Health Of Older People Research Articles

Primary care physicians' attitudes, practices, and perceived barriers toward depression screening in older people in the Kingdom of Bahrain

PurposeThis study aimed to explore attitudes, practices, and perceived barriers of primary care physicians (PCPs) toward depression screening in older people.MethodsThis cross-sectional study enrolled PCPs from randomly selected representative primary care centers in Bahrain. A self-administered piloted semi-structured questionnaire was used for data collection.ResultsWe enrolled 248 PCPs in the study (82.3% females, and the mean age = 40 ± 8.7 years). More than half of the participants (54.4%) had a positive attitude toward depression screening in older people. However, only 10.9% of the participants reported systematically screening for this condition without using specific tools for screening in 45.5%. The most reported barriers toward this service are short consultation time (95%), the presence of multiple co-morbidities in this age group (90%), and the absence of guidelines or appropriate training in around 30%. Positive attitudes were significantly higher among older PCPs (p = 0.039), family physician consultants (p = 0.008), those with more than 10 years of work experience (p = 0.024), and those who participated in related educational activities (p = 0.007). Under-screening practice is associated with perceived short consultation time (p = 0.002), insufficient continuous medical education (CME) activities attendance in older people's mental health (p = 0.048) as well as having a general physician's title (p = 0.049). Only the PCPs' job title, Adjusted Odds Ratio (OR) = 3.513, 95 C.I [1.225-10.074] and attendance of CME activities, OR = 1.278, 95 C.I [1.098 – 3.192] remained significant when controlled for age and experience.ConclusionMore training on older people's mental health and provision of screening and management guidelines are priorities to promote older people's mental health in primary care settings.

Loneliness, Psychological Well-being, Depression, and Social Participation in the Older Persons: Rural and Urban Differences.

The purpose of this study is to compare the loneliness, psychological well- being, depression, and social participation of elderly people living in Turkish society between rural and urban areas. The sample group of the study, in which a correlational survey model was used, consisted of 610 elderly adults. The study population consists of two groups: the first group consists of individuals over 65 years of age living in the city (Istanbul) (n= 291), and the second group consists of individuals over 65 years of age living in rural areas (rural areas of Ordu) (n= 319). Socio-demographic Information Form, Loneliness in the Elderly Scale, Geriatric Depression Scale, Psychological Well-Being in the Elderly Scale, and Social Inclusion Scale were applied online. Statistical analyses of the study were conducted using SPSS 27.00, and the Independent Samples t-test and ANOVA test were used. According to the findings of this study, statistically significant results were found in psychological well-being, social inclusion, social relations, loneliness and depression, and place of residence. It was observed that the social isolation and social acceptance levels of those living in urban areas were higher than those living in rural areas. Social, loneliness, and depression scores of those living in the village/town were found to be higher than those living in the city centre. Furthermore, the social relationship scores of those living in the village/town were found to be higher than those living in the city centre. The increasing elderly population worldwide has become an issue that requires global measures. Place of residence is one of the factors thought to affect older people's health and well- being. It is thought that the study data will contribute to new policies that will ensure the protection and promotion of elderly health and those working in this field. In addition, the study, which provides information about Turkish culture, will also enable intercultural comparisons.

Indoor Air Quality and health of older people: a pilot study

Abstract Background Older people often experience one or more chronic conditions, including respiratory conditions. Indoor air quality may (IAQ) may elevate symptoms of respiratory disease such as coughing. Consequently, people may experience a lower Health Related Quality of Life (HR-QoL). The objective of the Rotterdam K-HEALTHinAIR pilot site is to study IAQ and health among elderly: this study presents the design of the study and preliminary baseline results of IAQ and health. Methods A observational study is performed among n = 110 older people living in the broader Rotterdam-area, the Netherlands, recruited via opportunity sampling, hospitals and senior-residential corporations. Participants provide informed consent to participate in the study. IAQ is assessed near real-time using home sensors. An observation checklist captures environmental characteristics of the home. Participants complete a diary every 3 months and a self-report questionnaire at baseline, 6- and 12-months; measures include Health-Related Quality of Life, well-being and respiratory symptoms. Preliminary baseline data (n = 30 baseline questionnaires, n = 25 sensors) were analyzed using descriptive statistics and regression analyses. Results The mean age was 74.3 (SD: 6.3). Average concentrations were 684 ppm CO2 (SD: 723), PM2.5 was 4.8 µg/m3 (SD: 34.5) and average temperature 19.9 °C (SD:1.6). In total 40.0% participants were experiencing asthma and 43.3% COPD. Participants rated their general well-being 72.6 (SD: 18.6) (0-100). No associations were observed between indicators of IAQ and participant self-rated health and health symptoms in this preliminary dataset. Conclusions Future data collection will allow for overtime associations between IAQ and a broad range of health outcomes. In the second and third phase of the study we aim to deepen findings and develop interventions.

Risk factors for COVID-19 infection among the German older adult population

Abstract Background There are scarce analyses on COVID-19 infection risk factors for the older adult population. This study aims to examine COVID-19 infection risk factors in the older adult general population. Methods The data for this analysis came from the population-representative Study on Health of Older People in Germany (Gesundheit65+) conducted by the Robert Koch Institute from 10/2021 to 08/2022. We considered information on COVID-19 infection status (self-reported infection confirmed by PRC test at least once vs. never), socio-demographic factors, health risk factors, and different face-to-face interactions. The analysis was restricted to 2,976 individuals aged 65+ years with complete infection status information. We assessed weighted prevalences and used univariable and multivariable logistic regressions to evaluate infection risk factors. Results The overall prevalence of infection was 7.2% (95% confidence interval, 6.0-8.7). Infection prevalences were significantly higher (compared to their respective reference group) among participants living in assisted living facilities (24.7% vs. 6.7%), individuals who got help to perform basic activities of daily living (10.8% vs. 6.8%), COVID-19 unvaccinated individuals (25.2% vs. 6.9%), individuals who did not meet family or friends in the last month (12.7% vs. 6.7%), and participants who did not smoke (7.8% vs. 2.6%). No other variable was significantly related to COVID-19 infection. In multivariable analysis, variables independently associated with higher odds ratio (OR) of COVID-19 infection were: living in an assisted living facility OR 3.6 (1.8-7.2), not being vaccinated against COVID-19 OR 4.6 (1.5-14.1), and not smoking OR 1.6 (1.1-2.6). Conclusions The preliminary results of this study align with the prevalence of COVID-19 infection found in concomitant studies. A noteworthy element of our study is the vaccine’s protective effect. The pandemic had a particularly detrimental effect on residents of assisted living facilities Key messages • Improvement in quality of care and infection preventive measures in nursing homes is necessary. • Pandemic preparedness must consider the need for help in the daily life of the older population.

Measurements and medication data are indispensable for population blood pressure monitoring

Abstract Background The National Study on Health of Older People in Germany “Gesundheit 65+” included blood pressure (BP) measurements at home by a study nurse and classification of all current medication. Methods Nationally representative examination survey of the population aged 65 years and older residing in Germany using two-stage population registry sampling from 128 sample points, with a standardized examination at home from June 2022 to April 2023. Three standardized blood pressure measurements at two-minute intervals were taken after 5 minutes rest with an oscillometric device (Mobil-O-Graph) using one of five cuffs according to upper arm circumference. The mean of the second and third measurement was used for analysis. Hypertension was defined as mean systolic BP (SBP) at or above 140 mmHg, or mean diastolic BP (DBP) at or above 90 mmHg, or the use of antihypertensives (antihypertensives, diuretics, beta-blockers, calcium-channel blockers, ACEI and ARB) in participants with self-reported hypertension diagnosis. Provisional weights account for unequal sampling and participation probabilities. Results The “Gesundheit 65+” examination part included 1,493 participants of whom 1,475 (98.8%) had successful BP measurements (763 men and 712 women, aged 66 to 101 years). Based on self-reported diagnoses alone, the prevalence of hypertension would be 58.3% [95% CI 53.2-63.3] in men and 59.5% [53.8-64.9] in women. However, overall hypertension prevalence was estimated at 70.4% [65.8-74.7] in men and 72.3% [66.9-77.1] in women based on the study definition which combines self-reported diagnoses, standardized BP measurements and medication. Conclusions The prevalence of hypertension is greatly underestimated in the absence of examination survey data with standardized measurements and recording of medication use. In addition, measurement and medication data are needed for monitoring the hypertension cascade, i.e. awareness, treatment and control of hypertension. Key messages • Hypertension prevalence is underestimated in the absence of health examination surveys with measurements and medication data. • The hypertension cascade, i.e. assessment of awareness, treatment and control of hypertension needs population surveys with measurements and medication assessment.

Promoting active ageing: The positive impact of older people’s participation in Urban Gardens

Abstract Background The socio-health and economic consequences of the progressive population ageing constitute a global challenge for public health, which is committed to the promotion of active and healthy ageing as a strategy to mitigate these consequences. The European project U-GARDEN has evaluated from a comprehensive and innovative approach the impact of urban gardens on the promotion of active ageing through the participation of older people in urban agriculture. Methods A qualitative methodology was designed and implemented in order to analyse the information provided by people over 65 years of age, who actively participated in urban gardens, from a personal and subjective perspective through semi-structured in-depth interviews. The benefits obtained from participation in urban gardens were analysed, considering the different dimensions that make up the paradigm of active ageing: physical, psychological, economic, health, behavioural and personal impact. A total of 20 interviews were used to reach the saturation point. Results Qualitative analysis showed multiple benefits of active and healthy aging. Participants reported increased physical activity and psychosocial improvements such as higher personal satisfaction, reduced stress, and enhanced self-esteem, strengthening community connections and fostering a sense of belonging. Economically, they reported savings on food costs and increased food security. Overall, respondents noted improvements in general health and quality of life, highlighting urban gardening as valuable for well-being and social-economic integration. Conclusions The findings reported in the framework of the U-GARDEN project support the importance of implementing innovative strategies that encourage participation in urban gardens as a tool to improve the overall wellbeing and health of older people, effectively addressing some of the main challenges of ageing such as loneliness unwanted frailty and disability. Key messages • The U-GARDEN project is an example of good practice in the use of urban gardens as a platform for promoting active and healthy ageing. • The promotion of green spaces through the establishment of urban gardens should be considered by health and political authorities for their ability to promote the general well-being of society.

Prevalence of potentially inappropriate medication use in the older population living in Germany

Abstract Background Potentially inappropriate medications (PIM) are medicines for which the risks for adverse events (AEs) usually outweigh the clinical benefits in older adults. PIM is associated with an increased risk of AEs, hospitalizations, mortality and higher health care costs. This analysis presents the prevalence of PIM use and associated factors in people aged 66+ years living in Germany. Methods Data from the nationally representative Study on Health of Older People in Germany (Gesundheit 65+) conducted between 2021-2023 by the Robert Koch Institute, was analyzed. All medicines used, prescribed and over-the-counter (OTC), in the 7 days before the interview were classified into anatomical therapeutic chemical codes. PIM use was identified based on the PRISCUS 2.0 list. Weighted prevalences and associated factors for PIM use are presented. Results 96% of the sample (N = 1,474) took at least 1 medication in the 7 days before the interview. The prevalence of PIM use was 29% (95% CI: 26%-32%), 23% took 1 PIM and 6% 2+. There were no sex differences but a significant increase with age: 23% in the age group 66-74, 33% in the age group 75-84, and 39% in the age group 85 + (29% 1 PIM and 10% 2+). People with a low educational level had a PIM prevalence of 32% compared to 21% in those with a high educational level. Among those reporting having chronic diseases, the PIM prevalence was 34% compared to 19% among those not reporting them. The prevalence of PIM increased with the number of medicines used: 13% in 1-4 medicines, 31% in 5-9 medicines, and 53% in 10+ medicines. The most frequently used PIM in this sample was ginkgo biloba leaf extract (plant-based antidementia drug) followed by diclofenac (non-steroidal anti-inflammatory drug), and then by tricyclic antidepressant drugs (opipramol and amitriptyline). Conclusions PIM use was higher than suggested by prescription data analysis. It was associated with higher age, chronic diseases, polypharmacy and a low educational level. Key messages • PIM use was common, affecting more people with chronic diseases, older age groups and people with a low educational level. • Strategies to promote and monitor appropriate medication use are needed.

Polypharmacy and associated factors in the older population in Germany: Results Gesundheit 65+ study

Abstract Background Polypharmacy, the use of 5 or more medications simultaneously, favors the risk of adverse drug events, drug interactions, potentially inappropriate medication (PIM), hospitalizations, falls, frailty, and mortality. This analysis presents the prevalence of polypharmacy and associated factors in people aged 66+ years living in Germany. Methods Data from the nationally representative Study on Health of Older People in Germany (Gesundheit 65+) conducted between 2021-2023 by the Robert Koch Institute, was analyzed. All medicines used, prescribed and over-the-counter, in the 7 days before the interview were documented and classified into anatomical therapeutic chemical codes. Weighted prevalences and associated factors for polypharmacy are presented. Results 96% of the sample (N = 1,474) took at least 1 medication in the 7 days before the interview. Of these, 39% took up to 4 medications, 39% 5-9 and 22% 10+. The overall prevalence of polypharmacy was 61% (95%CI 58-65%) and was significantly higher in women (64%) than in men (59%). Polypharmacy increased with age, from 52% in the age group 66-74 (53% in men, 51% in women), 66% in the age group 75-84 (63% in men, 69% in women) to 81% in the age group 85 + (72% in men, 86% in women). People with low educational level had a polypharmacy prevalence of 63% (58% in men, 66% in women) compared to 56% (55% in men, 58% in women) in those with high educational level. Severe difficulties in organizing daily medication intake were reported in 1% of people taking up to 4 medicines, in 4% of people taking between 5-9 medicines and in 16% of people taking 10+. The prevalence of PIM increased with the number of medicines used: 13% in 1-4 medicines, 31% in 5-9 medicines, and 53% in 10+ medicines. Conclusions Polypharmacy was more frequent in women, older age groups and in people with low educational level. It was associated with increased difficulty in organizing medication intake and with PIM use. Key messages • Polypharmacy is very common, affecting more women, older age groups, people with a low educational level and is associated with PIM use. • Strategies to promote appropriate medication use are needed.

Dementia risk factors and cognitive function in a nationwide population-based sample aged 65+

Abstract Background Cognitive function is fundamental to healthy aging and independent living. As there is no cure for dementia, prevention of risk factors (e. g. physical inactivity, obesity, hypertension, diabetes, social isolation, depression) is crucial. The aim of our study was to analyze selected dementia risk factors and their association with cognitive function in people aged 65 years and older. Methods Cross-sectional data from the nationally representative examination Study on Health of Older People in Germany (Gesundheit 65+) conducted between 2022-2023 by the Robert Koch Institute (n = 1.493; 48% women; mean age 78.8 years). Cognitive function was assessed by the Letter Digit Substitution Test (LDST), a measure of general speed of information processing, and of the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) 10-word list delayed recall (WLR), a measure of memory. Weighted associations between age, sex, education, dementia risk scores and z-standardized test scores were examined using linear regression analysis. Results Higher age, male sex and lower level of education were significantly associated with lower z-scores in both tests (all p < 0.001). In separate models, all adjusted for age, sex and education, social isolation was associated with lower performance on both LDST (ß=-0.22; 95% confidence interval -0.42, -0.01) and CERAD WLR (ß=-0.21; -0.41, -0.01); depressive symptoms were associated with lower LDST z-scores (ß=-0.40; -0.67, -0.13), and physical inactivity with lower CERAD WLR z-scores (ß=-0.12; -0.24, -0.01). Obesity, hypertension, and diabetes were not significantly associated with any test. Conclusions Our findings from this nationwide general population study of old and very old adults show a clustering of reduced cognitive function with social isolation, symptoms of mental health impairments, and physical inactivity in old age which call for coordinated intersectoral health promotion and prevention activities. Key messages • The clustering of reduced cognition with dementia risk factors calls for intersectoral health actions. • Limitations in cognition should only be defined by age-, sex-, and education-specific norms.

'I am more stressed if my infection affects others': development of a COVID-19-related stress scale in older people and examination of its validity and associations with mental health risks.

COVID-19 was a collective traumatic event; however, different individuals may have perceived it differently. This study investigated what older people in a collective culture perceived as stressful during COVID-19 and examined how different stressors related to COVID-19 infection and mental health risks. Thirty-six participants from diverse backgrounds engaged in a three-round Delphi study to generate items for a COVID-19-related stress scale for older adults (CSS-OA). Subsequently, 4674 people (aged ≥60 years) participated in a cross-sectional telephone survey; interviewers collected their responses to CSS-OA and information about COVID-19 infection, depressive symptoms, anxiety, loneliness and demographics. Exploratory factor analysis and confirmatory factor analysis were conducted on CSS-OA. A multiple indicator multiple cause (MIMIC) model was used to examine associations between CSS-OA and other measures. The Delphi process generated eight items, all secondary or tertiary stressors related to infection. Exploratory factor analysis revealed a three-factor model, and confirmatory factor analysis confirmed an excellent fit (comparative fit index = 0.99, root mean square error of approximation = 0.06). Pre-existing mental health conditions, having family members/friends infected with COVID-19, loneliness, anxiety and depressive symptoms were associated with higher stress. Conversely, self-infection with COVID-19, older age, being female and living alone were negatively associated with some domains of CSS-OA (all P < 0.05). The Delphi process enhanced our understanding of what older people perceived as stressful, much of which resulted from certain healthcare strategies and reflected cultural influences. These and the MIMIC results highlight the need to balance public health policies with respect to infectious diseases and older people's mental health and quality of life.

Understanding the medication regimens associated with anticholinergic burden in older people's mental health services in the UK.

Medications with anticholinergic properties are associated with a range of adverse effects that tend to be worse in older people. To investigate medication regimens with high anticholinergic burden, prescribed for older adults under the care of mental health services. Clinical audit of prescribing practice, using a standardised data collection tool. Fifty-seven trusts/healthcare organisations submitted data on medicines prescribed for 7915 patients: two-thirds (66%) were prescribed medication with anticholinergic properties, while just under a quarter (23%) had a medication regimen with high anticholinergic burden (total score ≥3 on the anticholinergic effect on cognition (AEC) scale). Some 16% of patients with a diagnosis of dementia or mild cognitive impairment were prescribed medication regimens with a high anticholinergic burden, compared with 35% of those without such diagnoses. A high anticholinergic burden was mostly because of combinations of commonly prescribed psychotropic medications, principally antidepressant and antipsychotic medications with individual AEC scores of 1 or 2. Adults under the care of older people's mental health services are commonly prescribed multiple medications for psychiatric and physical disorders; these medication regimens can have a high anticholinergic burden, often an inadvertent consequence of the co-prescription of medications with modest anticholinergic activity. Prescribers for older adults should assess the anticholinergic burden of medication regimens, assiduously check for adverse anticholinergic effects and consider alternative medications with less anticholinergic effect where indicated. The use of a scale, such as the AEC, which identifies the level of central anticholinergic activity of relevant medications, can be a helpful clinical guide.

The Pathways to Community Living Initiative (PCLI) for older adults: implementation and outcomes.

To describe implementation of the Pathways to Community Living Initiative (PCLI) within an Older People's Mental Health (OPMH) service. A retrospective observational study was conducted. Implementation comprised partnership with a specialist Residential Aged Care Facility (RACF). Data were obtained from Clinical Advisory Committee (CAC) discussion and minutes, the PCLI database, and consumer medical records. Eighteen consumers were accepted onto the program between April 2019 and March 2023. Their PCLI and rating scale outcomes alongside interventions facilitating placements are described. Interventions included OPMH case management, wide-reaching liaison, and inservices. Challenges included communication, confusion regarding roles, and differing views on capacity to accommodate complex consumers. Solutions included streamlining communication, including clinical updates in the CAC, facility appointment of a lead PCLI-nurse, and targeted RACF education. Considered interventions strengthened the OPMH and specialist RACF partnership over time. Clarification of professional roles and intersection with other services was crucial. Successful placement for PCLI consumers required consideration of personalised needs and existing resident mix, liaison with stakeholders, and targeted staff training. These strategies may apply to other health services implementing similar initiatives supporting community placements for OPMH consumers with complex needs.

Extensivist: improving the delivery of enhanced health in older people’s care homes

BackgroundOlder people living in care homes are often frail and clinically complex. The Enhanced Health in Care Homes (EHCH) framework supports organisational and clinical strategies to deliver good care, promoting...

The impact of education as a proxy for lifestyle habits on reducing the association with dementia prevalence in the Southern Region of Brazil.

This study aimed to investigate the prevalence of dementia among older adults from Florianópolis, in the Southern Region of Brazil. Data were originally drawn from the Epifloripa Aging Cohort Study, a representative and community-based survey designed to evaluate older people's health. This cross-sectional study was conducted in two phases: the community-screening phase, in which the Mini-Mental State Examination and a multifunctional scale were administered to older subjects and close informants, respectively; and the hospital-diagnosis phase, when the Cambridge Examination and the National Institute on Aging criteria were used. Adjustment for screening accuracy was made in order to estimate dementia prevalence. Of 1184 subjects evaluated in the community, 243 were screened for the diagnosis phase, in which 47 were identified with dementia, resulting in a crude prevalence of 4.5% (95% CI: 3.241-5.758) and an estimated prevalence of 9.2% (95% CI: 7.446-10.954). Dementia was associated with older ages, lower education levels, and the presence of stroke. Mild alcohol use (in comparison with no alcohol use), community-group practice, internet use and a higher level of physical activity, rather than education, decreased the odds ratio for dementia. Education was directly associated with these lifestyle habits. Prevalence was lower than that in previous studies in the country, and multivariate analysis reinforced the importance of lifestyle in preventing cognitive disorders in the older population.

Lab study on the physiological thermoregulatory abilities of older people with different frailty levels

The advent of an aging society has increased the need for a better understanding of thermal comfort requirements, especially for older people's health. Differences in thermal comfort needs among older individuals with varying frailty levels are noted, but the impact of health on physiological thermoregulation is underexplored. This study, based on the frailty classification method characterized by Fried, selected 12 non-frail (age:71.00 ± 5.41) and 12 pre-frail (age:72.68 ± 5.7) older individuals for laboratory experiments. This experiment set sudden temperature change experiments to illustrate differences in subjective perceptions and physiological changes between non-frail and pre-frail older people. Results show that non-frail individuals are more likely to complain in warmer environments. Significant differences in perception only emerged when the temperature differential between neutral and warm conditions exceeded 5 °C. Pre-frail individuals exhibited slower skin temperature changes and required more time to stabilize with the environment, particularly in the foot. Pre-frail individuals tend to sweat less in changing environments and require more time to reach stable sweating. There is positive evidence indicating that heart rate of pre-frail individuals is higher than non-frail individuals, with different changing trends observed between the two groups. When the temperature difference exceeds 5 °C, the pulse intensity trend in pre-frail individuals diverges from that of non-frail individuals. In controlling indoor environments for older people, it is essential to consider both subjective comfort and physiological thermoregulation capabilities. For older adults with frailty characteristics, applying localized warming, using small temperature differences, gradually adjusting the environment may better meet their comfort needs.

Requirement Analysis of Different Variants of a Measurement and Training Station for Older Adults at Risk of Malnutrition and Reduced Mobility: Focus Group Study.

Demographic change is leading to an increasing proportion of older people in the German population and requires new approaches for prevention and rehabilitation to promote the independence and health of older people. Technical assistance systems can offer a promising solution for the early detection of nutritional and physical deficits and the initiation of appropriate interventions. Such a system should combine different components, such as devices for assessing physical and nutritional status, educational elements on these topics, and training and feedback options. The concept is that the whole system can be used independently by older adults (aged ≥70 years) for monitoring and early detection of problems in nutrition or physical function, as well as providing opportunities for intervention. This study aims to develop technical and digital elements for a measurement and training station (MuTs) with an associated app. Through focus group discussions, target group requirements, barriers, and favorable components for such a system were identified. Older adults (aged ≥70 years) were recruited from a community-based setting as well as from a geriatric rehabilitation center. Focus group interviews were conducted between August and November 2022. Following a semistructured interview guideline, attitudes, requirements, preferences, and barriers for the MuTs were discussed. Discussions were stimulated by videos, demonstrations of measuring devices, and participants' ratings of the content presented using rankings. After conducting 1 focus group in the rehabilitation center and 2 in the community, the interview guide was refined, making a more detailed discussion of identified elements and aspects possible. The interviews were recorded, transcribed verbatim, and analyzed using content analysis. A total of 21 older adults (female participants: n=11, 52%; mean age 78.5, SD 4.6 years) participated in 5 focus group discussions. There was a strong interest in the independent measurement of health parameters, such as pulse and hand grip strength, especially among people with health problems who would welcome feedback on their health development. Participants emphasized the importance of personal guidance and interaction before using the device, as well as the need for feedback mechanisms and personalized training for everyday use. Balance and coordination were mentioned as preferred training areas in a MuTs. New training options that motivate and invite people to participate could increase willingness to use the MuTs. The target group is generally open and interested in tracking and optimizing diet and physical activity. A general willingness to use a MuTs independently was identified, as well as a compelling need for guidance and feedback on measurement and training to be part of the station.

Effects of Virtual Reality Motor-Cognitive Training for Older People With Cognitive Frailty: Multicentered Randomized Controlled Trial.

Cognitive frailty refers to a clinical syndrome in which physical frailty and mild cognitive impairment coexist. Motor-cognitive training and virtual reality (VR) have been used to launch various therapeutic modalities to promote health in older people. The literature advocates that motor-cognitive training and VR are effective in promoting the cognitive and physical function of older people. However, the effects on older people with cognitive frailty are unclear. This study examined the effects of VR motor-cognitive training (VRMCT) on global cognitive function, physical frailty, walking speed, visual short-term memory, inhibition of cognitive interference, and executive function in older people with cognitive frailty. This study used a multicentered, assessor-blinded, 2-parallel-group randomized controlled trial design. Participants were recruited face-to-face in 8 older adult community centers. Eligible participants were aged ≥60 years, were community dwelling, lived with cognitive frailty, had no dementia, and were not mobility restricted. In the intervention group, participants received VRMCT led by interventionists with 16 one-hour training sessions delivered twice per week for 8 weeks. In the control group, participants received the usual care provided by the older adult community centers that the investigators did not interfere with. The primary outcome was global cognitive function. The secondary outcomes included physical frailty, walking speed, verbal short-term memory, inhibition of cognitive interference, and executive function. Data were collected at baseline (T0) and the week after the intervention (T1). Generalized estimating equations were used to examine the group, time, and interaction (time × group) effects on the outcomes. In total, 293 eligible participants enrolled in the study. The mean age of the participants was 74.5 (SD 6.8) years. Most participants were female (229/293, 78.2%), had completed primary education (152/293, 52.1%), were married (167/293, 57.2%), lived with friends (127/293, 43.3%), and had no VR experience (232/293, 79.5%). In the intervention group, 81.6% (119/146) of participants attended >80% (13/16, 81%) of the total number of sessions. A negligible number of participants experienced VR sickness symptoms (1/146, 0.7% to 5/146, 3%). VRMCT was effective in promoting global cognitive function (interaction effect: P=.03), marginally promoting executive function (interaction effect: P=.07), and reducing frailty (interaction effect: P=.03). The effects were not statistically significant on other outcomes. VRMCT is effective in promoting cognitive functions and reducing physical frailty and is well tolerated and accepted by older people with cognitive frailty, as evidenced by its high attendance rate and negligible VR sickness symptoms. Further studies should examine the efficacy of the intervention components (eg, VR vs non-VR or dual task vs single task) on health outcomes, the effect of using technology on intervention adherence, and the long-term effects of the intervention on older people with cognitive frailty at the level of daily living. ClinicalTrials.gov NCT04730817; https://clinicaltrials.gov/study/NCT04730817.

Associations between retirement, social security policies and the health of older people: a systematic review

BackgroundAs people age, they are more likely to experience several health conditions which are circumstances that arise throughout life that can interfere with an individual’s ability to work, leading them to demand the social security system. This research aims to systematically review and synthesize studies related to health conditions in the aging process with social security policy reforms.MethodsA systematic review was performed across Embase, Web of Science, Scopus, Pubmed, CINAHL, ASSIA (Proquest) and APA PsycNet from 1979 to 2022. Methods are outlined in a published protocol registered a priori on PROSPERO (CRD42021225820). Eligible studies include original empirical articles published in English, Spanish, French and Portuguese, using the search terms “aging” and “social security”. Identified outcomes were organized into categories and a meta-ethnography was completed following the phases proposed by Noblit and Hare and the eMERGe meta-ethnography reporting guidance.ResultsThere were 17 eligible studies from 4 continents with 10 cross-sectional, 1 both cross-sectional and longitudinal and 5 longitudinal data analysis. These assessed the relationship of health conditions that occur in the aging process related to social security policies, in particular, to retirement. The categories included (i) health as a way to promote an active working life for the elderly; (ii) health as an indicator for reforms in social security policies; (iii) retirement planning as a strategic element for coping with post-retirement life; and (iv) the relationship between social security policies and psychological health.ConclusionsThis review showed that health and retirement defined in social security policies are related and have an impact on people’s lives, especially in the decision to leave the labor market. Therefore, measures to assess the possible consequences of this relationship when promoting reforms on social security policies should be encouraged.

The Importance of Time: Nurses' Experiences of Working With Suicide Prevention and Suicide Risk Assessment in the Care of Older People

ABSTRACTAimTo describe nurses' experiences of working with suicide prevention and suicide risk assessment in the care of older people.BackgroundSuicide is a problem among older people, worldwide. Risk factors for suicide are, among others, depression, illness and pain and a feeling of isolation. Nurses have valuable experience in suicide prevention and risk assessments. This study can shed light on what is needed to promote the mental health of older people, which has been partly overlooked in previous research.Methods/DesignA descriptive qualitative study was conducted. Ten nurses working in care of older people across four different municipalities were interviewed. Conventional content analysis was used to analyse the data.ResultsDespite shortcomings in guidelines, nurses describe performing suicide risk assessments and suicide prevention in a similar manner. The importance of giving the patients time is emphasised, although time is exactly what appears to be lacking.ConclusionBy engaging with the experiences of nurses, important aspects that require further attention are highlighted. Nurses should inquire about suicidal ideation, even if older persons do not explicitly express such thoughts. Normal ageing needs to be comprehended and considered in assessments. In this work, time is important.Patient or Public ContributionThe results were coproduced by means of interviews with nurses working in care of older people.Reporting MethodThe study was conducted in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines.Implications for PracticeEncountering older people who may have experienced the loss of loved ones and addressing one's personal capabilities in the context of the ageing body imposes substantial challenges on nursing care, necessitating a capacity to adeptly navigate and address these complex issues.

제주지역 노인의 지역사회 계속거주에 미치는 영향요인 연구

This study examined the factors influencing Aging-in-Place(AIP) in older adults in the Jeju region. Also, the study tried to find supporting ways of AIP for older adults. The study used data from the 2020 Ministry of Health and Welfare Survey on Korea Older Adults and analyzed 375 cases of older adults in Jeju. The influencing factors of AIP consisted of functional, structural, phenomenological, and ecological factors. The main results are as follows: First, 98.2% of older adults in a healthy situation chose AIP, but this number drops to 59.5% when their health becomes weak and unhealthy. Second, the factors influencing the AIP of older adults in the Jeju area were age as a functional factor, household type and economic satisfaction as a structural factor, housing and residential environment satisfaction variables with a phenomenological factor, and satisfaction with neighborhood relationships as an ecological factor. Based on the above results, this study suggested the policy to support older adults in the Jeju area as they lead their daily lives and face old age. In particular, the willingness to AIP decreases significantly when the health of older people in the Jeju region deteriorates; the study emphasized and discussed the importance of creating a residential environment.