, HT, T2DM smoking, and, in age-standardized models, obesity, high WHR, and hyperglycemia.Conclusions. In a population cohort of 45 years and older, among CVD risk factors male sex, HT, smoking, central obesity, and T2DM independently contributed to the risk of all-cause death. Among lipid parameters, low HDL-C and high TG levels increased the risk of death in men. Associations between cardiovascular risk factors and the risk of all-cause death in older people have the patterns specific for older age; these features are important to take into account in a strategy to reduce mortality in the population.

Neck Circumference Cut-Off Points for Identifying Adiposity: Association with Chronic Metabolic Diseases in Older People.

The leading cause of death in older people is cardiovascular diseases. Several studies have found that neck circumference (NC) is a simple anthropometric marker associated with adiposity. The aim of this study is to estimate and validate NC cut-off points as adiposity markers and analyze their association with cardiovascular and chronic metabolic diseases in older people. A cross-sectional study in 358 non-disabled, community-dwelling older people (71.7 ± 3.9 years) living in Santiago de Chile and participating in the HTSMayor study was conducted. Measurements of body composition and cardiovascular risks were evaluated. Receiver operating characteristic (ROC) curves and multiple logistic regression models were used to evaluate the association of NC with cardiovascular and chronic metabolic diseases. NC cut-off points were obtained to predict obesity, abdominal obesity, and adiposity. The best performance values of neck circumference relative to obesity and adiposity were obtained with respect to abdominal obesity (40.6 cm in men and 34.2 cm in women). Higher NC values were associated with a higher area under the curve (AUC) for men and women (men: AUC = 0.84; women: AUC = 0.86). NC was significantly associated with a higher risk for diabetes mellitus (OR = 1.95), hypertension (OR = 2.42), acute myocardial infarction (OR = 4.36), and comorbidities (OR = 2.01), and a lower risk for sarcopenia (OR = 0.35). This study shows that NC is a useful tool for detecting abdominal obesity, obesity, and adiposity in older people and that a higher NC increases the risk of chronic diseases.

Longitudinal trajectories of frailty are associated with short-term mortality in older people: a joint latent class models analysis using 2 UK primary care databases

ObjectivesFrailty is a dynamic health state that changes over time. Our hypothesis was that there are identifiable subgroups of the older population that have specific patterns of deterioration. The objective of this study was to evaluate the application of joint latent class model in identifying trajectories of frailty progression over time and their group-specific risk of death in older people. Study Design and SettingThe primary care records of UK patients, aged over 65 as of January 1, 2010, included in the Clinical Practice Research Datalink: GOLD and AURUM databases, were analyzed and linked to mortality data. The electronic frailty index (eFI) scores were calculated at baseline and annually in subsequent years (2010-2013). Joint latent class model was used to divide the population into clusters with different trajectories and associated mortality hazard ratios. The model was built in GOLD and validated in AURUM. ResultsFive trajectory clusters were identified and characterized based on baseline and speed of progression: low–slow, low–moderate, low–rapid, high–slow, and high–rapid. The high–rapid cluster had the highest average starting eFI score; 7.9, while the low–rapid cluster had the steepest rate of eFI progression; 1.7. Taking the low–slow cluster as reference, low–rapid and high–rapid had the highest hazard ratios: 3.73 (95% CI 3.71, 3.76) and 3.63 (3.57-3.69), respectively. Good validation was found in the AURUM population. ConclusionOur research found that there are vulnerable subgroups of the older population who are currently frail or have rapid frailty progression. Such groups may be targeted for greater healthcare monitoring.

Gastric ischemia as an under-reported cause of death in older people.

Acute gastric ischemia is a rare condition due to the rich vascular supply of the stomach. Here we present a case of fatal gastric ischemia associated with bowel ischemia, only diagnosed at autopsy, which was requested for the suspicion of medical liability. A complete post-mortem examination was conducted, along with a macroscopic analysis of the superior mesenteric artery and detailed histological analyses. Past clinical data was also reviewed. The macroscopic blackish discoloration of the stomach and the bowel, coupled with the presence of neutrophils in the mucosa and submucosal non-occlusive thrombi, were consistent with gastric and bowel ischemia, despite the presence of confounding putrefactive changes. The unique aspect of this case resides in the ante-mortem peculiar vascularization of the stomach, supplied by small collateral vessels. No mechanical occlusion was identified, and the cause of the ischemia was deemed as non-occlusive, likely due to systemic hypoperfusion. The analysis of clinical data and documentation of associated comorbidities are strongly recommended, especially when a rare cause of death is suspected. With the aging population, especially among women, and the prevalence of risk factors, the forensic pathologist could increasingly encounter rare cases of gastric ischemia.

The epidemiology of dying within 48hours of presentation to emergency departments: a retrospective cohort study of older people across Australia and New Zealand.

Emergency department (ED) clinicians are more frequently providing care, including end-of-life care, to older people. To estimate the need for ED end-of-life care for people aged ≥65years, describe characteristics of those dying within 48 hours of ED presentation and compare those dying in ED with those dying elsewhere. We conducted a retrospective cohort study analysing data from 177 hospitals in Australia and New Zealand. Data on older people presenting to ED from January to December 2018, and those who died within 48hours of ED presentation, were analysed using simple descriptive statistics and univariate logistic regression. From participating hospitals in Australia or New Zealand, 10,921 deaths in older people occurred. The 48-hour mortality rate was 6.43 per 1,000 ED presentations (95% confidence interval: 6.31-6.56). Just over a quarter (n = 3,067, 28.1%) died in ED. About one-quarter of the cohort (n = 2,887, 26.4%) was triaged into less urgent triage categories. Factors with an increased risk of dying in ED included age 65-74years, ambulance arrival, most urgent triage categories, principal diagnosis of circulatory system disorder, and not identifying as an Aboriginal or Torres Strait Islander person. Of the 7,677 older people admitted, half (n = 3,836, 50.0%) had an encounter for palliative care prior to, or during, this presentation. Our findings provide insight into the challenges of recognising the dying older patient and differentiating those appropriate for end-of-life care. We support recommendations for national advanced care planning registers and suggest a review of triage systems with an older person-focused lens.

Lessons from a population-based bladder cancer registry: exploring why survival is not improving.

To explore the causes of the decrease in bladder cancer survival that has occurred over the past four decades. We extracted data from the South Australian Cancer Registry. Data from the period 1 January 1977 to 31 December 2020 were extracted to explore changes in incidence and survival among a total of 8356 patients diagnosed with ≥pT1 disease. Invasive bladder cancer was defined as ≥pT1 in this study. Invasive bladder cancer age-standardized incidence decreased from 7.20 cases per 100 000 people in 1977 to 5.85 cases per 100 000 in 2020. The mean age at diagnosis increased from 68 years to 76 years. The crude incidence for patients aged 80 years and over increased by 3.3% per year (95% confidence interval [CI] 2.1 to 4.6). Overall survival decreased over the study period (hazard ratio [HR] 1.22 [95% CI 1.09 to 1.35]), however, survival increased after adjusting for age at diagnosis (HR 0.80 [95% CI 0.76 to 0.94]). Despite a decrease in non-bladder cancer-specific deaths in older people, there was no change in the bladder cancer-specific death rate in older people (HR 0.94 [95% CI 0.70 to 1.26]). Male sex was associated with higher survival (HR 0.87 [95% CI 0.83 to 0.92]), whereas socioeconomic advantage was not. Invasive bladder cancer survival has decreased over the past 40 years, with the age structure of the population being a significant contributing factor. We looked at why bladder cancer survival is decreasing using a large cancer registry with information from 1977 to 2020. We found that people are now more likely to be diagnosed at an older age. Older people often live for a shorter time with bladder cancer compared to younger people. Bladder cancer survival has decreased because there are more older people with the disease than previously.

Association of changes in frailty status with the risk of all-cause mortality and cardiovascular death in older people: results from the Chinese Longitudinal Healthy Longevity Survey (CLHLS)

BackgroundFew studies have investigated the association between changes in frailty status and all-cause mortality, inconsistent results were reported. What’s more, studies that evaluated the effect of changes of frailty on cardiovascular death in older population are scanty. Therefore, the present study aims to investigate the association of such changes with the risk of all-cause mortality and cardiovascular death in older people, using data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS).MethodsA total of 2805 older participants from two consecutive waves (i.e. 2011 and 2014) of the CLHLS were included for analysis. Based on the changes in frailty status from wave 2011 to wave 2014, participants were categorized into 4 subgroups, including sustained pre/frailty, robustness to pre/frailty, pre/frailty to robustness and sustained robustness. Study outcomes were all-cause mortality and cardiovascular death, and Cox regression analysis examined the association of changes in frailty status with outcomes.ResultsFrom wave 2011 to wave 2014, 33.2% of the participants had frailty transitions. From wave 2014 to wave 2018, there were 952 all-cause mortalities and 170 cardiovascular deaths during a follow-up of 9530.1 person-years, and Kaplan-Meier analysis demonstrated that cumulative incidences of the two outcomes were significantly lower in more robust participants (all log-rank p < 0.001). Compared with the subgroup of sustained pre/frailty, the fully adjusted HRs of all-cause mortality were 0.61 (95% CI: 0.51–0.73, p < 0.001), 0.51 (95% CI: 0.42–0.63, p < 0.001) and 0.41 (0.34–0.49, p < 0.001) in the subgroup of robustness to pre/frailty, the subgroup of pre/frailty to robustness, and the subgroup of sustained robustness, respectively. The fully adjusted HRs of cardiovascular death were 0.79 (95% CI: 0.52–1.19, p = 0.256) in the subgroup of robustness to pre/frailty, 0.45 (95% CI: 0.26–0.76, p = 0.003) in the subgroup of pre/frailty to robustness and 0.51 (0.33–0.78, p = 0.002) in the subgroup of sustained robustness when comparing to the subgroup of sustained pre/frailty, respectively. Stratified analysis and extensive sensitivity analyses revealed similar results.ConclusionsFrailty is a dynamic process, and improved frailty and remaining robust are significantly associated with lower risk of all-cause mortality and cardiovascular death in older people.

Heart Failure in Elderly People: From Pathophysiology to Diagnosis and Management

As the older population increases, there is an increase in age-related chronic diseases, especially heart failure. It affects 25% of over 75-year-old outpatients and represents the leading cause of hospitalization and death in older people. This review aimed to point out the main characteristics concerning heart failure in older people, taking into account clinical symptoms, diagnosis, and treatment. An extensive search on heart failure was made on PubMed and Google, using the keywords older people, heart failure, epidemiology, diagnosis, clinical symptoms, and pharmacological approach. Our results underline how heart failure in older patients is a complex and multifaceted reality that requires a multidimensional assessment to frame the patient correctly, resolve the acute episode, and set a targeted therapeutic, pharmacological, and non-pharmacological approach, without neglecting the psychogeriatric aspect. The latter must be aimed at reducing the relapse rate and preserving functional autonomy and quality of life, decreasing the rate of re-hospitalization and institutionalization, the length of hospitalization, and improving predictive outcomes.

Long-Term Survival After Aspiration Pneumonia in Older Inpatients: A Comparative Study.

Aspiration pneumonia (AsP), a leading cause of death in older people, remains poorly studied. We aimed to evaluate short- and long-term prognosis after AsP in older inpatients. Retrospective cohort study. All consecutive patients aged ≥75years hospitalized in a 62-bed acute geriatric unit during a 1-year period. We compared clinical characteristics and overall 2-year survival between patients with a main diagnosis of AsP, patients with other types of acute pneumonia (non-AsP), and patients hospitalized for another cause. Among the 1774 patients hospitalized over 1 year (median age: 87years, 41% female), 125 (7%) had a primary diagnosis of acute pneumonia, of whom 39 (31%) had AsP and 86 (69%) non-AsP. Patients with AsP were more frequently male, lived more frequently in a nursing home, and had a more frequent history of stroke or neurocognitive disorders. Mortality rates were much higher after AsP, reaching 31% at 30days (vs 15% after Non-AsP and 11% in the rest of the cohort, P < .001), and 69% 2 years after admission (vs 56% and 49%, P < .001). After adjustment for confounders, AsP was significantly associated with mortality but non-AsP was not [adjusted hazard ratio (95% CI): 3.09 (1.72-5.57) at 30days and 1.67 (1.13-2.45) at 2years for AsP; 1.36 (0.77-2.39) and 1.14 (0.85-1.52) for non-AsP]. However, among patients who survived at 30days, mortality did not significantly differ between the 3 groups (P= .1). In an unselected cohort of patients hospitalized in an acute geriatric unit, a third of AsP patients died within the first month after admission. However, among those surviving at 30days, long-term mortality did not significantly differ from the rest of the cohort. These findings underline the importance of optimizing the early management of AsP.

Geriatric dizziness

The prevalence of vertigo and dizziness in the elderly is rapidly increasing due to aging of population. The presence of dizziness in the aged may be connected to falls, which is the leading cause of accidental death in older people. The geriatric dizziness may manifest differently, as patients tend to report less rotatory vertigo and more non-specific and complex dizziness than younger patients. The understanding of pathophysiology in the geriatric dizziness and systematic approach for this symptom help a clinician to find proper management. In this review, we present age-related degenerative changes in nervous system and diagnostic and therapeutic approaches focusing on the elderly patients with dizziness.

Predicting Disability Using a Nomogram of the Tilburg Frailty Indicator (TFI).

Disability is associated with lower quality of life and premature death in older people. Therefore, prevention and intervention targeting older people living with a disability is important. Frailty can be considered a major predictor of disability. In this study, we aimed to develop nomograms with items of the Tilburg Frailty Indicator (TFI) as predictors by using cross-sectional and longitudinal data (follow-up of five and nine years), focusing on the prediction of total disability, disability in activities of daily living (ADL), and disability in instrumental activities of daily living (IADL). At baseline, 479 Dutch community-dwelling people aged ≥75 years participated. They completed a questionnaire that included the TFI and the Groningen Activity Restriction Scale to assess the three disability variables. We showed that the TFI items scored different points, especially over time. Therefore, not every item was equally important in predicting disability. 'Difficulty in walking' and 'unexplained weight loss' appeared to be important predictors of disability. Healthcare professionals need to focus on these two items to prevent disability. We also conclude that the points given to frailty items differed between total, ADL, and IADL disability and also differed regarding years of follow-up. Creating one monogram that does justice to this seems impossible.

Remote health monitoring services in nursing homes

Aged people are challenged by serious complications from chronic diseases, such as mood disorder, diabetes, heart disease, and infectious diseases, which are also the most common causes of death in older people. Therefore, elderly care facilities are more important than ever. The most common causes of death in elderly care facilities were reported to be diabetes, cardiovascular disease, and pneumonia. Recently, the coronavirus disease 2019 (COVID-19) pandemic have a great impact on blind spots of safety where aged people were isolated from society. Elderly care facilities were one of the blind spots in the midst of the pandemic, where major casualties were reported from COVID-19 complications because most people had one or two mortality risk factors, such as diabetes or cardiovascular disease. Therefore, medical governance of public health center and hospital, and elderly care facility is becoming important issue of priority. Thus, remote health monitoring service by the Internet of Medical Things (IoMT) sensors is more important than ever. Recently, technological breakthroughs have enabled healthcare professionals to have easy access to patients in medical blind spots through the use of IoT sensors. These sensors can detect medically urgent situations in a timely fashion and make medical decisions for aged people in elderly care facilities. Real-time electrocardiograms and blood sugar monitoring sensors are approved by the medical insurance service. Real-time monitoring services in medical blind spots, such as elderly care facilities, has been suggested. Heart rhythm monitoring could play a role in detecting early cardiovascular disease events and monitoring blood glucose levels in the management of chronic diseases, such as diabetes, in aged people in elderly care facilities. This review presents the potential usefulness of remote monitoring with IoMT sensors in medical blind spots and clinical suggestions for applications.

Leading causes of death in older people and old age according to medical certificates of death in Moscow

BACKGROUND: The proportion of older people is increasing worldwide. Leading causes of death must be understood for the organization of medical and social care.&#x0D; AIM: This study aimed to identify and discuss the leading causes of death in older people and old age based on data from medical death certificates.&#x0D; MATERIAL AND METHODS: From the electronic database of the Main Department of the Civil Registry Office of the Moscow Region (the system of the Unified State Register of Civil Status Records), all cases in which diseases were indicated as the initial cause of death (all codes of external causes, injuries, and poisoning were excluded) were selected. From a total of 109,126 deceased individuals, 90,269 (82.7%) were 60 years old. Eighteen groups of initial causes of death were made (95.2% of deaths from diseases); 40,442 (44.8%) medical death certificates were issued by the Bureau of Forensic Medicine.&#x0D; RESULTS: Five leading causes of death were COVID-19 (24.2%), pathologies associated with cognitive impairment and dementia (21.15%; aged 6069 years, 6.02%; aged 100 years, 63.5%), chronic ischemic heart disease (18.6%), malignant neoplasms (10.7%; aged 6069 years, 16.7%; aged 100 years, 1.46%), and acute cerebrovascular accident (6.2%). The contribution of causes such as acute forms of coronary artery disease, stroke, hypertension, diabetes mellitus, COVID-19, and others is low in older people. Only 30% of the medical death certificates have their part II completed. The probability of filling out part II of the medical death certificate is influenced by age, place of death, place of issuance of the medical death certificates (in the Bureau of Forensic Medicine less than in other medical organizations), and teaching staff. With age, the proportion of MCAs issued by the Bureau of Forensic Medicine is increasing. Medical death certificates often use codes that are not analogous to clinical diagnoses.&#x0D; CONCLUSION: The contribution of individual causes (and groups of causes) of death changes with age. For a better understanding of the leading causes of death, a multidisciplinary consensus is needed in determining the criteria and validity of the use of the International Statistical Classification of Diseases and Health-Related Problems, Tenth revision, codes.

WOMEN'S CLOTHES AND DECORATIONS OF THE CITY OF NAKHCHIVAN

The land of Azerbaijan is divided into various historical and ethnographic regions in terms of their unique customs and traditions. One of such historical and ethnographic regions is Nakhchivan. In the XIX-XX centuries, this region consisted of two large cities - Nakhchivan and Ordubad. The article explores women's clothing, jewelry and decor items typical for the Nakhchivan region of Azerbaijan. National clothes are an important ethnographic phenomenon that characterizes, distinguishes and conveys the national aspect as a kind of material culture. Like other areas of material culture, clothing is also related to the socio-economic conditions of human life and clearly reflects the labor activity of people, artistic and aesthetic taste and class differences between social groups of society. In addition to religious beliefs, climatic, geographical and natural conditions also influence the style of clothing. The study of folk costumes in historical and ethnographic regions determines the general (similar) and local (different) characteristics of the Azerbaijani clothing culture and helps to closely monitor ethnocultural ties with the neighboring peoples of Azerbaijan. It is clear from research that although the clothing style of the 19th century is a logical continuation of the types of clothing formed in previous historical periods in accordance with the style method and sewing technique, it has undergone changes in accordance with the needs of the new period. This feature is most often found in urban and professional clothing. In particular, the deepening of the division of labor led to the creation of various types of professional clothing. The growth of trade union differences in society over time manifested itself in their clothing. Researchers note that in the 19th century, changes took place in Azerbaijani clothing, one of which was the gradual disappearance of military clothing and related types and their disappearance from the market over time. Only the dagger hanging from the belt and lead pockets on the side of the rope remain in addition to the clothes. After that, these elements partially lost their functional significance, which was preserved as a decorative element of decor Clothes are usually made from cloth. Fabric is one of the elements that reflect the culture of people. The patterns and colors of fabrics are important features that make the difference both between people and between rich and poor.&nbsp;&nbsp; Since the middle of the 20th century, as in any clothing, national features began to disappear in women's clothing over time. Changes to the shape and features of clothing are now reflected in the style of clothing. Today, national clothes are practically not used among the townspeople. In particular, the media and the socio-economic structure form the basis of the dress change. In addition, the death of older people who wore traditional clothes and the interest of young people in today's fashion have led to the fact that national clothes are not in demand and are on the verge of extinction every day. To prevent this, it is necessary to create the necessary infrastructure for the transfer of these clothes to future generations.

Quantifying the effect of delaying the second COVID-19 vaccine dose in England: a mathematical modelling study

The UK was the first country to start national COVID-19 vaccination programmes, initially administering doses 3 weeks apart. However, early evidence of high vaccine effectiveness after the first dose and the emergence of the SARS-CoV-2 alpha variant prompted the UK to extend the interval between doses to 12 weeks. In this study, we aimed to quantify the effect of delaying the second vaccine dose in England. We used a previously described model of SARS-CoV-2 transmission, calibrated to COVID-19 surveillance data from England, including hospital admissions, hospital occupancy, seroprevalence data, and population-level PCR testing data, using a Bayesian evidence-synthesis framework. We modelled and compared the epidemic trajectory in the counterfactual scenario in which vaccine doses were administered 3 weeks apart against the real reported vaccine roll-out schedule of 12 weeks. We estimated and compared the resulting numbers of daily infections, hospital admissions, and deaths. In sensitivity analyses, we investigated scenarios spanning a range of vaccine effectiveness and waning assumptions. In the period from Dec 8, 2020, to Sept 13, 2021, the number of individuals who received a first vaccine dose was higher under the 12-week strategy than the 3-week strategy. For this period, we estimated that delaying the interval between the first and second COVID-19 vaccine doses from 3 to 12 weeks averted a median (calculated as the median of the posterior sample) of 58 000 COVID-19 hospital admissions (291 000 cumulative hospitalisations [95% credible interval 275 000-319 000] under the 3-week strategy vs 233 000 [229 000-238 000] under the 12-week strategy) and 10 100 deaths (64 800 deaths [60 200-68 900] vs 54 700 [52 800-55 600]). Similarly, we estimated that the 3-week strategy would have resulted in more infections compared with the 12-week strategy. Across all sensitivity analyses the 3-week strategy resulted in a greater number of hospital admissions. In results by age group, the 12-week strategy led to more hospitalisations and deaths in older people in spring 2021, but fewer following the emergence of the delta variant during summer 2021. England's delayed-second-dose vaccination strategy was informed by early real-world data on vaccine effectiveness in the context of limited vaccine supplies in a growing epidemic. Our study shows that rapidly providing partial (single-dose) vaccine-induced protection to a larger proportion of the population was successful in reducing the burden of COVID-19 hospitalisations and deaths overall. UK National Institute for Health Research; UK Medical Research Council; Community Jameel; Wellcome Trust; UK Foreign, Commonwealth and Development Office; Australian National Health and Medical Research Council; and EU.

Anticholinergic action is rarely a good thing.

The evidence for the risks associated with anticholinergic agents has grown considerably in the last two decades. Not only are they associated with causing peripheral side effects such as dry mouth, blurred vision and constipation, but they can also cause central effects such as cognitive impairment; and more recently, they have consistently been linked with an increased risk of dementia and death in older people. This paper reviews the evidence for the associations of anticholinergic agents and the risk of dementia and increased mortality in dementia.

The effect of combination pretreatment of donepezil and environmental enrichment on memory deficits in amyloid-beta-induced Alzheimer-like rat model

Alzheimer's disease (AD) is progressive neurodegeneration known as the most common cause of dementia, and it is the sixth leading cause of death in older people. Given the promising data on the additive effect of combination therapy with donepezil (Aricept), an acetylcholinesterase inhibitor (AChEI), and regarding the similar neuronal mechanisms through which donepezil (DON) and environmental enrichment (EE) exert their enhancing effects on cognition; we asked whether simultaneous treatment with two paradigms in amyloid-beta-induced AD rats may lead to greater protection against the cognitive impairments than either treatment individually. The experimental groups consisted of Alz, sham-operated, Alz + DON, Alz + EE, and Alz + DON + EE. AD was induced by intrahippocampal injection of amyloid-beta (1–42, 6 μg), and DON was orally administrated (4 mg/kg) for 21 days. Environmental enrichment consisted of housing animals in large cages (50 × 50 × 50 cm) containing a running wheel and differently shaped objects for 21 days. Spatial learning and memory were assessed in the Morris water maze (MWM) and Real-time PCR was performed to assess the expression of brain-derived neurotrophic factor (BDNF) and M1 muscarinic acetylcholine receptor (AchM1R) within the hippocampus. Spatial memory was impaired in Alz animals, and while neither pretreatment with DON nor EE alone could significantly restore spatial memory scores in Alz rats, combination therapy was effective. BDNF expression was suppressed in Alz rats and pretreatment with DON plus EE could increase it to the saline levels. The data suggest that a cholinesterase inhibitor and cognitive stimulation can be used effectively in combination to protect cognitive loss in an AD rat model. This additive protective effect may be in part due to the augmented influence of this combination on BDNF levels and cholinergic neuronal system within the hippocampus.

Deprescribing Medications that Increase the Risk of Falls in Older People: Exploring Doctors' Perspectives Using the Theoretical Domains Framework (TDF).

Falls can lead to hospitalisation and death in older people. Polypharmacy is a major risk factor, and deprescribing fall-risk increasing drugs (FRIDs) is one of several possible important preventive measures. The objective of this study was to explore the factors that influence doctors when deprescribing FRIDs in a hospital setting. Semi-structured interviews were conducted with consultant geriatricians and hospital doctors experienced in dealing with patients aged 65 years or older, at a large academic teaching hospital (~ 1000 beds), Dublin, Ireland. The interviews were directed by an interview guide and audio recorded and transcribed verbatim, with subsequent thematic analysis in NVivo 12 software. A total of 18 participants were interviewed. Barriers to deprescribing included: insufficient time, incomplete patient records, changing medications initiated by other specialists and difficulties following up patients after discharge. Facilitators included: enhanced documentation through electronic patient records, the support of other healthcare professionals such as clinical pharmacists, and patients' engagement, which is considered essential for the success of the deprescribing process's outcome. Deprescribing FRIDs in older adults in the hospital setting is challenging. Implementation of the process in practice requires combined effort from stakeholders to tackle everyday work environment challenges. Future studies are required examining the clinical effect of the suggested interventions and exploring patients' involvement in deprescribing decisions.

79 EXPERIENCES OF DIRECTORS OF NURSING IN RESIDENTIAL CARE OF OLDER PEOPLE DURING COVID 19

Abstract Background COVID-19 was a global public health crisis and deaths in the over 65 age group represented a disproportionate number of deaths in older people. In particular, nursing homes experienced clusters of infection and high mortality rates. This paper discusses experiences of care homes’ Directors of Nursing/Persons in Charge (DoN) in their preparedness, management and control of care during COVID-19. Methods A mixed methods approach was used (survey- n=122) and semi-structured interviews (n=20) were conducted with DoNs in private and voluntary older person care homes in the Republic of Ireland. Survey data was analysed using descriptive and inferential statistics. Interviews were analysed using Braun &amp; Clarke's thematic analysis. Results DoNs demonstrated an initial challenge in protecting residents from infection and also managing infection outbreak. However, over time they experienced more effectiveness in managing infection prevention and control as demanded at the level of a pandemic. Fifty percent of respondents experienced an infection outbreak and the data does not demonstrate any significant difference in preparedness and management in care homes which had outbreaks and those who had no outbreaks. Other challenges were related to financial sustainability of their facility while 47% of DoNs were either actively seeking other work, or thinking of leaving their post. In the interviews, the DoNs spoke of persistent concerns with the well-being of the staff and residents and a constant worry about meeting regulatory requirements and ensuring adequate staff cover for residents care needs. Moreover, the DoNs spoke of the difficulties when the media sensationalized poor care leading to a reduction of public confidence in the sector. Conclusion The DoNs were under constant alert and although had acclimatized to high level of infection control and prevention and managing emerging issues, the strain of the pandemic remained evident. Recommendations are given related to care homes and related to system level management for future public health crisis.

Sociodemographic Differences in COVID-19 Self-Reported Symptoms by Ethnicity and Older Adults in Bolivia.

The effects of COVID-19 revealed the fragility of health systems in the LAC region, with greater risk of death in older people than in younger people, as well as greater vulnerability to infection due to living with people aged 30–59 years, who have a higher prevalence of COVID-19. On the other hand, there is not much information on inequalities in the incidence of COVID-19 in indigenous people, a population with lower immunological resistance. The objectives are: 1) To determine the association between sociodemographic variables with self-reported COVID-19 symptoms. 2) To investigate whether this relationship shows inequalities by ethnicity and age. For that purpose I conducted a cross-sectional analysis using the 2020 Household Survey and investigated the association between sociodemographic variables and self -reported COVID-19 symptoms and explore the contribution of factors such as employment type, household living arrangements, years of education, age, ethnicity, gender, current status of working and residence area. I performed bivariate analysis to establish trends. Subsequently using logistic regressions to establish the risks to self-reported COVID-19 symptoms. A fully interacted model is analysed by ethnicity. I found those who were living alone were less likely than those living in a Couple with/without relatives’ household arrangement to self-reported COVID-19 symptoms (OR = 0.79, 95% CI: 0.66–0.94, p < .01). Odds of the older persons aged 45–59 (OR = 1.44, 95% CI: 1.27–1.62, p < .05) were relatively more likely than younger people (OR = 1.19, 95% CI: 1.05–1.35, p < .01). Indigenous living in a couple with/without children household arrangement were less likely than non-Indigenous (OR = 0.75, 95% CI: 0.62–0.90, p < .01). Odds of Indigenous people of age 30–44 (OR = 1.26, 95% CI: 1.04–1.53, p < .01) were more likely than non-Indigenous. Odds of Indigenous persons of age 45–59 (OR = 1.59, 95% CI: 1.32–1.91, p < .05) were more likely than non-Indigenous (OR = 1.32, 95% CI: 1.12–1.55, p < .01). As conclusions, 45–59 age group shows higher risk factors and those aged 60 + show lower risks. These are increased in people working in managerial, administrative and professional, and technical positions, those living in a household with/without relatives, men, those living in urban areas, and/or non-indigenous people.