Disease In Older Adults Research Articles

Advanced renal cell carcinoma - an overview of current systemic therapy

Renal cell carcinoma (RCC) is one of the more common tumor diseases in older adults. The only curative treatment method is surgical resection in the localized stage. Based on current study data, drug (combination) therapy in the metastatic stage is the most effective treatment option for non-resectable/metastatic RCC (mRCC). Immuno-oncological combinations of 2 Checkpoint-Inhibitors (CPI) or CPIs and Tyrosine kinase inhibitors (TKI) are now standard in the first-line treatment of metastatic RCC. Since the results of foundational combination therapy studies are not fully comparable due to different study design and patient populations, additional clinical and patient-related criteria are required when making individual treatment decisions. The systemic therapy of advanced RCC is therefore based on tumor extent, treatment pressure, concomitant diseases, and personal circumstances. A decision on first-line therapy should be made individually as part of a "shared decision" with the patient. The selection of a second-line systemic therapy is based on individual criteria; the data available for a well-founded classification of a possible therapy sequence after progression to first-line therapy is sparse. Further investigations to optimize systemic therapy (expansion of combination therapy to triple combination of CPI+CPI+TKI) or evaluation of therapy in other histological subtypes of renal cell carcinoma are the subject of ongoing clinical studies.

Chronic Kidney Disease in Older Adults. Consensus Statement of Russian Association of Gerontologists and Geriatricians, Scientific Society of Nephrologists of Russia and Eurasian Association of Therapists

The prevalence of chronic kidney disease (CKD) increases with age, but CKD is often underdiagnosed in older adults and regarded as age-related changes of kidney function. Screening for CKD is mandatory in older adults and should include estimated glomerular filtration rate (eGFR) using both the CKD EPI creatinine-based formula and the albumin/creatinine ratio in a urine spot sample. In older adults the diagnostic criteria of CKD are the same as in younger subjects. CKD is associated with advanced ageing and requires careful assessment of geriatric syndromes. Renal function should be assessed at least annually, considering a rate of decline in eGFR greater than 1 ml/min/1.73 m2 per year as significant. Older adults with CKD are characterized by high comorbidity; risk factors for CKD and geriatric syndromes overlap. CKD should be considered among a number of comorbid conditions that increase the risk of deterioration of geriatric status and underline the need for multidisciplinary management based on a comprehensive geriatric assessment. Patients with eGFR <60 ml/min/1.73 m2 should be considered at high risk for renal and extrarenal adverse drug effects. In these patients, inappropriate medications, supplements, and vitamins should be carefully identified and corrected using STOPP/START criteria. eGFR and estimated creatinine clearance should be carefully monitored during treatment with drugs that can potentially affect renal function and/or the dose of which is adjusted based on renal function, as well as during acute illness or exacerbation of chronic conditions.

Association of indoor dampness indicators with rheumatic diseases/symptoms in older adults: A comparative cross-sectional study in Chongqing and Beijing.

Dampness is strongly associated with rheumatic diseases, which particularly affect the older adults. Tackling dampness is therefore important, especially given that climate change is expected to exacerbate rheumatic diseases; however, limited studies have compared the risk of rheumatic diseases in older adults based on humidity levels across different regions. To explore this, a comparative cross-sectional study was conducted to collect information on the residential characteristics, lifestyles, and health outcomes of 2000 individuals aged 60-74years from Chongqing and Beijing. From this data, we tested for an association between six indoor dampness indicators and rheumatic related diseases/symptoms. The results showed that the risk values for joint pain were higher in Chongqing than in Beijing. Moreover, the risk of joint stiffness increased more strongly in Chongqing than in Beijing as the cumulative number of dampness exposure indicators increased. The key indoor dampness indicators affecting rheumatic diseases were different for Chongqing and Beijing. Overall, this study compared the risk of rheumatic diseases in older adults in the north and south of China because of dampness exposure and, from these, provided suggestions for modifying the indoor environments to prevent or reduce rheumatic symptoms.

Geriatric Importance of Histopathological Parameters Evaluated in Thyroidectomy Specimens: A Single Center Retrospective Analysis.

Nowadays, the aging human population exerts a notable influence on the treatment of thyroid diseases. The most appropriate approach for the treatment of benign and malignant thyroid diseases in older adults has not yet been determined. The aim of our study is to evaluate the effect of thyroidectomies in geriatric patients considering age, sex and histopathological parameters and to determine the importance of thyroidectomy as a treatment option in the geriatric population. A total of 910 cases from all age groups were included, for which thyroidectomies were examined and reported. In accordance with the College of American Pathologists Cancer Protocol for thyroid reporting, considering geriatric patients, the rate of Thyroid Follicular Nodular Disease was significantly higher among the tumor types in the benign tumor group (p = 0.033), while Anaplastic Thyroid Carcinoma rate was higher in the malignant tumor group. The diagnosis rate of malignant tumors was higher in males, reflecting a more advanced pT stage (p < 0.001), larger tumor size (p < 0.001) and increased lymph node involvement rate (p = 0.039). Given that increasing age is associated with a heightened incidence of thyroid disease, the safety of surgery for geriatric patients is an important issue. Thyroidectomy should be considered in the treatment of these patients, especially in males, as the rate of malignant diagnosis and worse histopathological parameters are seen with increasing age.

A comprehensive view of the promotion and prevention of Chronic Non-Communicable Diseases in older adults at the Clemencia Foundation and the Sofia Ratinoff Nursing Home

Health promotion and disease prevention in older adults are essential to improve their quality of life and reduce health care costs in this growing population. A diagnostic study in this area focuses on identifying specific health needs, assessing risk factors, and proposing effective interventions. The objective of this study is to characterize the current state of health promotion and NCD prevention in older adults at the Clemencia Foundation and the Sofia Ratinoff Asylum in the city of Guayaquil. This research is developed by students and teachers of the Emergency Medical career of the Instituto Superior Universitario Espiritu Santo, as part of the project "Promotion and control of NCDs in older adults". The study uses a combination of quantitative and qualitative methods, including surveys, interviews and statistical data analysis. The population studied includes older adults and health professionals from the Clemencia Foundation and the Sofia Ratinoff Asylum, providing a comprehensive view of their health conditions and needs. The results conclude that chronic diseases such as hypertension, diabetes and arthritis are common in older adults, as are respiratory and mental health problems. Risk factors identified include poor dietary habits, lack of physical activity, poor vital sign monitoring, and limited participation of older adults in health promotion programs.

Association of physical activity with socio-economic status and chronic disease in older adults in China: cross-sectional findings from the survey of CLASS 2020 after the outbreak of COVID-19

BackgroundIn 2021, China had a population of 264·01 million individuals over the age of 60, indicating a high prevalence of chronic diseases. Among older adults, physical inactivity (PI) is a significant risk factor for chronic diseases. However, few studies have been conducted on the correlation of physical activity (PA) with the economic status, geography and chronic disease risks in Chinese elderly. The objectives of this study were to better understand the distribution of PA among older adults in China and its relationship with economic status, geography, and chronic disease risks.MethodsThis study utilized data from the China Longitudinal Aging Social Survey (CLASS) in 2020, post-COVID-19. The study employed a stratified, multistage, probabilistic sampling approach and included 11,396 adults over the age of 59 from 28 provinces in China. Data on demographics, the duration and intensity of PA, history of diseases and personalized factors influencing PA were collected via structured interviews by researchers. In this study, we conducted a comprehensive analysis, employing a range of statistical methods including descriptive analysis, Wilcoxon rank-sum tests, Bayesian networks, and chi-square tests.ResultsThe prevalence of PI among older adults over 59 in China is 28·82%. Significant regional differences were observed in the duration of PA at different intensities. Older adults residing in more economically developed areas were more likely to engage in moderate-to-vigorous physical activity (MVPA) and exhibited longer sedentary behavior. Economic status and urban-rural disparities consistently emerged as direct influential factors across all intensity types. Chronic disease risks were significantly lower in active older adults compared to inactive ones. Lack of social guidance, family support, and personal inclination towards sedentary behavior were the main personalized factors affecting PA among older adults, and these factors could be relatively easily modified.ConclusionsEconomic status, geography, and living areas (urban and rural) significantly influenced the distribution of physical activities in China. Particularly, economic status and living areas acted as direct factors. Older adults reaching the recommended standards for PA had significantly lower chronic disease risks, highlighting the importance of improving personalized factors which are crucial for promoting PA.

Coronary artery disease in older adults with congenital heart defects: risk factors and pharmacotherapy.

With advancing age, adults with congenital heart disease (ACHD) are at a higher risk of developing atherosclerotic coronary artery disease (CAD). We aimed to determine the prevalence of CAD, its risk factors, and use of guideline‑directed pharmacotherapy among older patients with ACHD. Patients and methods: We studied all ACHD patients aged 60 years or older hospitalized in our department between the years 2013 and 2020. CAD was defined as a history of acute coronary syndrome or coronary revascularization, or more than 50% diameter stenosis on coronary angiography. Data regarding the underlying heart defect, prevalence of cardiovascular risk factors, and drug prescriptions were collected. A total of 198 patients with known coronary artery status (mean [SD] age, 66.2 [5.3] years; 43.3% men) were included in the analysis. Of them, 54 (27.3%) had CAD. The individuals with CAD were more often men, and they were more likely to have a mild heart defect, dyslipidemia, and a history of hypertension and tobacco use. Multivariable analysis showed that male sex (P = 0.001), dyslipidemia (P = 0.003), and hypertension (P = 0.04) were positive independent predictors of CAD, whereas overweight / obesity was identified as a negative independent predictor (P = 0.04). The proportion of CAD patients on antiplatelet and / or anticoagulant drugs was 92.6%. β‑Blockers were prescribed to 87% of the patients, and a lipid‑lowering agent to 96% of the study population. CAD is common in older patients with ACHD. Our results underline the importance of identification and treatment of modifiable CAD risk factors in individuals with ACHD. The obesity paradox might also play a role in this population. The rate of guideline‑recommended pharmacotherapy implementation seems to be satisfactory.

The Association between Social Support, Metabolic Syndrome, and Incidence of Cardio-Cerebrovascular Diseases in Older Adults: The ARIRANG Study.

We investigated the association between social support, metabolic syndrome, and incident cardio-cerebrovascular disease (CCVD) in rural Koreans aged ≥50 years. We conducted a prospective study using the Korean Genome and Epidemiology Study on Atherosclerosis Risk of Rural Areas in the Korean General Population (KoGES-ARIRANG) dataset. From the baseline of 5169 adults, 1682 participants were finally included according to the exclusion criteria. For outcomes, myocardial infarction, angina, and stroke were included. For independent variables, the social support score and metabolic syndrome were used. Descriptive statistics and multivariate logistic regression were performed to investigate the association among the variables. Paired t-test was conducted to analyze the longitudinal variation of social support scores. During the 6.37 years of median follow-up, 137 participants developed CCVD. The adjusted odds ratio (aOR) of metabolic syndrome with persistently high social support was 2.175 [95% confidence interval (CI): 1.479-3.119]. The aOR of metabolic syndrome with persistently low social support was 2.494 (95% CI: 1.141-5.452). The longitudinal variation of the social support score of persistently high social support group was increased significantly by 4.26±26.32. The score of the persistently low social support group was decreased by 1.34±16.87 with no statistical significance. The presence of metabolic syndrome increases the likelihood of developing onset CCVD. Within the metabolic syndrome positive group, when social support was persistently low, the cohort developed more cardio-cerebrovascular disease compared to the persistently higher social support group. The social support score of the persistently low social support group could be improved through proper intervention. To prevent CCVD, metabolic syndrome components and low social support should be improved in the study participants.

Pancreatic carcinoma - diagnosis and modern multimodal treatment

Pancreatic cancer is one of the most aggressive tumors and is among the top ten most common malignancies in the world. This is a disease of older adults, and men get it more often. Pancreatic carcinomas risk factors are obesity and type II diabetes, smoking, and alcohol consumption. Symptoms of the disease include obstructive jaundice, loss of appetite, weight loss, fatigue, and back pain. The diagnosis of pancreatic cancer involves computed tomography of the thorax, abdomen and pelvis or magnetic resonance imaging of the abdomen and pelvis, and endoscopic ultrasound with biopsy. The most common histological type of pancreatic cancer is ductal adenocarcinoma. The TNM classification is used to determine the stage of the disease. Pancreatic cancer treatment is complex, multidisciplinary, and multimodal, and involves the use of surgery, chemotherapy, and radiotherapy, alone or in different combinations. Surgery is the main treatment modality for these tumors, especially in localized stages. Chemotherapy is applied in all forms in the treatment of pancreatic cancer as neoadjuvant, adjuvant, and systemic. Immunotherapy, as the newest type of treatment, is used in a limited way in the metastatic phase of pancreatic cancer. The role of radiotherapy in the treatment of pancreatic cancer is still debated, and it is most often applied in a neoadjuvant and palliative approach. Palliative therapy and care are an indispensable part of the treatment of patients with pancreatic cancer.

Comparison of formulas for calculating estimated glomerular filtration rate and its diagnostic thresholds for chronic kidney disease in older adults: a cross-sectional study

Resumo Objetivo Avaliar e comparar as fórmulas CKD-EPI, BIS1 e MDRD e o limiar diagnóstico de 45 e 60 ml/min/1,73m2 em pacientes idosos. Método Estudo observacional do tipo transversal, de caráter descritivo e analítico. Foram incluídos pacientes atendidos em ambulatório de referência entre janeiro/2020 e junho/2022, com idade ≥65 anos. Foram excluídos pacientes com apenas uma dosagem de creatinina ou com alterações transitórias da TFG. Resultados Observou-se que entre o grupo de pacientes com idade entre 65-74 anos e 75-84 anos as estimativas da TFG feitas pela fórmula CKD-EPI foram superiores às fórmulas BIS1 e MDRD. Enquanto, no grupo de pacientes com 85-94 anos a CKD-EPI não apresentou diferença quando comparada com MDRD, permaneceu com estimativas maiores apenas quando comparada com a BIS1. Observamos maior dispersão entre CKD-EPI e BIS1, mostrando menor concordância entre essas fórmulas, confirmada pelo teste Kappa (76,7%) e a concordância quase perfeita entre CKD-EPI e MDRD. Conclusão A fórmula BIS1 apresentou melhor correlação da diminuição da TFGe conforme o avanço das faixas etárias, podendo-se relacionar com o processo de envelhecimento renal fisiológico, podendo ser uma ferramenta auxiliar na estimativa da TFG em idosos, auxiliando no diagnóstico mais preciso da DRC, assim como, no planejamento de intervenções que possam retardar a progressão da DRC e prever risco de mortalidade por doenças cardiovasculares.

Poor self-rated health is associated with faster cognitive decline and greater small vessel disease in older adults with type 2 diabetes.

Self-rated health (SRH) is a predictor for poor health outcomes and cognition. Older adults with type 2 diabetes mellitus (T2D) have multi-morbidity and greater cognitive impairment. In the present study we investigated the association of SRH with cognitive decline and brain pathology in older adults with T2D. Participants (n=1122) were from the Israel Diabetes and Cognitive Decline study, and SRH was categorised as low (n=202), moderate (n=400) or high (n=520). Cognition was measured by four cognitive domains: episodic memory, executive functions, language, and attention/working memory. Global cognition was the average of the cognitive domains. Statistical models adjusted for sociodemographic, cardiovascular, and clinical variables. In a randomly selected subsample (n=230) that had magnetic resonance imaging, we examined relationships between baseline SRH and brain characteristics (white matter hyperintensities [WMHs], hippocampal, and total grey matter [GM] volumes). Low SRH was associated with a decline in executive functions, which accelerated over time when compared to high SRH (est=-0.0036; p=<0.001). Compared to high SRH, low SRH was associated with a faster decline in global cognition (est=-0.0024; p=0.009). Low SRH at baseline was associated with higher volumes of WMHs (est=9.8420; p<0.0008). SRH was not associated with other cognitive domains, or with hippocampal and total GM. Low SRH is associated with cognitive decline in T2D older adults and may serve as a risk assessment. WMHs may represent an underlying mechanism.

Dietary Supplementation with Omega‐3 PUFAs Modulates Gut Microbiota and Protects the Intestinal Barrier in Senescence‐Accelerated Mice

Intestinal mucosal barrier aging is a major cause of the occurrence and development of many chronic diseases in older adults and is closely associated with gut microbiota. However, it remains unclear whether exogenous supplementation with omega‐3 polyunsaturated fatty acids (ω‐3 PUFAs) can ameliorate aging‐induced intestinal mucosal barrier damage by regulating the gut microbiota. This study was conducted to explore the roles of ω‐3 PUFAs and gut microbiota in the process of maintaining the intestinal mucosal barrier. Senescence‐accelerated mouse prone 8 (SAMP8) mice were used to establish a geriatric animal model and given reasonable doses of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) supplemented diets for six months to validate the effect of ω‐3 PUFAs. Differences in the composition and function of gut microbiota were analyzed using 16S rRNA gene sequencing. This study revealed that aging SAMP8 mice showed increased intestinal permeability and gut microbiota disorder. Long‐term supplementation with ω‐3 PUFAs reduced intestinal mucosal permeability (P &lt; 0.05), regulated gut microbiota, strengthened the microecological interactions, and enhanced enrichment of metabolic pathways producing short‐chain fatty acids (P &lt; 0.05), ultimately ameliorating intestinal mucosal barrier dysfunction. Furthermore, we demonstrated that ω‐3 PUFAs could maintain the aging intestinal mucosal barrier by regulating the relative abundance of eight key characteristic microbial strains to increase the concentration of DHA and EPA in the plasma and colon tissue and reduced intestinal permeability of SAMP8 mice. ω‐3 PUFAs can significantly ameliorate intestinal mucosal barrier function in senescence‐accelerated mice, and this effect is mediated by the gut microbiota. The findings of our study provide a scientific basis for the rational intake of ω‐3 PUFAs in older adults to maintain intestinal mucosal barrier function.

Association between food insecurity and chronic non-communicable diseases in older adults covered by the family health strategy: a cross-sectional study in the Brazilian Northeast

Association between food insecurity and chronic non-communicable diseases in older adults covered by the family health strategy: a cross-sectional study in the Brazilian Northeast

Dietary Patterns and Common Diseases in Chinese Elderly: Exploring Associations and Providing Guidance for Personalized Interventions

The current state of geriatric disease prevention and treatment in China has not yet been able to meet the urgent needs brought about by an aging population, and specific dietary patterns can significantly improve or exacerbate the risk of certain diseases. However, the relationship between geriatric diseases and the dietary patterns of the Chinese elderly population has not been fully explored. CLHLS 2018 were analyzed in the present study. Principal component analysis was employed to identify the main dietary patterns of the Chinese elderly, and binary logistic regression models were used to analyze the associations between these dietary patterns and the 16 common diseases. Four main dietary patterns were identified in the Chinese elderly population: Egg-Milk Pattern, Salt-preserved vegetable-Nut Pattern, Vegetable-Fruit Pattern, and Fish-Meat Pattern. Higher scores for the Egg-Milk Pattern were associated with a greater risk of heart disease, stroke or cardiovascular disease, respiratory disease, glaucoma, prostate tumor, and Parkinson's disease in older adults (p&lt;0.05). Higher scores for Salt-preserved vegetable-Nut Pattern correlated with a greater risk of hypertension, heart disease, and uterine tumors and a lower risk of rheumatism or rheumatoid disease in older adults (P&lt;0.05). The higher scores of the Vegetable-Fruit Pattern were associated with a lower risk of heart disease in older adults (p&lt;0.05). Finally, higher scores of the Fish-Meat Pattern correlated with a lower risk of heart disease, stroke, and cardiovascular disease and a greater risk of rheumatic or rheumatoid disease in older adults (p&lt;0.05). The same dietary pattern may have contrasting effects on different diseases. The correlations between dietary patterns and diseases derived from this study may provide a basis for the prevention and individualized management of diseases in the elderly.

CROSS-TISSUE COMPARISON OF AGING BIOLOGY MEASURES AS NOVEL BIOMARKERS FOR HEALTHY AGING

Abstract We compared the role of aging biology biomarkers measured in saliva (N=5,808) and blood (N=9,934) as novel biomarkers for prevention of stroke and heart disease in a sample of older adults (aged 50 and older) from the Health and Retirement Study (HRS). Individuals who consented for blood and saliva draw in the HRS 2016 Venous blood and 2008 Telomere length studies were included. Measures in saliva included telomere length. Measures in blood included DNA methylation and physiology biomarkers. The main outcomes included stroke, heart disease and disease-free aging. Cases and disease-free adults were matched on age and sex using a probit link and propensity scores. No association was observed between saliva-based telomere length with stroke or heart disease. In contrast, blood-based biomarkers of aging biology showed strong associations with stroke and heart disease. Biologically older individuals had 3- and 2.5-times higher odds of stroke based on DNA methylation Grim Age (aOR=3.00, 1.87, 4.82, P&amp;lt; 0.001) and Physiology-based Phenotypic Age (aOR=2.50, 1.57, 3.98, P&amp;lt;0.001). Individuals who were biologically older had 3.6- and 2.3-times higher odds of heart disease according to physiology-based Phenotypic Age (aOR=3.64, 95% CI 2.68, 4.94, p &amp;lt; 0.001) and DNA methylation Grim Age (aOR=2.36, 95% CI 1.73, 3.23, P&amp;lt;0.001). Findings of the present study suggest that saliva-based telomere length and blood-based DNA methylation and physiology biomarkers likely capture different aspects of individual aging and vary in their precision and sensitivity as novel biomarkers for prevention of stroke and heart disease in older adults.

3-HK SUPPLEMENTATION INCREASES NICOTINATE PHOSPHORIBOSYLTRANSFERASE (NAPRT) EXPRESSION IN DROSOPHILA

Abstract The increasing prevalence of physical frailty and aging related diseases in older adults necessitates the development of novel biological strategies to slow age-related declines. In humans, tryptophan metabolism through the kynurenine pathway (KP), which produces the energy metabolite and cellular cofactor nicotinamide adenine dinucleotide (NAD+), has been linked to various aging-related diseases including metabolic syndrome, neurodegenerative diseases, and physical frailty. Elevated levels of KP metabolites, such as 3-hydroxykinurenine (3-HK), correlate negatively with lifespan and physical function. A profile of downstream KP metabolites in the serum of older adults showed that 3-HK was increased in frail compared to both non-frail and young subjects, and liver kynurenine/tryptophan ratio correlates negatively with maximum lifespan in twenty-six mammalian species. To comprehensively explore the effects of elevated cytotoxic KP metabolites, we fed DGRP_229 Drosophila males diet infused with 3-HK. We found that treatment with 3-HK reduced average lifespan by 17% (P&amp;lt; 0.0001) compared against control. To elucidate the biological mechanisms of 3-HK treatment, we performed qRT-PCR on 11 genes involved in tryptophan metabolism. We found that treatment with 3-HK significantly decreased the expression of nicotinate phosphoribosyltransferase (Naprt) (P=0.0022), which plays an important role in NAD+ biosynthesis and protects against oxidative stress. Our findings indicate that some of the detrimental effects observed after 3-HK supplementation may be mediated by changes in NAD+ biosynthesis and highlight the potential feasibility of using NAD+ supplementation as an intervention method.

Pemphigus and pemphigoid are associated with Alzheimer’s disease in older adults: evidence from the US Nationwide inpatient sample 2016–2018

BackgroundPemphigus and pemphigoid are rare autoimmune skin disorders caused by autoantibodies against structural proteins and characterized by blistering of the skin and/or mucous membranes. Associations have been noted between skin diseases and Alzheimer’s dementia (AD). Dementia is a neurological disorder of progressive cognitive impairment with increasing incidence among older adults. This study aimed to assess the potential associations between pemphigus, pemphigoid and AD in a large, nationally representative US cohort.MethodsAll data of hospitalized patients aged 60 years or older were extracted from the US Nationwide Inpatient Sample (NIS) database 2016–2018. Patients with a history of head trauma, diagnosis of vascular dementia, history of cerebrovascular disease, or malformation of cerebral vessels were excluded. The study population was divided into those with and without pemphigus (cohort 1) and with and without pemphigoid (cohort 2).ResultsPemphigus was independently associated with a 69% increased risk of AD. Adults ≥80 years old with pemphigus were 72% more likely to develop AD than adults without pemphigus. Women with pemphigus were 78% more likely to develop AD than women without pemphigus. On the other hand, pemphigoid was independently associated with a 39% increased risk for AD and subjects ≥80 years with pemphigoid were 40% more likely to have AD than those without pemphigoid. Females with pemphigoid were 63% more likely to have AD than those without pemphigoid. Moreover, Hispanic older adults with pemphigus were 3-times more likely to have AD than those without pemphigoid.ConclusionsPemphigus and pemphigoid were both independently associated with AD in older adults, especially among females and octogenarians. Further studies addressing the etiology and mechanisms underlying these associations are highly warranted.

SA12 Discrepancy of Health State Utility Values in Cost-Utility Analyses of Interventions Against Infectious Diseases in Older Adults

SA12 Discrepancy of Health State Utility Values in Cost-Utility Analyses of Interventions Against Infectious Diseases in Older Adults

Microlearning helps Alzheimer’s Disease Patients

Alzheimer's disease is one of the most common diseases in older adults, and as the disease progresses, the need for daily care increases. Caregivers of Alzheimer's Disease patients face a variety of stresses and work pressures. Receiving professional and continuous training is one of the effective ways to improve their skills and competencies. A new approach to education is microlearning, where microeducational content is provided to learners. Microlearning as a pedagogical technique focuses on designing learning modules through micro-steps in a digital media environment. These activities can be integrated into learners' daily lives and tasks. Unlike "traditional" e-learning methods, microlearning often favours technology delivered through push media, thus reducing the cognitive load on the learner. Microlearning educational methods have been shown to be effective and efficient in educating and delivering materials to caregivers of older adults with Alzheimer's disease. This paper begins with a brief introduction to microlearning. And it details the key features and benefits of microlearning. Microlearning offers potential benefits to Alzheimer's Disease patients and their caregivers with its concise and focused approach. Secondly, machine learning enhances the design and delivery of microlearning, helping to provide a more personalised and effective learning experience. Machine learning plays a role in the design of microlearning. To conclude, microlearning offers a promising avenue of support and care for Alzheimer's Disease patients. Microlearning also provides a valuable resource for carers and healthcare professionals to gain the knowledge and skills needed to provide effective care.

2593. Epidemiology and Clinical Burden of Invasive Pneumococcal Disease in Older Adults in the City of São Paulo, Brazil

Abstract Background The Brazilian National Immunization Program currently provides pneumococcal vaccination for children and high-risk adults. However, the burden of invasive pneumococcal disease (IPD) remains poorly described, especially among older adults. We evaluated the incidence, demographics, clinical characteristics, and outcomes among older adults hospitalized with IPD in São Paulo (SP), the largest city in Brazil. Methods Retrospective chart review of adults ≥ 60y hospitalized with IPD at three tertiary teaching hospitals from January 2016 to December 2018. Incidence was determined, only for people living in SP, using as numerator the number of IPD cases at study hospitals and as denominator the proportion of admissions at study hospitals considering the whole SP public system among people ≥ 60 living in SP. Demographic and clinical data were described for all patients with information. Results Ninety-four patients were included: 98.9% had ≥ 1 selected risk factor (most frequent: cancer, 68.2%), and 90% had unknown vaccination status (Table 1). The 3-year incidence was 121.8 per 100,000 people (60-74y: 117.6 and ≥ 75y: 132.6), while annual incidences per 100,000 people were 47.5 in 2016, 40.1 in 2017, and 34.2 in 2018. Most patients had community-onset disease (89.4%) and the main presentation was bacteremic pneumonia (68.1%), followed by meningitis (10.6%). The median hospitalization length was 10 days, 53.4% of patients had ICU stay (median duration of 7 days). About 22.2% had antimicrobial resistance to more than one class. During hospitalization, 85.1% of patients had ≥ 1 complication (Figure 1), 32.3% developed septic shock, 63.8% required supplemental oxygen, and 36.2% required mechanical ventilation (median: 5 days). In-hospital mortality was 42.6% and, among survivors (n=54), 20.4% reported sequelae (mostly chronic respiratory failure). Demographic and clinical characteristics of older adults with invasive pneumococcal disease, São Paulo city, 2016-2018 (n=94) Complications during hospitalization due to of invasive pneumococcal disease Note: Percentages calculated for all included patients. CNS, central nervous system. (a) More than one complication possible per patient. Only complications with frequency ≥10% are described. (b) Median (range) duration of mechanical ventilation support: 5 (1-28) days. Conclusion This study showed a high burden of IPD in older adults, with higher incidence than reported for other countries such as the USA (26 /100,000 people ≥ 65 y in 2018) or Chile (12.1 /100,000 people ≥ 65y in 2018). The important rates of morbidity and mortality, and a considerable burden on healthcare resources support the importance to expand and improve pneumococcal prevention for older population in Brazil. Disclosures Licieri Figueiredo, MD, MSD Brazil: This is an employee of the MSD company leading the study Cícera P. Marcelino, n/a, MSD LATAM: This is an employee of the MSD company responsible for the management and operation of the study Paula M. Batista, n/a, MSD LATAM: This is an employee of the MSD company responsible for the management and operation of the study Marina D N Paula, n/a, MSD Brazil: This is an employee of the MSD company who is the leader of the therapeutic area of the study Thais Moreira, MD, MSc, MSD LATAM: This is an employee of the MSD company that provides scientific support for the study regionally