General Population Of Older Adults Research Articles

Associations between housing and psychological damage by earthquake and modifiable risk factors for dementia in general older adults: Tohoku Medical Megabank community-based cohort study.

To evaluate the association between housing and psychological damage caused by the Great East Japan Earthquake (GEJE) and modifiable risk factors (MRFs) of dementia for general population of older adults. This cross-sectional study enrolled 29 039 community-dwelling older adults (mean age 69.1 ± 2.9 years, 55.5% women). We evaluated disaster-related damage (by complete or not complete housing damage) and psychological damage (by post-traumatic stress reaction [PTSR]) after the GEJE using a self-report questionnaire. MRFs encompassed the presence of depression, social isolation, physical inactivity, smoking, and diabetes. We examined the association between disaster-related damage and MRFs using ordinary least squares and modified Poisson regression models adjusted for sociodemographic and health status variables. Complete housing damage and PTSR were identified in 2704 (10.0%) and 855 (3.2%) individuals, respectively. The number of MRFs was significantly larger for the individuals with complete housing damage (β = 0.23; 95% confidence interval [CI]: 0.19-0.27) and PTSR (β = 0.60; 95% CI: 0.53-0.67). Prevalence ratios (PRs) for depression and physical inactivity were higher in individuals with complete housing damage. The PRs for all domains of the MRFs were significantly higher in individuals with PTSR. Housing and psychological damage caused by the GEJE were associated with an increased risk factor of dementia. To attenuate the risk of dementia, especially among older victims who have experienced housing and psychological damage after a disaster, multidimensional support across various aspects of MRFs is required. Geriatr Gerontol Int 2024; ••: ••-••.

Chronic kidney disease and its association with cerebral small vessel disease in the general older hypertensive population

BackgroundCerebral small vessel disease can be identified using magnetic resonance imaging, and includes white matter hyperintensities, lacunar infarcts, cerebral microbleeds, and brain atrophy. Cerebral small vessel disease and chronic kidney disease share many risk factors, including hypertension. This study aims to explore an association between chronic kidney disease and cerebral small vessel disease, and also to explore the role of hypertension in this relationship.MethodsWith a cross sectional study design, data from 390 older adults was retrieved from the general population study Good Aging in Skåne. Chronic kidney disease was defined as glomerular filtration rate < 60 ml/min/1,73m2. Associations between chronic kidney disease and magnetic resonance imaging markers of cerebral small vessel disease were explored using logistic regression models adjusted for age and sex. In a secondary analysis, the same calculations were performed with the study sample stratified based on hypertension status.ResultsIn the whole group, adjusted for age and sex, chronic kidney disease was not associated with any markers of cerebral small vessel disease. After stratification by hypertension status and adjusted for age and sex, we observed that chronic kidney disease was associated with cerebral microbleeds (OR 1.93, CI 1.04–3.59, p-value 0.037), as well as with cortical atrophy (OR 2.45, CI 1.34–4.48, p-value 0.004) only in the hypertensive group. In the non-hypertensive group, no associations were observed.ConclusionsIn this exploratory cross-sectional study, we observed that chronic kidney disease was associated with markers of cerebral small vessel disease only in the hypertensive subgroup of a general population of older adults. This might indicate that hypertension is an important link between chronic kidney disease and cerebral small vessel disease. Further studies investigating the relationship between CKD, CSVD, and hypertension are warranted.

Latent transition analysis to explore patterns of physical functional decline among older adults in China: A national 6-year longitudinal study

Background and aimsMultiple limitations often co-occur and accumulate, leading to subsequent function decline. However, there is a scarcity of longitudinal studies examining the progression of physical function among the general population of older adults in China. This study aimed to define typical physical function status and its change, which were characterized by the coexistence and accumulation of diverse limitations targeting a Chinese sample of older adults. MethodsThis study used the three recent public data waves of the Chinese Longitudinal Healthy Longevity Survey during a 6-year follow-up period. 9765 individuals who were over 65 and participated in the 2011 survey were included. Latent transition analysis was used to identify the latent physical function status and explore the transition of older adults among different latent statuses. ResultsSeven latent statuses of physical function were identified, with visual impairment and related limitations being particularly prevalent among older adults. Upper limb mobility appeared to be a differentiated indicator of physical functional status. Physical function decline mainly started with the limitations in squatting, carrying weights and walking, then to the status with intact upper limb mobility and hearing function only, or converted directly into the latter, then to complete dysfunction. ConclusionsOur findings suggest some indicative limitations and critical steps in the process of functional decline among older adults. These results may provide insight for researchers and policymakers to develop tailored preventive and rehabilitation care and provide support for physically limited elderly according to their latent status and course of functional decline.

Precipitating Mechanisms of Falls in Preclinical Alzheimer's Disease.

Individuals with Alzheimer's disease (AD) are more than twice as likely to incur a serious fall as the general population of older adults. Although AD is commonly associated with cognitive changes, impairments in other clinical measures such as strength or functional mobility (i.e., gait and balance) may precede symptomatic cognitive impairment in preclinical AD and lead to increased fall risk. To examine mechanisms (i.e., functional mobility, cognition, AD biomarkers) associated with increased falls in cognitively normal older adults. This 1-year study was part of an ongoing longitudinal cohort study. We examined the relationships among falls, clinical measures of functional mobility and cognition, and neuroimaging AD biomarkers in cognitively normal older adults. We also investigated which domain(s) best predicted fall propensity and severity through multiple regression models. A total of 182 older adults were included (mean age 75 years, 53% female). A total of 227 falls were reported over the year; falls per person ranged from 0-16 with a median of 1. Measures of functional mobility were the best predictors of fall propensity and severity. Cognition and AD biomarkers were associated with each other but not with the fall outcome measures. These results suggest that, although subtle changes in cognition may be more closely associated with AD neuropathology, functional mobility indicators better predict falls in cognitively normal older adults. This study adds to our understanding of the mechanisms underlying falls in older adults and could lead to the development of targeted fall prevention strategies.

The relationship of social isolation and sleep in older adults: evidence from cross-sectional and longitudinal studies

Objectives This study aimed to explore the relationship between social isolation and sleep in later life and the role of loneliness in this relationship. Methods In Study 1, we conducted a cross-sectional analysis of the correlation between social isolation and sleep in community-dwelling older adults (N = 108). This relationship was assessed using subjective and objective measures. Moreover, we examined the mediating role of loneliness cross-sectionally (Study 1) and longitudinally (Study 2). Longitudinal study was based on three waves of data from the National Scale Life, Health, and Aging Project (N = 1, 554). Results The results showed that social isolation was robustly associated with sleep in the general population of older adults. Specifically, subjective social isolation was associated with subjective sleep, and objective social isolation was associated with objective sleep. The results of the longitudinal study showed that loneliness mediated the reciprocal link between social isolation and sleep across time after controlling for autoregressive effects and basic demographics. Conclusions These findings address the gap in the literature on the link between social isolation and sleep in older adults, extending the understanding of improvement in older adults' social networks, sleep quality, and psychological well-being.

Research Participant Selection Bias in the Workshop Using Socially Assistive Robots for Older Adults and Its Effect on Population Representativeness.

Every research participant has their own personality characteristics. For example, older adults assisted by socially assistive robots (SAR) may have their own unique characteristics and may not be representative of the general population of older adults. In this research, we compared the average personality characteristics of participants in a workshop on robotics recruited directly through posting with those of older Japanese adults to examine participant selection bias and group representativeness for future study of SARs. After a one-week recruitment period, the workshop was attended by 20 older participants (nine males and 11 females) aged between 62 and 86 years. Extroversion among workshop participants was 4.38, 0.40 higher than the average for older adults in Japan. The workshop participants' openness was 4.55, 1.09 higher than the average for the Japanese elderly. Thus, the results indicate a slight selection bias in the personal characteristics of the participants depending on the recruitment method when compared to the Japan national average for older adults. In addition, only one of 20 participants was below the cutoff on the LSNS-6 score and considered to have a tendency toward social isolation. The development and introduction of socially assistive robots is often being considered to support people in social isolation in their daily lives; however, the results of this study showed that it is difficult to recruit people who tend to be socially isolated when gathering research participants by methods such as posting. Therefore, the effectiveness of the method of recruiting participants should be carefully verified in research regarding socially assistive robots.

Breathlessness in older adults: What we know and what we still need to know.

Breathlessness is common among older adults, but it is often hidden as "normal aging "or considered narrowly as a symptom of cardio-respiratory diseases. Studies on breathlessness in older adults are mostly focused on specific diseases, whereas older adults are characterized by multimorbidity and multi-system age-related impairments. This article aims to provide an overview of what is known so far on breathlessness in the general population of older adults and identify areas for further research. Research shows that breathlessness in older adults is a multifactorial geriatric condition, crossing the borders of system-based impairments and diseases, and a valuable independent prognostic indicator for adverse outcomes. Further research needs to investigate (1) the multi-factorial mechanisms of breathlessness in community-dwelling older adults including the role of respiratory sarcopenia; (2) the influence of affective and cognitive changes of older age on the perception and report of breathlessness; (3) the best way to assess and use breathlessness for risk prediction of adverse outcomes in general geriatric assessments; and (4) the most appropriate multi-modal rehabilitation interventions and their outcomes. Clinicians need to shift their approach to dyspnea from a disease symptom to a multifactorial geriatric condition that should be proactively searched for, as it identifies higher risk for adverse outcomes, and can be addressed with evidence-based interventions that can improve the quality of life and may reduce the risk of adverse outcomes in older adults.

Differences in Risk of Alzheimer's Disease Following Later-Life Traumatic Brain Injury in Veteran and Civilian Populations.

To directly compare the effect of incident age 68+ traumatic brain injury (TBI) on the risk of diagnosis of clinical Alzheimer's disease (AD) in the general population of older adults, and between male veterans and nonveterans; to assess how this effect changes with time since TBI. Community-dwelling traditional Medicare beneficiaries 68 years or older from the Health and Retirement Study (HRS). Fine-Gray models combined with inverse-probability weighting were used to identify associations between incident TBI, post-TBI duration, and TBI treatment intensity, with a diagnosis of clinical AD dementia. The study included 16 829 older adults followed over the 1991-2015 period. For analyses of veteran-specific risks, 4281 veteran males and 3093 nonveteran males were identified. Analysis of veteran females was unfeasible due to the age structure of the population. Information on occurrence(s) of TBI, and onset of AD and risk-related comorbidities was constructed from individual-level HRS-linked Medicare claim records while demographic and socioeconomic risk factors were based on the survey data. Later-life TBI was strongly associated with increased clinical AD risk in the full sample (pseudo-hazard ratio [HR]: 3.22; 95% confidence interval [CI]: 2.57-4.05) and in veteran/nonveteran males (HR: 5.31; CI: 3.42-7.94), especially those requiring high-intensity/duration care (HR: 1.58; CI: 1.29-1.91). Effect magnitude decreased with time following TBI (HR: 0.72: CI: 0.68-0.80). Later-life TBI was strongly associated with increased AD risk, especially in those requiring high-intensity/duration care. Effect magnitude decreased with time following TBI. Univariate analysis showed no differences in AD risk between veterans and nonveterans, while the protective effect associated with veteran status in Fine-Gray models was largely due to differences in demographics, socioeconomics, and morbidity. Future longitudinal studies incorporating diagnostic procedures and documentation quantifying lifetime TBI events are necessary to uncover pathophysiological mediating and/or moderating mechanisms between TBI and AD.

The Sociodemographic Profile of Community-Dwelling Older Adults With Serious Mental Illness in Kerala - A Cross-Sectional Study.

Older adults with serious mental illness (OASMI) have to manage the twin challenges of old age and mental illness. Understanding their characteristics will help policymakers and researchers plan tailored interventions. The profile of OASMI is not described in any publication from India, and this paper addresses that gap. The information from this study will serve as a baseline for the planned periodic follow-up of the study participants. This study employed a cross- sectional design among a sample of OASMI identified through multistage cluster sampling from three districts in Kerala. We interviewed them in their households and collected sociodemographic data using a pretested tool. Among the 917 OASMI participants, 66% were females, 18% were the 'oldest-old' (≥80 years), 94.1% were unemployed, 51.7% were socially backward, 68.5% were financially weak, 10.1% were living alone, 59.4% were living without partners, and 63.7% had caregivers. Compared to the general population of older adults in Kerala, the OASMI have poorer socioeconomic status and higher rates of social isolation, and males are dying earlier. The profile of the OASMI depicts their multiple vulnerabilities and the need to address those.

PREDICTIVE MODEL OF 30-DAY HOSPITAL READMISSION FOR PATIENTS WITH ALZHEIMER’S DISEASE

Abstract Hospitals are insufficiently equipped for patients with Alzheimer’s disease and related dementia (ADRD). Thus, 30-day hospital readmission is higher and costlier among ADRD patients than the general population of older adults. Our objective was to develop a risk-assessment tool for hospitalized patients with ADRD. We used 2016-2019 electronic medical record (EMR) data from the University of Michigan health system and applied machine learning techniques to develop a readmission risk-assessment tool. We identified 2,899 individuals with ADRD who had at least one index hospital admission. All data features available in EMR – demographics, lab results, prior counts of healthcare use, and characteristics of index hospitalization – were included in our predictive models. Additionally, we geocoded the street address of patients using the National Neighborhood Data Archive using the U.S. Census tract-level information to include two composite measures of socioeconomic status: disadvantage and affluence. The readmission rate for ADRD patients was 22% versus 17% for the general population. The best predictive model was the Random Forest (area under the receiver operating characteristic curve=0.66; sensitivity=0.64; specificity=0.61). The accuracy of our model (0.61) was 42% higher than the LACE score (0.43), which is currently used by the hospital for all patients. The top 5 predictors of 30-day readmission among people with ADRD included length of hospital stay, frailty index, living in a disadvantaged neighborhood, and total prior-year healthcare charges. Our risk-assessment tool identifies ADRD patients at high risk of readmission and why they are at higher risk. The tool enables better decision-making before discharge.

Medication Prescribed Within One Year Preceding Fall-Related Injuries in Ontario Older Adults.

Serious injuries secondary to falls are becoming more prevalent due to the worldwide ageing of societies. Several medication classes have been associated with falls and fall-related injuries. The purpose of this study was to describe medication classes and the number of medication classes prescribed to older adults prior to the fall-related injury. This population-based descriptive study used secondary administrative health-care data in Ontario, Canada for 2010-2014. Descriptive statistics were reported for Anatomic Therapeutic Chemical 4th level medication classes. Frequency of medications prescribed to older adults was calculated on different sex, age groups, types of medications, and injures. Over five years (2010-2014), 288,251 older adults (63.2% females) were admitted to an emergency department for a fall-related injury (40.0% fractures, 12.1% brain injury). In the year before the injury, 48.5% were prescribed statins, 27.2% antidepressants, 25.0% opioids, and 16.6% anxiolytics. Females were prescribed more diuretics, antidepressants, and anxiolytics than males; and people aged 85 years and older had a higher percentage of diuretics, antidepressants, and antipsychotics. There were 36.4% of older adults prescribed 5-9 different medication classes and 41.2% were prescribed 10 or more medication classes. Older adults experiencing fall-related injuries were prescribed more opioids, benzodiazepines, and antidepressants than previously reported for the general population of older adults in Ontario. Higher percentage of females and more 85+ older adults were prescribed with psychotropic drugs, and they were also found to be at higher risk of fall-related injuries. Further associations between medications and fall-related injuries need to be explored in well-defined cohort studies.

Cooking methods are associated with inflammatory factors, renal function, and other hormones and nutritional biomarkers in older adults

Evidence of the role of cooking methods on inflammation and metabolic health is scarce due to the paucity of large-size studies. Our aim was to evaluate the association of cooking methods with inflammatory markers, renal function, and other hormones and nutritional biomarkers in a general population of older adults. In a cross sectional analysis with 2467 individuals aged ≥ 65, dietary and cooking information was collected using a validated face-to-face dietary history. Eight cooking methods were considered: raw, boiling, roasting, pan-frying, frying, toasting, sautéing, and stewing. Biomarkers were analyzed in a central laboratory following standard procedures. Marginal effects from generalized linear models were calculated and percentage differences (PD) of the multivariable-adjusted means of biomarkers between extreme sex-specific quintiles (Q) of cooking methods consumption were computed ([Q5 − Q1/Q1] × 100). Participants’ mean age was 71.6 years (53% women). Significant PD for the highest vs lowest quintile of raw food consumption was − 54.7% for high sensitivity-C reactive protein (hs-CRP), − 11.9% for neutrophils, − 11.9% for Growth Differentiation Factor-15, − 25.0% for Interleukin-6 (IL-6), − 12.3% for urinary albumin, and − 10.3% for uric acid. PD for boiling were − 17.8% for hs-CRP, − 12.4% for urinary albumin, and − 11.3% for thyroid-stimulating hormone. Concerning pan-frying, the PD was − 23.2% for hs-CRP, − 11.5% for IL-6, − 16.3% for urinary albumin and 10.9% for serum vitamin D. For frying, the PD was a 25.7% for hs-CRP, and − 12.6% for vitamin D. For toasting, corresponding figures were − 21.4% for hs-CRP, − 11.1% for IL-6 and 10.6% for vitamin D. For stewing, the PD was 13.3% for hs-CRP. Raw, boiling, pan-frying, and toasting were associated with healthy profiles as for inflammatory markers, renal function, thyroid hormones, and serum vitamin D. On the contrary, frying and, to a less extent, stewing showed unhealthier profiles. Cooking methods not including added fats where healthier than those with added fats heated at high temperatures or during longer periods of time.

Long-Term Cardiovascular Mortality among 80,042 Older Patients with Bladder Cancer

Simple SummaryWe conducted a large-scale population-based study with long-term follow-up to obtain a comprehensive assessment of death causes, especially cardiovascular disease death, among 80,042 older bladder cancer patients from a national cancer registry containing 44 years of data. To our knowledge, this was the first study to report the importance of CVD-related death as a competing risk among older patients with bladder cancer. CVD-related death surpassed BC as the leading cause of death 5–10 years after diagnosis among older BC patients, especially for patients with localized-stage and low-grade tumors. Furthermore, older BC patients had a higher risk of CVD-related death than the general population. Although BC management should be the primary focus of older BC patients, our results emphasized the importance of competing risks, the most prominent being CVD. Individual follow-up and management should focus not only on primary cancer but also on CVD-related death to minimize the risk of death in older patients with bladder cancer.Background: To identify the risk of death from cardiovascular disease (CVD) in older patients with bladder cancer (BC). Methods: This population-based study included 80,042 older BC patients (≥65 years) diagnosed between 1975 and 2018, with a mean follow-up of 17.2 years. The proportion of deaths, competing risk models, standardized mortality ratio (SMR), and absolute excess risk (AER) per 10,000 person-years were applied to identify the risk of CVD-related deaths among older BC patients. Results: For older patients with BC, CVD-related death was the chief cause of death, and cumulative CVD-related mortality also exceeded primary BC as the leading cause of death mostly 5–10 years after BC diagnosis, especially in localized-stage and low-grade subgroups. The risk of short- and long-term CVD-related death in older BC patients was higher than in the general older adult population (SMR = 1.30, 95% CI 1.28–1.32; AER = 105.68). The risk of sex-specific CVD-related deaths also increased compared to the general population of older adults, including heart disease, cerebrovascular diseases, hypertension without heart disease, atherosclerosis, aortic aneurysm and dissection, and other diseases of the arteries, arterioles, and capillaries. Conclusions: CVD-related death is an important competing risk among older BC patients and has surpassed primary BC as the chief cause of death, mainly 5–10 years after BC diagnosis. The risk of CVD-related death in older patients with BC was greater than in the general population. The management of older patients with BC should focus not only on the primary cancer but also on CVD-related death.

Feasibility and efficacy of a remotely delivered fall prevention exercise program for community-dwelling older adults with cancer: Protocol for the STABLE trial

Falls are a major issue in older adults with cancer due to the effects of cancer and its treatments. Ample evidence in the general population of older adults has demonstrated the effectiveness of strength and balance training in reducing fall rates in older adults. However, data on effective fall prevention interventions in the oncology setting are lacking. The objective of this study is to evaluate the feasibility and efficacy of a remotely delivered, partially-supervised, resistance and balance training program on lower body strength, balance, and falls in community-dwelling older adults with cancer. The proposed study is an observer-blinded, parallel group (intervention group vs. control group) randomized controlled trial (ClinicalTrials.gov Identifier: NCT04518098). This study will recruit 74 eligible community-dwelling older adults with cancer from a comprehensive cancer centre. Intervention includes a remotely delivered exercise program for 3 months. Outcome measures include feasibility measures, lower body strength, balance, and fall rates. Research ethics approval has been granted by the Biomedical Research Ethics Boards of the University of Saskatchewan. If found effective, findings from this study will inform a subsequent, phase III definitive trial, with the ultimate goal to reduce falls and reduce impact on cancer treatment. Study findings will be disseminated through presentation at community level and scientific conferences, and in scientific journals.Trial registration: ClinicalTrials.gov identifier: NCT04518098

Prevalence and features of chronic pain syndrome in persons over 65 years old: Russian epidemiological study EVKALIPT

Background . The prevalence of chronic pain syndrome in general population of older adults in the Russian Federation is unknown. Aim . To study the prevalence and features of chronic pain syndrome in subjects aged ≥65 years. Materials and methods . There were examined 4308 subjects (30% males) aged from 65 to 107 years (mean age 78±8 years), living in 11 regions of the Russian Federation, who were divided into 3 age groups (65–74 years, 75– 84 years and ≥85 years). All participants underwent a comprehensive geriatric assessment consisted of two stages: 1) questioning based on a specially designed questionnaire; 2) physical examination. The «Chronic pain» module of questionnaire included: 1) questions concerning the presence, localization, character and frequency of chronic pain syndrome, as well as the frequency of taking analgesics; 2) self-assessment of pain intensity on a visual-analogue scale at the moment of examination and for the previous week; 3) DN4 questionnaire to detect neuropathic pain. Results . The prevalence of chronic pain syndrome was 87.2%, including 83.8% in subjects aged 65–74 years, 87.7% — 75–84 years, 91.1% — ≥85 years (p for trend &lt;0.001). In women, chronic pain was detected more often than in men (90.2% vs. 80.2%; p&lt;0.001). The most frequent localization of pain syndrome were large joints (75%), back (68%) and head (64%). The prevalence of different types of pain was as follows: nociceptive — 67.3%, neuropathic — 21.2%, nociplastic — 11.4%. With age, the frequency of detection of neuropathic pain increased (from 18.9% in patients aged 65–74 to 23.8% in patients ≥85 years; p for trend = 0.013), nociplastic, on the contrary, decreased (from 13.8% to 9%; p for trend = 0.001), and nociceptive — remained unchanged (67.3% in patients aged 65–74, 67.6% — 75–84 years, 67.2% — ≥85 years; p for trend = 0.974). In patients with neuropathic pain, more severe manifestations of pain syndrome were revealed: they were more likely to experience pain of any localization with a large number of pain zones/areas, they had a higher frequency and intensity of pain syndrome, and they were more likely to take analgesics and noted limitations in daily life due to pain. Conclusion . In the EVKALIPT study, for the first time, domestic data on the prevalence and features of chronic pain syndrome in subjects aged ≥65 years in the general population was obtained.

Prevalence and burden of COPD misclassification in the Canadian Longitudinal Study on Aging (CLSA)

IntroductionTo examine the prevalence of chronic obstructive pulmonary disease (COPD) misclassification and the associated burden of symptoms, healthcare utilisation and physical performance status in the Canadian general population. This information...

Self-reported health and the well-being paradox among community-dwelling older adults: a cross-sectional study using baseline data from the Canadian Longitudinal Study on Aging (CLSA)

BackgroundSelf-reported health is a widely used epidemiologic measure, however, the factors that predict self-reported health among community-dwelling older adults (≥65 years), especially those with multimorbidity (≥2 chronic conditions), are poorly understood. Further, it is not known why some older adults self-report their health positively despite the presence of high levels of multimorbidity, a phenomenon known as the well-being paradox. The objectives of this study were to: 1) examine the factors that moderate or mediate the relationship between multimorbidity and self-reported health; 2) identify the factors that predict high self-reported health; and 3) determine whether these same factors predict high self-reported health among those with high levels of multimorbidity to better understand the well-being paradox.MethodsA cross-sectional analysis of baseline data from the Canadian Longitudinal Study on Aging was completed (n = 21,503). Bivariate stratified analyses were used to explore whether each factor moderated or mediated the relationship between multimorbidity and self-reported health. Logistic regression was used to determine the factors that predict high self-reported health in the general population of community-dwelling older adults and those displaying the well-being paradox.ResultsNone of the factors explored in this study moderated or mediated the relationship between multimorbidity and self-reported health, yet all were independently associated with self-reported health. The ‘top five’ factors predicting high self-reported health in the general older adult population were: lower level of multimorbidity (odds ratio [OR] 0.75, 95% confidence interval [CI] 0.74-0.76), female sex (OR 0.62, CI 0.57-0.68), higher Life Space Index score (OR 1.01, CI 1.01-1.01), higher functional resilience (OR 1.16, CI 1.14-1.19), and higher psychological resilience (OR 1.26, CI 1.23-1.29). These same ‘top five’ factors predicted high self-reported health among the subset of this population with the well-being paradox.ConclusionsThe factors that predict high self-reported health in the general population of older adults are the same for the subset of this population with the well-being paradox. A number of these factors are potentially modifiable and can be the target of future interventions to improve the self-reported health of this population.

Statement on falls in long-term care facilities by the Japan Geriatrics Society and the Japan Association of Geriatric Health Services Facilities.

In current clinical practice, when a fall occurs in a long-term care facility, it is often treated as an accident. Falls are classified as one of the most commonly prevalent geriatric syndromes. As their causes are extremely diverse and complex, their occurrence rate depends on individual susceptibility, even if appropriate fall prevention measures are taken. Falls are common among older adults, and fractures and intracranial hemorrhage resulting from falls can lead to the deterioration of activities of daily living and death. For this reason, it is recommended that the risk of falls is assessed in the general population of older adults, and that appropriate interventions are carried out for those at high risk. In response to this situation, the Japan Geriatrics Society and the Japan Association of Geriatric Health Services Facilities have issued the following statements on falls as a geriatric syndrome based on scientific evidence, especially considering the frequent occurrence of falls in long-term care facilities. Geriatr Gerontol Int 2022; 22: 193-205.

Knowledge, confidence, attitudes and beliefs of physiotherapists and physiotherapy students working with people with dementia: A mixed‐methods systematic review

AbstractBackgroundClinical care for people with dementia as a primary diagnosis, or as a co‐morbidity, can be complex. Physiotherapists play a key role in the care of people living with dementia in multiple settings. The aim of this systematic review is to understand the attitudes, beliefs, knowledge and confidence of physiotherapists and physiotherapy students when working with people with dementia.MethodThis was a mixed‐methods systematic review that included qualitative and quantitative studies. Participants were physiotherapists working in any clinical specialty (e.g. gerontology, orthopaedic, neurological, cardio‐respiratory), and physiotherapy students who had completed at least one clinical placement. If studies investigated physiotherapist and physiotherapy students’ knowledge, confidence, attitudes or beliefs on working with a general population of older adults, they were excluded. The phenomena of interest and context were attitudes, beliefs, knowledge and confidence when working with people with dementia in any setting. Eleven databases were searched. Data synthesis followed a convergent integrated approach according to Joanna Briggs Institute methodology for mixed methods systematic reviews.Result15 studies were eligible for inclusion (9 quantitative and 6 qualitative studies). There were 5 key themes: rehabilitation potential (variable outcomes, poor potential), challenges in dementia care (communication, behaviour, cognition, risk, stress and burnout), education in dementia practice (inadequate training and knowledge, importance of experience), specialised area of practice (complexity of presentation, nuance of care, importance of time, holistic approach) and unsupportive systems (environment, time, risk aversion). One code, lack of desire to provide dementia care, did not contribute to any themes.ConclusionPhysiotherapists and physiotherapy students have low levels of knowledge and confidence in several areas important to working with people with dementia. With higher levels of knowledge and confidence associated with more positive attitudes and beliefs, dementia education needs of physiotherapists at all levels needs to be addressed.

Association of resting heart rate with cognitive decline and dementia in older adults: A prospective population‐based study

AbstractBackgroundResting heart rate (RHR) is easily assessed and predicts future risk of cardiovascular (CV) events. However, large‐scale population‐based studies investigating the relationship of RHR with dementia and cognitive decline are scarce.MethodWe analysed data from baseline dementia‐free participants of the population‐based Swedish National study on Aging and Care in Kungsholmen (n=2423, age ≥60 years, mean age 71 years, female 61%) who were regularly followed from 2001‐2004 through 2013‐2016. RHR was assessed using a 12‐lead ECG at baseline. Incident dementia was diagnosed following the DSM‐IV criteria and global cognitive function was assessed using Mini‐Mental State Examination (MMSE). We used Cox proportional hazard models and linear mixed‐effects models with random intercepts and slopes to investigate the associations of RHR with incident dementia and cognitive decline, respectively, while controlling for demographics (age, sex, and education), smoking, physical activity, CV risk factors, and existing cardiovascular diseases.ResultDuring the 12‐year follow up period, 332 participants developed dementia. As a continuous variable, per 10‐bpm increase in RHR was significantly associated with 12% increased risk of dementia (multi‐adjusted hazard ratio [HR] 1.12, 95% CI 1.02, 1.23). As a categorical variable, the multi‐adjusted HR (95% CI) of dementia associated with RHR (bpm) of &lt;60, 60‐69 (reference), 70‐79, and ≥80 were 1.00 (0.75, 1.33), 1.00 (reference), 1.19 (0.89, 1.59), and 1.47 (1.04, 2.06), respectively. The multi‐adjusted β‐coefficients (95% CI) of MMSE score associated with the four categories of RHR were 0.01 (‐0.05, 0.07), 0.00 (reference), ‐0.10 (‐0.16, ‐0.03), and ‐0.16 (‐0.24, ‐0,08), respectively. There was no statistical interaction of RHR with gender and APOE ε4 allele on dementia risk (P for interaction &gt;0.1).ConclusionHigher RHR is associated with increased risk for dementia and greater cognitive decline independent of CV risk factors and related diseases in a general population of older adults.