Large Proportion Of Older Adults Research Articles

Determinants of multimorbidity in older adults in Iran: a cross-sectional study using latent class analysis on the Bushehr Elderly Health (BEH) program

Background and objectivesMultimorbidity, defined as the presence of two or more long-term health conditions in an individual, is one of the most significant challenges facing health systems worldwide. This study aimed to identify determinants of classes of multimorbidity among older adults in Iran.Research Design and methodsIn a cross-sectional sample of older adults (aged ≥ 60 years) from the second stage of the Bushehr Elderly Health (BEH) program in southern Iran, latent class analysis (LCA) was used to identify patterns of multimorbidity. Multinomial logistic regression was conducted to investigate factors associated with each multimorbidity class, including age, gender, education, household income, physical activity, smoking status, and polypharmacy.ResultsIn 2,426 study participants (mean age 69 years, 52% female), the overall prevalence of multimorbidity was 80.2%. Among those with multimorbidity, 3 latent classes were identified. These comprised: class 1, individuals with a low burden of multisystem disease (56.9%); class 2, individuals with predominantly cardiovascular-metabolic disorders (25.8%) and class 3, individuals with predominantly cognitive and metabolic disorders (17.1%). Compared with men, women were more likely to belong to class 2 (odds ratio [OR] 1.96, 95% confidence interval [CI] 1.52–2.54) and class 3 (OR 4.52, 95% CI 3.22–6.35). Polypharmacy was associated with membership class 2 (OR 3.52, 95% CI: 2.65–4.68) and class 3 (OR 1.84, 95% CI 1.28–2.63). Smoking was associated with membership in class 3 (OR 1.44, 95% CI 1.01–2.08). Individuals with higher education levels (59%) and higher levels of physical activity (39%) were less likely to belong to class 3 (OR 0.41; 95% CI: 0.28–0.62) and to class 2 (OR 0.61; 95% CI: 0.38–0.97), respectively. Those at older age were less likely to belong to class 2 (OR 0.95).Discussion and implicationsA large proportion of older adults in Iran have multimorbidity. Female sex, polypharmacy, sedentary lifestyle, and poor education levels were associated with cardiovascular-metabolic multimorbidity and cognitive and metabolic multimorbidity. A greater understanding of the determinants of multimorbidity may lead to strategies to prevent its development.

Smartwatch Technology's Diagnostic Use in Atrial Fibrillation Detection – A Literature Review

Introduction: An ECG is the gold standard for detecting various cardiology pathologies including AF. Current ambulatory heart rhythm monitoring technology include Holter monitoring and various implantable event monitors, which provide continuous monitoring but are invasive, uncomfortable and may lack in detecting intermittent arrhythmias, due to their periodic exploratory monitoring strategy. Methods: A systematic search was conducted using the following databases: Cochrane Library, Embase, PubMed, and Google Scholar. The search was conducted using the keywords "atrial fibrillation," "smartwatch," "ECG," "stroke," and "PPG”. Relevant sources between 2018 and 2023 were chosen, and data was analysed to establish clinical utility in early diagnosis of AF. Results: Two studies assessing the diagnostic efficacy of smartwatch technology, two studies investigating the usability of new technology and one study assessing cost-effectiveness were included in our review. The diagnostic efficacy of smartwatches ranges from 93.5-98.25% accurate, 92.45-97.3% sensitive and 88.6-100% specific, with PPV ranging from 91.6-100%, and NPV ranging from 93.85-96.83%. Targeted audiences of AF detection includes a larger proportion of older adults with possible declined technological and/or cognitive function, and may find difficulty using current smartwatch technology. With a simplified user interface, novel software like Pulsewatch promotes user accessibility in smartwatch technology, making AF detection simple to identify, particularly in elderly people. 90 patients used the Pulsewatch system, and more than half reported having a positive experience with the system; only 13% considered it excessively stressful. Discussion: Due to the low 65+ age group representation (6.6%) in studies like Fitbit, Huawei, and Apple heart studies, they overlook potential bias in older adults' adherence to pAF monitoring. Pulsewatch addresses this issue. Smartwatches, being user-friendly and cost-effective, offer real-time, reasonably accurate prospective data for patients. However, further research is required to gauge their clinical utility in early AF detection, diagnostic effectiveness during daily activities, and the heterogeneity of smartwatch devices remains to be fully explored. Conclusion: User-friendly PPG-based smartwatch technology is a medically accurate alternative to standard AF detection techniques that may speed up the diagnosis and treatment of AF, lowering stroke and cardiovascular disease-related morbidity and mortality as well as AF-related healthcare costs.

Acceptability of physical activity signposting for pre-frail older adults: a qualitative study to inform intervention development

Frailty is a medical condition common in older adults characterised by diminished strength and reduced physiologic function in which individuals are more vulnerable to multiple adverse health outcomes. Pre-frailty is an intermediate stage associated with some minor health outcomes. However, the main risk is progression toward moderate/severe frailty. Evidence shows physical activity interventions to be effective in slowing or modifying the progression of frailty. Researchers at the University of Manchester are developing a behaviour change intervention targeting pre-frail older adults, signposting them to group-based physical activity classes known to be effective for delaying/slowing frailty. This paper reports on the initial intervention development work with key stakeholders exploring the practicality of taking forward this intervention and identifying uncertainties to be explored in the feasibility stage. These included issues around physical activity messaging, the use of the term ‘frail’, identification/recruitment of pre-frail older adults, and the acceptability of behaviour change techniques. There was overwhelming support for a proactive approach to addressing pre-frailty issues. Given that a large proportion of older adults are estimated to be pre-frail, interventions aimed at this group have the potential to support healthy ageing, positively impacting on frailty outcomes and providing wider population health benefits.

Health Disparities in Appalachian and Other Rural Communities.

Rural areas are home to a larger proportion of older adults and populations who age within these locales and suffer disproportionately from health, mental health, and economic disparities compared to their urban counterparts. This article will explore the disparities faced by persons that reside in rural communities across the lifespan. It will briefly discuss what is meant by rural. As a rural region at specific risk, the issues confronting those aging in Appalachia will be examined. Finally, best practices and future directions to combat health disparities among rural residents and elders will be discussed. This includes the Appalachian Gerontology Experiences: Advancing Diversity in Aging Research training program which recruits and trains minority and first-generation undergraduate students in aging and health disparity research.

Persistence of Pneumococcal Carriage among Older Adults in the Community despite COVID-19 Mitigation Measures.

Reported rates of invasive pneumococcal disease were markedly lower than normal during the 2020/2021 winter in the Northern Hemisphere, the first year after the start of the COVID-19 pandemic. However, little is known about rates of carriage of pneumococcus among adults during this period. Between October 2020-August 2021, couples in the Greater New Haven Area, USA, were enrolled if both individuals were aged 60 years and above and did not have any individuals under the age of 60 years living in the household. Saliva samples and questionnaires regarding social activities and contacts and medical history were obtained every 2 weeks for a period of 10 weeks. Following culture-enrichment, extracted DNA was tested using qPCR for pneumococcus-specific sequences piaB and lytA. Individuals were considered positive for pneumococcal carriage when Ct values for piaB were ≤40. Results. We collected 567 saliva samples from 95 individuals (47 household pairs and 1 singleton). Of those, 7.1% of samples tested positive for pneumococcus, representing 22/95 (23.2%) individuals and 16/48 (33.3%) households. Study participants attended few social events during this period. However, many participants continued to have regular contact with children. Individuals who had regular contact with preschool and school-aged children (i.e., 2 to 9 year olds) had a higher prevalence of carriage (15.9% versus 5.4%). Despite COVID-19-related disruptions, a large proportion of older adults continued to carry pneumococcus. Prevalence was particularly high among those who had contact with school-aged children, but carriage was not limited to this group. IMPORTANCE Carriage of Streptococcus pneumoniae (pneumococcus) in the upper respiratory tract is considered a prerequisite to invasive pneumococcal disease. During the first year of the COVID-19 pandemic, markedly lower rates of invasive pneumococcal disease were reported worldwide. Despite this, by testing saliva samples with PCR, we found that older adults continued to carry pneumococcus at pre-pandemic levels. Importantly, this study was conducted during a period when transmission mitigation measures related to the COVID-19 pandemic were in place. However, our observations are in line with reports from Israel and Belgium where carriage was also found to persist in children. In line with this, we observed that carriage prevalence was particularly high among the older adults in our study who maintained contact with school-aged children.

The Cognitive Daisy (COG-D) for improving care for residents with dementia in care homes: protocol of a feasibility RCT

BackgroundCognitive problems associated with dementia affect a large proportion of older adults living in residential care. Knowledge of cognitive impairments is important for providing person-centred care (PCC). The impact of specific cognitive impairments on residents’ needs is often overlooked in dementia training and information about residents’ individual cognitive profiles are frequently underspecified in care-plans, potentially undermining the delivery of PCC. This can lead to reduced resident quality of life and increased distressed behaviours—a major cause of staff stress and burnout. The COG-D package was developed to fill this gap. Daisies provide a visual representation of a resident’s individual cognitive strengths and weaknesses in a colourful flower (Daisy) representing five cognitive domains. By viewing a resident’s Daisy, care-staff can flexibly adjust in-the-moment care-decisions and can consult Daisies in care-plans for longer-term planning. The primary aim of this study is to assess the feasibility of implementing the COG-D package in residential care homes for older adults.Methods/designThis 24-month feasibility cluster randomized controlled trial involves a 6-month intervention of the use of Cognitive Daisies in 8–10 residential care homes for older adults after training of care staff on the use of Cognitive Daisies in daily care (basic training) and on conducting the COG-D assessments with residents (advanced training). The key feasibility outcomes include % residents recruited, % COG-D assessments completed, and % staff completing the training. Candidate outcome measures for residents and staff will be obtained at baseline, and at 6 and 9 months post-randomization. COG-D assessments of residents will be repeated 6 months after the first assessment. A process evaluation will assess intervention implementation and barriers and facilitators to this through care-plan audits, interviews and focus groups with staff, residents, and relatives. Feasibility outcomes will be analysed against progression criteria to a full trial.DiscussionThe results of this study will provide important information about the feasibility of using COG-D in care homes and will inform the design of a future large-scale cluster RCT to assess the effectiveness and cost-effectiveness of the COG-D intervention in care homes.Trial registrationThis trial was registered on 28/09/2022 (ISRCTN15208844) and is currently open to recruitment.

Peroral Endoscopic Myotomy for Achalasia in Older Adults: A Retrospective Analysis of 39 Cases with a Minimum Follow-Up of 5 Years.

Peroral endoscopic myotomy (POEM) has demonstrated favorable short-term safety and efficacy in older adults, while a comprehensive understanding of the long-term outcomes were vague. We aimed to evaluate clinical outcomes in older adults' 5-year postop after undergoing POEM to treatment achalasia. Older adults from a single hospital who received POEM between January 2010 and January 2017 were analyzed. Older persons were reached to evaluate their symptoms at present and encouraged repeat examinations for objective follow-up. The clinical success, POEM-related indicators, POEM-related adverse events, and quality of life were assessed. Thirty-nine older adults with a mean age of 70.82 ± 4.72 who underwent POEM were studied at a mean 84.23 ± 25.06month follow-up. The preoperative diagnosis was achalasia type I in 7 older adults, achalasia type II in 26 older adults, and achalasia type III in 2 older adults. Sixteen older adults had prior treatment and 21 older adults suffered from comorbidities. The median operative time was 50 (25-120) minutes, and perioperative adverse events were recorded in four older adults. The current Eckardt scores were significantly lower than that before POEM (2.08 ± 2.12 vs. 6.58 ± 1.78, P < 0.001). Besides, long-term clinical success was gained in 66.7% of older adults. Three older adults received postop treatment for symptom recurrence. Ultimately, 80.6% of old adults expressed satisfaction with POEM, while 27.8% of older adults suffered from symptomatic reflux.In conclusion, POEM can provide symptomatic improvement in a large proportion of older adults with achalasia at 5-year postop.

Changes in Medicaid enrollment during the COVID-19 pandemic across 6 states

The coronavirus disease 2019 public health emergency (PHE) caused extensive job loss and loss of employer-sponsored insurance. State Medicaid programs experienced a related increase in enrollment during the PHE. However, the composition of enrollment and enrollee changes during the pandemic is unknown. This study examined changes in Medicaid enrollment and population characteristics during the PHE. A retrospective study documenting changes in Medicaid new enrollment and disenrollment, and enrollee characteristics between March and October 2020 compared to the same time in 2019 using full-state Medicaid populations from 6 states of a wide geographical region. The primary outcomes were Medicaid enrollment and disenrollment during the PHE. New enrollment included persons enrolled in Medicaid between March and October 2020 who were not enrolled in January or February, 2020. Disenrollment included persons who were enrolled in March of 2020 but not enrolled in October 2020. The study included 8.50 million Medicaid enrollees in 2020 and 8.46 million in 2019. Overall, enrollment increased by 13.0% (1.19 million) in the selected states during the PHE compared to 2019. New enrollment accounted for 24.9% of the relative increase, while the remaining 75.1% was due to disenrollment. A larger proportion of new enrollment in 2020 was among adults aged 27 to 44 (28.3% vs 23.6%), Hispanics (34.3% vs 32.5%) and in the financial needy (44.0% vs 39.0%) category compared to 2019. Disenrollment included a larger proportion of older adults (26.1% vs 8.1%) and non-Hispanics (70.3% vs 66.4%) than in 2019. Medicaid enrollment grew considerably during the PHE, and most enrollment growth was attributed to decreases in disenrollment rather than increases in new enrollment. Our results highlight the impact of coronavirus disease 2019 on state health programs and can guide federal and state budgetary planning once the PHE ends.

Older Adults' Loneliness and Social Relationships in the Philippines: Comparison Between Rural and Urban Contexts.

This study compared patterns of association between social relationship measures and levels of loneliness for rural and urban older adults in the Philippines. We analyzed social relationship measures and loneliness scores (UCLA Three-Item Loneliness Scale) of a nationally representative sample of Filipino adults 60 years and older in the baseline survey of the 2018 Longitudinal Study of Ageing and Health in the Philippines (LSAHP) (n=4,704). The loneliness score was slightly higher for rural older adults (5.8) than for their urban counterparts (5.1; p=.0001). A significantly larger proportion of older adults in rural areas (12.7%) lived alone than in urban areas (5.4%; p=.0008). The overall pattern of association between social relationship measures and loneliness scores for the two groups was mostly similar. For both groups, living alone, having less active social involvement, and seeing friends less frequently were related to higher levels of loneliness. Poorer subjective financial well-being (e.g., the perception of considerable difficulty in making ends meet) was also significantly associated with higher loneliness scores. These findings suggest that the prevention of loneliness for older adults in countries in the early stages of population aging such as the Philippines requires a broad range of public health initiatives.

Relationship Between Old-Aged Preferences Regarding Various Types of Physical Activity and Chronic Disease Status: A Cross-Sectional Study in Shanghai, China.

BackgroundA lack of physical activity (PA) is a threat to public health. However, for the elderly, most PA abilities are limited. By focusing on the types and intensity of PA that the elderly can bear, this study aimed to reveal whether preferences regarding types of PA (including housework, transportation, and recreational activities) and their intensity were associated with health status. The main forms of PA include shopping, cooking, cleaning, walking, cycling, various fitness activities and other activities with a certain intensity.MethodsSurveillance data on chronic diseases and their risk factors were collected from one district of Shanghai in 2017-2018. A Kish table was used for sampling 500 older adults, including the diagnosed group (chronic diseases diagnosed by physicians, n = 119), the abnormal group (not diagnosed but abnormal indicators detected in this investigation, n = 287) and the healthy group (n = 94). Multiple regressions were used to test the relationship between the various types, durations and intensities of PA the elderly individuals participated in and their health status.ResultsAll three groups included a large proportion of older adults who participated in housework- and transport-related PA. The diagnosed group had the largest proportion (63.06% for housework-related PA; 87.39% for transport-related PA) and median minutes (17.14 min of housework-related PA per day; 30.00 min of transport-related PA per day). The diagnosed group had more metabolic equivalents (METs) of moderate-intensity PA than the two other groups (H = 33.01, P < 0.01), and more people met the WHO recommendation (χ2 = 34.71, P < 0.01). Diagnosis was associated with performing housework- and transport-related PA and moderate-intensity PA and with meeting the WHO's recommendation. Higher education levels were a positive factor for elderly individuals to participate in PA.ConclusionsTransportation and housework activities are good targets for increasing PA in older adults. Diagnosis is associated with older adults' more PA.

Functionalized polyanhydride nanoparticles for improved treatment of mitochondrial dysfunction.

Parkinson's disease (PD) is a devastating neurodegenerative disease affecting a large proportion of older adults. Exposure to pesticides like rotenone is a leading cause for PD. To reduce disease progression and prolong life expectancy, it is important to target disease mechanisms that contribute to dopaminergic neuronal atrophy, including mitochondrial dysfunction. Achieving targeted mitochondrial delivery is difficult for many therapeutics by themselves, necessitating higher therapeutic doses that could lead to toxicity. To minimize this adverse effect, targeted nano-carriers such as polyanhydride nanoparticles (NPs) can protect therapeutics from degradation and provide sustained release, enabling fewer administrations and lower therapeutic dose. This work expands upon the use of the polyanhydride NP platform for targeted drug delivery by functionalizing the polymer with a derivative of triphenylphosphonium called (3-carboxypropyl) triphenylphosphonium (CPTP) using a novel method that enables longer CPTP persistence on the NPs. The extent to which neurons internalized both nonfunctionalized and functionalized NPs was tested. Next, the efficacy of these nanoformulations in treating rotenone-induced mitochondrial dysfunction in the same cell line was evaluated using a novel neuroprotective drug, mito-metformin. CPTP functionalization significantly improved NP internalization by neuronal cells. This was correlated with significant protection by CPTP-functionalized, mito-metformin encapsulated NPs against rotenone-induced mitochondrial dysfunction. However, nonfunctionalized, mito-metformin encapsulated NPs and soluble mito-metformin administered at the same dose did not significantly protect cells from rotenone-induced toxicity. These results indicate that the targeted NP platform can provide enhanced dose-sparing and potentially reduce the occurrence of systemic side-effects for PD therapeutics.

Adaption and preliminary validation of the Addenbrooke's Cognitive Examination-III as a screening test for mild cognitive impairment and dementia in hearing-impaired individuals.

A large proportion of older adults assessed for cognitive impairment likely have hearing loss, potentially affecting accuracy of cognitive performance estimations. This study aimed to develop a hearing-impaired version of the Addenbrooke's Cognitive Examination-III (HI-ACE-III) and to assess whether the HI-ACE-III can accurately distinguish people with mild cognitive impairment (MCI) and dementia from cognitively intact controls. The HI-ACE-III was developed by converting verbal instructions into a visual, timed PowerPoint presentation. Seventy-four participants over the age of 60 years were classified into three groups: 29 had MCI, 15 had mild to moderate dementia and 30 were cognitively intact controls. Receiver operating characteristic (ROC) curves were graphed to test screening accuracy. Concurrent validity was examined through correlations between HI-ACE-III domain scores and relevant, visually presented standardized neuropsychological measures. ROC analysis for dementia revealed an area under the curve (AUC) of 0.99, achieving excellent sensitivity (100%) and good specificity (93.3%) at an optimum cut-off of <87. The AUC for MCI was 0.86, achieving reasonable sensitivity (75.9%) and good specificity (86.7%) at an optimum cut-off of <92. HI-ACE-III subtests shared anticipated and statistically significant correlations with established measures of cognitive functioning. Internal consistency of the HI-ACE-III was excellent as verified with Cronbach's alpha (α=0.904). Preliminarily, the HI-ACE-III showed good reliability, validity and screening utility for MCI and dementia in older adults in a hearing-impairment context. The adapted HI-ACE-III may offer accurate and reliable indication of cognitive performance, supporting timely diagnosis and research examining links between hearing loss and cognitive decline.

Assessment of Common Comorbidity Phenotypes Among Older Adults With Knee Osteoarthritis to Inform Integrated Care Models.

ObjectiveTo establish the frequency of concordant, discordant, and clinically dominant comorbidities among Medicare beneficiaries with knee osteoarthritis (KOA) and to identify common concordant condition subgroups.Participants and MethodsWe used a 5% representative sample of Medicare claims data to identify beneficiaries who received a diagnosis of KOA between January 1, 2012, and September 30, 2015, and matched control group without an osteoarthritis (OA) diagnosis. Frequency of 34 comorbid conditions was categorized as concordant, discordant, or clinically dominant among those with KOA and a matched sample without OA. Comorbid condition phenotypes were characterized by concordant conditions and derived using latent class analysis among those with KOA.ResultsThe study sample included 203,361 beneficiaries with KOA and 203,361 non-OA controls. The largest difference in frequency between the two cohorts was for co-occurring musculoskeletal conditions (23.7% absolute difference), chronic pain syndromes (6.5%), and rheumatic diseases (4.5%), all with a higher frequency among those with knee OA. Phenotypes were identified as low comorbidity (53% of cohort with classification), hypothyroid/osteoporosis (27%), vascular disease (10%), and high medical and psychological comorbidity (10%).ConclusionsApproximately 47% of Medicare beneficiaries with KOA in this sample had a phenotype characterized by one or more concordant conditions, suggesting that existing clinical pathways that rely on single or dominant providers might be insufficient for a large proportion of older adults with KOA. These findings could guide development of integrated KOA-comorbidity care pathways that are responsive to emerging priorities for personalized, value-based health care.

Changes in Medicaid Enrollment During the COVID-19 Pandemic Across Six States

Background: The COVID-19 public health emergency (PHE) has caused extensive job loss and loss of employer-sponsored insurance. State Medicaid programs have experienced a related increase in enrollment during the PHE. However, the composition of enrollment and enrollee changes during the pandemic is unknown. Understanding changes in the Medicaid population during the PHE may inform policy development and identify strategies to meet the rising needs for insurance coverage during public health emergencies. This study aims to examine changes in Medicaid enrollment and population characteristics during the PHE.Methods: A retrospective descriptive study documenting changes in Medicaid new enrollment and disenrollment, and enrollee characteristics between March and October 2020 compared to the same time period in 2019 using Full-state Medicaid populations from six states of a wide geographical region. The primary outcomes were medicaid enrollment and disenrollment during the PHE. New enrollment included persons enrolled in Medicaid between March and October 2020 who were not enrolled in January or February of 2020. Disenrollment included persons who were enrolled in March of 2020 but not enrolled in October 2020.Results: The study included 8.50 million Medicaid enrollees in 2020 and 8.46 million in 2019. Overall, enrollment increased by 13.0% during the PHE compared to 2019, relative enrollment growth of 1.19 million. New enrollment accounted for 24.9% of the relative increase, while the remaining 75.1% was due to disenrollment. A larger proportion of new enrollment in 2020 was among adults aged 27-44 (28.3% vs 23.6%), Hispanics (34.3% vs 32.5%) and in the financial needy (44.0% vs 39.0%) category compared to 2019. Disenrollment included a larger proportion of older adults (26.1% vs 8.1%) and non-Hispanics (70.3% vs 66.4%) than in 2019.Conclusions and Relevance: Medicaid enrollment grew considerably during the PHE, and the majority of enrollment growth was attributed to decreases in disenrollment rather than increases in new enrollment. Our results highlight the impact of COVID-19 on state health programs and can guide federal and state budgetary planning.Funding: This study was supported from the Digital Health CRC (Cooperative Research Centre). The DHCRC is established and supported under the Australian Government’s Cooperative Research Centres Program. Funding for Antonia Chan was provided by the Stanford Medical Scholars Fellowship Program.Declaration of Interest: None to declare.

The Impact of the COVID-19 Epidemic on Older Adults in Rural and Urban Areas in Mexico.

ObjectivesMexico is among the countries in Latin America hit hardest by coronavirus disease 2019 (COVID-19). A large proportion of older adults in Mexico have high prevalence of multimorbidity and live in poverty with limited access to health care services. These statistics are even higher among adults living in rural areas, which suggest that older adults in rural communities may be more susceptible to COVID-19. The objectives of the article were to compare clinical and demographic characteristics for people diagnosed with COVID-19 by age group, and to describe cases and mortality in rural and urban communities.MethodWe linked publicly available data from the Mexican Ministry of Health and the Census. Municipalities were classified based on population as rural (<2,500), semirural (≥2,500 and <15,000), semiurban (≥15,000 and <100,000), and urban (≥100,000). Zero-inflated negative binomial models were performed to calculate the total number of COVID-19 cases, and deaths per 1,000,000 persons using the population of each municipality as a denominator.ResultsOlder adults were more likely to be hospitalized and reported severe cases, with higher mortality rates. In addition, rural municipalities reported a higher number of COVID-19 cases and mortality related to COVID-19 per million than urban municipalities. The adjusted absolute difference in COVID-19 cases was 912.7 per million (95% confidence interval [CI]: 79.0–1746.4) and mortality related to COVID-19 was 390.6 per million (95% CI: 204.5–576.7).DiscussionUrgent policy efforts are needed to mandate the use of face masks, encourage handwashing, and improve specialty care for Mexicans in rural areas.

Identifying and assessing the impact of key neighborhood-level determinants on geographic variation in stroke: a machine learning and multilevel modeling approach

BackgroundStroke is a chronic cardiovascular disease that puts major stresses on U.S. health and economy.The prevalence of stroke exhibits a strong geographical pattern at the state-level, where a cluster of southern states with a substantially higher prevalence of stroke has been called the stroke belt of the nation. Despite this recognition, the extent to which key neighborhood characteristics affect stroke prevalence remains to be further clarified.MethodsWe generated a new neighborhood health data set at the census tract level on nearly 27,000 tracts by pooling information from multiple data sources including the CDC’s 500 Cities Project 2017 data release. We employed a two-stage modeling approach to understand how key neighborhood-level risk factors affect the neighborhood-level stroke prevalence in each state of the US. The first stage used a state-of-the-art Bayesian machine learning algorithm to identify key neighborhood-level determinants. The second stage applied a Bayesian multilevel modeling approach to describe how these key determinants explain the variability in stroke prevalence in each state.ResultsNeighborhoods with a larger proportion of older adults and non-Hispanic blacks were associated with neighborhoods with a higher prevalence of stroke. Higher median household income was linked to lower stroke prevalence. Ozone was found to be positively associated with stroke prevalence in 10 states, while negatively associated with stroke in five states. There was substantial variation in both the direction and magnitude of the associations between these four key factors with stroke prevalence across the states.ConclusionsWhen used in a principled variable selection framework, high-performance machine learning can identify key factors of neighborhood-level prevalence of stroke from wide-ranging information in a data-driven way. The Bayesian multilevel modeling approach provides a detailed view of the impact of key factors across the states. The identified major factors and their effect mechanisms can potentially aid policy makers in developing area-based stroke prevention strategies.

Epidemiology of burn injury in older adults: An Australian and New Zealand perspective.

Introduction:The ageing global population presents a novel set of challenges for trauma systems. Less research has focused on the older adult population with burns and how they differ compared to younger patients. This study aimed to describe, and compare with younger peers, the number, causes and surgical management of older adults with burn injuries in Australia and New Zealand.Methods:The Burns Registry of Australia and New Zealand was used to identify patients with burn injuries between 1 July 2009 and 31 December 2018. Temporal trends in incidence rates were evaluated and categorised by age at injury. Patient demographics, injury severity and event characteristics, surgical intervention and in-hospital outcomes were investigated.Results:There were 2394 burn-injured older adults admitted during the study period, accounting for 13.4% of adult admissions. Scalds were the most common cause of burn injury in older adults. The incidence of older adult burns increased by 2.96% each year (incidence rate ratio = 1.030, 95% confidence interval = 1.013–1.046, P < 0.001). Compared to their younger peers, a smaller proportion of older adult patients were taken to theatre for a surgical procedure, though a larger proportion of older adults received a skin graft.Discussion:Differences in patient and injury characteristics, surgical management and in-hospital outcomes were observed for older adults. These findings provide the Australian and New Zealand burn care community with a greater understanding of burn injury and their treatments in a unique group of patients who are at risk of poorer outcomes than younger people.Lay SummaryThe number and proportion of older persons in every country of the world is growing. This may create challenges for healthcare systems. While burn injuries are a unique subset of trauma that affect individuals of all ages, less is known about burns in older adults and how they differ from younger patients.We wanted to look at the number, type, management, and outcomes of burns in older adults in Australia and New Zealand. To do this, we used data from the Burns Registry of Australia and New Zealand, or BRANZ. The BRANZ is a database that collects information on patients that present to Australian and New Zealand hospitals that have a specialist burns unit.Our research found that one in eight adult burns patients was over the age of 65, and that the rate of burn injuries in older adults has increased over the last decade. Older adult burns patients were most commonly affected by scalds after coming in contact with wet heat such as boiling liquids or steam. Fewer older adults went to theatre for an operation or surgical procedure compared to their younger counterparts. However, a larger proportion of older adults that went to theatre had a skin graft (where skin is removed from an uninjured part of the body and placed over the injured part).This research provides important information about a unique and growing group of patients to the local burn care community. It also highlights potential avenues for injury prevention initiatives.

Biomodulina T May Restore Immunity in Older Adults.

Worldwide, there has been a progressive demographic shift over the past 50 years resulting in a larger proportion of older adults in the general population. Aging itself is a complex biological phenomenon characterized in part by changes in the immune system known as "immunosenescence", which makes older adults more susceptible to infectious, cardiovascular and autoimmune diseases, as well as cancers. Several strategies have been proposed in an attempt to reverse immunosenescence, including use of hormones, cytokines and thymic factors. A promising drug in the search to restore the thymic microenvironment (which plays an important role in the regulation and maintenance of the immune system) in older adults is Biomodulina T, a Cuban product registered for use in patients with recurrent respiratory infections. The administration of Biomodulina T increases the number of naïve T-lymphocyte, CD4-positive cells that have recently migrated from the thymus gland (recent thymic emigrants) and memory CD8-positive T lymphocytes, which have characteristics akin to stem cells (stem cell-like memory). Furthermore, the expression of programmed cell death 1 protein in CD4-positive T lymphocytes and CD4-positive T lymphocytes decreases, and the proliferative capacity of CD4-positive T lymphocytes increases, without changes in the frequency of regulatory T lymphocytes. These results suggest that the administration of Biomodulina T could be used to restore immunity in older adults and in other immunocompromised individuals, improve response to other immunotherapies in cancer patients, and increase the effi cacy of vaccinations in older adults. Its use has been approved in Cuba for immune system restoration.KEYWORDS Immunosenescence, aging, immunotherapy, immuno-modulation, antineoplastic protocols, Cuba.

Comparison of the eating behaviour and dietary consumption in older adults with and without visual impairment.

Globally, a high prevalence of obesity and undernutrition has been reported in people with visual impairment (VI) who have reported multi-factorial obstacles that prevent them from achieving a healthy diet, such as having restricted shopping and cooking abilities. The present study is the first to investigate the relationship between VI and dietary consumption using a representative sample size, standardised methods to categorise VI and a detailed analysis of dietary consumption. Ninety-six participants with VI and an age-matched control group of fifty participants were recruited from across the UK. All participants were aged 50 years or over. The participants completed a 24-h food recall for a period of 3 d. The participants also answered questions about their abilities to shop for and cook food as well as their knowledge of healthy eating. The participants with VI in this sample consumed significantly fewer energy content and other nutrients than is recommended for their age group and when compared with an age-matched control group. The participants with VI mainly made food choices irrespective of nutritional value. The results of the present study highlight for the first time that a large proportion of older adults with VI in the UK are undernourished. These results suggest local and government-led initiatives should be implemented to support the diets of older adults in the UK, and these initiatives could include healthy eating workshops, café clubs or skills training and rehabilitation.

CAREGIVER TYPE AND ITS ASSOCIATION WITH MORTALITY AMONG OLDER ADULTS WITH DISABILITY IN CHINA

A large proportion of older adults in China needs assistance with activities of daily living (ADL). The quality of care for this population has gained growing attention. However, little is known about the patterns of their caregiver type or its association with mortality. We examined the patterns of primary caregiver type among community-dwelling older adults in China and to examine the association between caregiver type and mortality. Data were from the 2005, 2008, and 2011 waves of the China Longitudinal Health and Longevity Study. We included 437 married and 3,971 widowed participants. The average age was 96.7 years (SD=6.9) and 73.7% were female. For married persons, 55.1%, 25.2%, 12.1%, 2.3%, and 3.9% of the primary caregiver was spouse, son/daughter-in-law, daughter/son-in-law, grandchildren, and housekeeper. For widowed persons, 60.2%, 21.1%, 9.9%, and 5.9% of the primary caregiver was son/daughter-in-law, daughter/son-in-law, grandchildren, and housekeeper, respectively. Multivariable-adjusted model showed that, among married older adults, son/daughter-in-law and daughter/son-in-law as the primary caregiver was associated with 41% (95% confidence interval [CI]=6%-87%) and 67% (95%CI=10%-154%) higher mortality than spouse as the primary caregiver, respectively. For widowed persons, daughter/son-in-law and grandchildren as the primary caregiver was associated with 12% (95%CI=3%-20%) and 14% (95%CI=2%-24%) lower mortality than son/daughter-in-law as the primary caregiver, respectively. Majority of disabled older adults in China relied on their spouse and children to care for them. Type of primary caregiver was associated with death in both married and widowed persons. More resources need to be allocated to disabled Chinese older adults with poor survival outcomes.