Disability In Elderly Research Articles

Review of evolution of the public long-term care insurance (LTCI) system in different countries: influence and challenge

BackgroundThe growing demand for LTC (Long-term care) services for disabled elderly has become a daunting task for countries worldwide, especially China, where population aging is particularly severe. According to CSY (China Statistical Yearbook,2019), the elderly aged 65 or above has reached 167 million in 2018, and the number of disabled elderly is as high as 54%. Germany and other countries have alleviated the crisis by promoting the public LTCI (Long-Term Care Insurance) system since the 1990s, while China’s public LTCI system formal pilot only started in 2016. Therefore, the development of the public LTCI system has gradually become a hot topic for scholars in various countries, including China.MethodsThis review has been systematically sorted the existing related literature to discuss the development of public LTCI (Long-Term Care Insurance)system form four aspects, namely, the comparison of public LTCI systems in different countries, the influence of public LTCI, challenge of public LTCI, and the relationship between public LTCI and private LTCI. We searched some databases including Web of Science Core Collection, Medline, SCOPUS, EBSCO, EMBASE, ProQuest and PubMed from January 2008 to September 2020. The quality of 38 quantitative and 21 qualitative articles was evaluated using the CASP(Critical Appraisal Skills Programme) critical evaluation checklist.ResultsThe review systematically examines the development of public LTCI system from four aspects, namely, the comparison of public LTCI systems in different countries, the influence of public LTCI, the challenge of public LTCI, and the relationship between public LTCI and private LTCI. For example, LTCI has a positive effect on the health and life quality of the disabled elderly. However, the role of LTCI in alleviating the financial burden on families with the disabled elderly may be limited.ConclusionSome policy implications on the future development of China’s LTCI system can be obtained. For example, the government should fully consider the constraints such as price rise, the elderly disability rate, and the substantial economic burden. It also can strengthen the effective combination of public LTCI and private LTCI. It does not only help to expand the space for its theoretical research but also to learn the experiences in the practice of the LTCI system in various countries around the world. It will significantly help the smooth development and further promote the in-depth reform of the LTCI system in China.

Examining social determinants by locale to inform community linkages

Abstract Achieving a long-lasting impact on health outcomes requires focus not just on patient care, but also on community approaches aimed at improving population health through addressing gaps in Social Determinants of Health (SDOH). SDOH have been found to disproportionately affect those in low-income brackets and the disabled to varying degrees based on locale. The purpose of this exploratory research was to determine 1) which SDOH have the greatest negative impact on disabled and elderly populations within four targeted states (Iowa, Ohio, Minnesota, Wisconsin) and 2) if there is a difference in negative SDOH impact between metro and non-metro locales. Individual-level data were obtained from disabled persons aged 65 years or older who responded to the Centers for Disease Control and Prevention's 2017 Behavioral Risk Factor Surveillance System (BRFSS) survey. Utilizing these data, frequency distributions were obtained using SPSS. Rank order variation in SDOH was observed among four Midwestern states and between metro vs. non-metro geographic regions. Frequency distributions assisted in identifying the greatest negative impacting SDOH on elderly disabled populations. An examination of the rank order tables allowed the investigator to accurately assess the rank of negative impacts. There were variabilities in responses to questions with moving two or more times within 12 months having the lowest negative impact. When regrouped based upon SDOH negative impacts, were you able to pay your bills was the most frequent SDOH across all states. Feeling unsafe or extremely unsafe in your neighborhood was the highest negatively impacted SDOH within states. Cited determinants in three categories were highest in Ohio. Ohio also had the highest proportion of negatively impacted SDOH across all states. No money for balanced meals was a close second SDOH across states. Key messages Social Determinants Impacting Elderly Disabled. Impact of Social Determinants by Geography.

Protective Effects of Curcumin and Broccoli Seed Extract Against Age-Related Bone Loss in Mice

Abstract Objectives Age-related bone loss occurs in both men and women, and is the leading cause of elderly disability. An age-related bone loss model was established in mice to investigate the protective effects of curcumin and broccoli seed extract. Methods 20 young (6-month-old) male C57BL/6 J mice after administration with vehicle once daily were sacrificed at four time points: day 0, 30, 60 and 90. 8 out of the 109 aged (18-month-old) male C57BL/6 J mice were sacrificed at the beginning and used as control. The rest of these aged mice were then randomly divided into four groups: one group served as control (vehicle), the other three groups were administrated with curcumin (CMN) and/or broccoli seed extract (BSE) by oral gavage. Mice in each group were sacrificed at four time points: day 0, 30, 60 and 90. L2 vertebrae of mice were fixed with paraformaldehyde and scanned with a Scanco Medical μCT40 scanner. Quantitative analyses of bone volume (BV), tissue volume (TV), trabecular number (Tb.N), trabecular thickness (Tb.Th) and trabecular spacing (Tb.Sp) were performed with the Scanco Medical's software. Results BV/TV of the young mice group were significantly higher compared to the aged mice group at all four time points. Similarly, Tb.N and Tb.Th were also higher in the young mice group compared to the aged mice group. In contrast, Tb.Sp was lower in the young mice group. When comparing different groups in the aged mice, we found that mice administered with CMN had a higher BV/TV value compared to the mice in the control group at all three time points. Such a difference is significant by day 30. The mice administered with combined CMN and BSE also showed significant increase in BV/TV on day 30. For Tb.N, both mice administered with either CMN or BSE had higher values at all three time points. But no obvious difference in Tb.N was found for mice administered with combined CMN and BSE. For Tb.Th, both mice administered with CMN and with combined CMN and BSE had higher values compared to the control. For Tb.Sp, both mice administered with either CMN or BSE had lower values compared to the control. Conclusions This study showed that curcumin could slow down bone loss in the mouse model. There is no obvious positive effect with broccoli seed extract or with curcumin and broccoli seed extract combined. The curcumin used in this study may shed light on the alleviation of bone loss in humans. Funding Sources Nu Skin Enterprises.

1130 Insomnia Short Sleep Phenotype is Associated With Frailty in Patients With Mild Cognitive Impairment (MCI)

Abstract Introduction Insomnia short sleep phenotype is associated with cardiometabolic morbidity and mortality and neuropsychological impairment. In elderly untreated insomnia is associated with worse cognitive performance. The goal of the study was to examine the association between insomnia, objective sleep duration and physical and mental health in elderly patients with Mild Cognitive Impairment (MCI). Methods A sub-sample of 105 patients with MCI (mean age: 75.9 years, males 36%) were recruited from a large population-based cohort (Cretan Aging Cohort) in the island of Crete, Greece of 3,140 elders (≥ 60yrs). All participants underwent a complete medical history/ physical examination, extensive neuropsychiatric and neuropsychological evaluation and 3-day 24hr actigraphy. Insomnia was defined based on a question “do you have insomnia for more than a year”. Frailty was assessed with the Simple “Frail” Questionnaire Screening Tool. Comparisons between patients with insomnia and without insomnia were made using ANOVA controlling for age, gender and BMI. Results MCI patients with insomnia (n=23) compared to those without insomnia (n=82), had significantly shorter objective total sleep time (TST: 377 vs. 410 min, p=0.05) and significantly higher scores on the Geriatric Depression Scale and the Hospital Anxiety Scale (both p <0.001). Furthermore, total frailty score, as well as scores in individual items, were significantly lower in MCI patients with insomnia (p<0.01). This association remained significant after controlling for demographics, depression and anxiety. Finally, there was a statistical trend of association between insomnia and hypertension (p= 0.1). Conclusion In MCI patients, insomnia is associated with objective short sleep duration, and frailty. Improving insomnia and lengthening sleep duration may decrease frailty, a major problem associated with morbidity, disability and mortality in elders with cognitive decline. Support National Strategic Reference Framework (ESPA) 2007-2013, Program: THALES, University of Crete, title: “A multi-disciplinary network for the study of Alzheimer’s Disease” (Grant: MIS 377299).

Development of matching service with supply and demand questionnaire for the disabled elderly in medical-nursing combined institutions

Objective To develop a matching service with supply and demand questionnaire for the disabled elderly in medical-nursing combined institutions. Methods From April to May 2019, the first draft of questionnaire was designed based on literature review, semi-structured interview and expert consultation. Two rounds of expert consultation by 14 experts were carried out with the Delphi method. The questionnaire was revised and perfected according to results of expert consultation to form the final version of questionnaire. We calculated the expert active coefficient, expert authority coefficient, concentration and coordination coefficient of expert opinion. Results Around two rounds of expert consultation, the valid recovery rates of questionnaire were 93.3% and 100.0% with 0.92 for the expert authority coefficient. In the second expert consultation, coordination coefficients of expert opinion of dimension and item were 0.638 and 0.407 respectively with statistical differences (P<0.001) and with <20% for all the coefficients of variation. The final version of the matching service with supply and demand questionnaire for the disabled elder in medical-nursing combined institutions included 5 dimensions and 30 items. Conclusions The matching service with supply and demand questionnaire for the disabled elderly in medical-nursing combined institutions has the high level of scientific nature, reliability and all-round content. The questionnaire can be used to researches on matching service with supply and demand questionnaire for the disabled elder as a beneficial investigation tool and can provide a reference for formulating a supply and demand plan of medical and nursing combined care service. Key words: Aged; The disabled elderly; Combination of medical-nursing; Service demand; Service supply and demand; Delphi technique

The Elderly Disabled: The Applicability of Disability Rights for Age-Related Disability

The question for all who live long lives will be not will one become disabled but when, and in what combinations of factors will one’s disability occur? As people age, their ability to care for the...

A Novel Multi-Period Two-Sided Matching Method on Solving Long-Term Care Problem for Disabled Elders With Probabilistic Linguistic Information

China is facing an aging society, and more and more disabled elders need Long-Term Care(LTC) from care-givers. On the other hand, care-givers can obtain some income from providing their care services. Two-sided matching decision-making method is a very useful tool to deal with this social problem. In this paper, we propose a novel multi-period two-sided matching decision-making method for probabilistic linguistic information using D-S evidence theory. Firstly, we use D-S evidence theory to aggregate the information for different attributes. By D-S evidence theory, we can reduce the information loss in the process of aggregating the information in different attributes. Then, we use a programming to compute the time weighting vector, which can solve the dynamic decision making problem. Furthermore, we propose a novel method to obtain the value perception function based on prospect theory, by which the bounded rationality of decision maker can be considered. Finally, we apply our method to a real case in rural village in Zhenjiang City, Jiangsu Province to illustrate the effectiveness of our method.

The Relationship between Sleep and Sedentary Behavior in Home-bound Elderly Disabled Persons

The Relationship between Sleep and Sedentary Behavior in Home-bound Elderly Disabled Persons

Malnutrition and disability in the elderly

老年人营养不良是导致老年人失能的重要因素之一。运用有效的营养筛查和评估工具可及早发现营养不良及营养风险，并通过老年人综合评估，寻找相关的危险因素来预测潜在不良预后的风险；采取给予口服营养补充制剂等适当的营养支持以及针对多个风险因素的团队干预可以有效地降低不良事件的发生，改善疾病预后及老年人功能状态，提高老年人的生活质量。

Frailty and disability in the elderly

衰弱和失能是老年人常见的健康问题。衰弱可以导致失能，但二者的关系有时被混淆，在评估标准上也是如此。衰弱的研究中迫切需要解决的问题包括各个系统的退行程度与衰弱的出现及其程度的关系。对老年人失能的评估应该充分强调独立生活能力和生活质量，但失能导致的精神和社会等方面的因素增加了评估的难度。预防和干预衰弱是减少失能发生的重要一环。目前的干预手段缺乏良好的证据基础，有必要在未来的研究中得到更清晰的认识。

Disability and rehabilitation in the elderly

失能是老年人的常见问题，并给老年人带来一系列不良影响。以运动训练、认知训练为代表的康复治疗手段可有效地延缓老年人的肌肉萎缩、体能下降、日常活动量减少、记忆力减退、执行能力下降等功能障碍，并能预防跌倒等二次损伤，从而改善其生存质量、延长生命。

Disability of the elderly and the construction of age-friendly hospital

对老年人而言，到医院就诊或住院治疗并不是绝对安全的，尤其是长时间的住院治疗会导致老年人医源性损伤、营养不良、睡眠障碍、衰弱、跌倒、尿失禁等老年综合征或老年照护问题，绝对静养或长期卧床更易导致废用综合征的发生，进而导致老年人的失能。构建老年友善医院，树立一切以患者为中心的服务理念，为老年患者提供综合、连续、科学、合理的医疗照护服务，可有效预防或减少失能的发生，甚至会有效逆转失能损伤的程度。本文就老年友善医院的建设对预防失能或降低失能损伤的程度进行简要阐述。

Pay attention to the prevention of disability in the elderly

失能严重影响老年人生活质量，同时给个人家庭社会带来沉重的负担。目前，我国无论是老年人还是医务工作者对老年人失能均未足够重视。因此，预防老年人失能应成为老年人、老年医学工作者及社会公众高度重视的公共卫生问题。老年人及社会公众应树立健康的老年观，老年医学从业人员要进一步系统学习预防老年人失能核心信息所涉及的专业知识和技能，努力为老年人提供全方位的健康服务。通过全社会的努力，不断降低老年人失能的发生率。

Comprehensive geriatric assessment and disability in the elderly

老年人综合评估是现代老年医学的核心技术之一。对老年人失能情况的评估是老年人综合评估的一项重要内容，但目前尚无国际通用的失能评估金标准。本文对目前在老年人综合评估中常用的失能评估工具做一简要概述。

Current status of disability in the elderly and its influencing factors

WHO数据显示，全球约15.6%的人口存在不同程度的失能，且随增龄失能率显著升高。，由于各国对老年人失能的评估标准不同，各国老年人失能率差异显著。老年人失能过程中受诸多因素影响，在失能的前期或早期阶段对风险因素进行干预，能减缓甚至逆转内在能力的下降。本文系统介绍了老年人失能的流行病学概况及其影响因素。

Dementia and disability in the elderly

老年人失智引起日常生活能力受损和精神行为异常，导致不同程度的失能，给家庭和社会带来沉重的负担。不同阶段的失智和失能需要不同的照料，通过干预危险因素、改变生活方式和药物治疗等能减缓失智的发展，减少失能的发生。

Factors Associated With Hospitalization Before the Start of Long-Term Care Among Elderly Disabled People.

The growing number of elderly people with functional limitations, cognitive impairment, and disability is an organizational challenge for the health care sector. This study investigated the factors associated with hospitalization in the period between evaluation and the start of a long-term care (LTC) program for patients on the waiting list. A population-based historical cohort study was performed using data extracted from different administrative databases. The cohort included disabled individuals 65 years and older who were evaluated for entrance into an LTC program between January 1, 2012, and December 31, 2013, in Tuscany, Italy. The sample consisted of 11,429 subjects. The characteristics positively associated with hospital admission were residence zone {urban incidence rate ratio (IRR) = 0.83 (95% confidence interval [CI] 0.74-0.94)}, number of prescribed drugs IRR = 1.01 (95% CI 1.00-1.02), a Charlson Comorbidity Index of 2 IRR = 1.44 (95% CI 1.26-1.64), and lower social conditions IRR = 0.99 (95% CI 0.98-1.00). The rate of hospitalization for patients with heart failure, chronic obstructive pulmonary disease, and dementia was higher than for patients without these diseases. Our results indicate that it may be possible to predict factors that can lead to hospitalization before the start of an LTC program.

노년기 장애인의 문제음주와 우울 관계에서 사회적 지지의 조절 효과

노년기 장애인의 문제음주와 우울 관계에서 사회적 지지의 조절 효과

Correlation between resilience and psychological status of main caregivers among disabled elderly

Objective To explore the correlation between resilience and psychological status of main caregivers among disabled elderly of Guangzhou region. Methods From June 2015 to December 2015, a total of 300 main caregivers of disabled elders were investigated with the general information questionnaire, the Chinese version of Connor-Davidson Resilience Scale (CD-RISC) , Activities Daily Living Scale (ADLS) , Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) by convenience sampling. Results The total score of resilience, standard score of anxiety and depression were (58.2±15.8) , (49.05±10.5) and (51.73±11.52) respectively among main caregivers of disabled elders. The competence dimension of CD-RISC had negative correlations with anxiety (r=-0.260, P<0.01) and depression (r=-0.316, P<0.01) in main caregivers of disabled elders, and the toughness dimension was negatively correlated with the depressive symptoms (r=-0.147, P<0.05) . Conclusions Main caregivers of disabled elderly of Guangzhou region are with poor resilience along with the high ratio of detection in anxiety and depression suggesting that the mental status is not optimistic. Key words: Aged; Anxiety; Depression; Disability; Resilience, psychological

Are the Elderly Perceived as a Burden to Society? The Perspective of Family Caregivers in Belgium and Kenya: A Comparative Study.

It is estimated that 70% to 80% of informal care for frail and disabled elders is provided by family caregivers (FCGs). To better understand how caregiving for the elderly has affected FCGs lives and to compare the perspective of these caregivers in Belgium and Kenya. Semistructured interviews were undertaken with 15 FCGs in Kenya and 15 FCGs in Belgium. Interpretative phenomenological analysis was used to identify themes. Themes discovered in the experience of family caregiving included profile of the care receiver, impact of caregiving on the FCG, cultural values and norms, challenges in caregiving, coping strategies and caregiver well-being. FCGs in both Kenya and Belgium identified experiencing serious concerns. In Kenya, the lack of resources and formal structures play a more important role than in Belgium. Despite this difference, culture-specific views and norms are paramount to explaining the FCG experience in the two countries.