Last Decades Of Life Research Articles

Incontinencia fecal en el paciente anciano. Revisión de conjunto

Fecal incontinence is one of the leading causes for the institutionalization of people in the last decades of life, associated with a great psychosocial and economic burden. The literature is scarce in this population group, due to the absence of universally accepted criteria to define “elderly patients” and difficulties in detection and diagnostic. The aim of this article was to conduct a narrative review of the main aspects related to fecal incontinence in older patients, providing management support. Toileting assistance, dietary change, controlling stool consistency and medical treatment can be used to treat these patients. Nevertheless, other therapies, such as biofeedback, neuromodulation or surgical treatment, can be considered in selected patients.

Cecily Duchess of York by J. L. Laynesmith

Reviewed by: Cecily Duchess of York by J. L. Laynesmith Michele Seah Laynesmith, J. L., Cecily Duchess of York, London, Bloomsbury, 2017; hardback; pp. xxii, 262; 10 b/w illustrations; R.R.P. £85.00; ISBN 9781474272254. Cecily Neville, Duchess of York, styled herself at different junctures of her life as the king's mother and as the queen's grandmother. She was the mother of two Yorkist kings, Edward IV and Richard III, and her granddaughter, Elizabeth of York, daughter of Edward IV, was married to Henry VII, the progenitor of the Tudor dynasty. In comparison with some other individuals in this extended family, there is not as much scholarly work focused on the duchess even though she figures prominently in the political landscape of the later fifteenth century. Previous literature centred on her includes popular biographies and historical fiction, and a handful of scholarly articles. This latest biography of the duchess by J. L. Laynesmith marks the culmination of many years of research that began with her Master of Arts dissertation and is another fine testament to the expertise of this noted queenship scholar. Laynesmith's admitted aim is to produce a 'broadly chronological biography'(p. 2), and to illuminate both Cecily Neville's life story and those political events in which she was involved by weaving both these aspects together. Therefore, the book is arranged in a series of chapters, each one matching a particular period in her life. The first four chapters approximately correspond with the first four decades of Cecily's life, detailing her birth, childhood, marriage, and childbearing years. The next five chapters, encompassing the following two decades, appear to [End Page 181] parallel her position as rebel's wife, widow, and king's mother, although their titles do not quite make sense in this regard. The penultimate chapter covers the period from just before Edward IV's death to Richard III's loss of life and crown in 1485, while the last chapter is concerned with the duchess's last decade of life during which she 'celebrated her own status as the queen's grandmother' (p. 165) before ending with her death in 1495. Happily for Laynesmith, she has plenty to work with in terms of primary evidence in the form of account rolls for Cecily Neville's estates, the duchess's will, court cases and records, correspondence, and her books, to name only a few types. This evidence is skilfully used and intertwined with the narrative and analysis of each chapter, and it is rare that the author is unable to refer to specific sources and resorts to conjecture. The first chapter is one such example. Little is known about the duchess's birth and early life apart from her birth-date. Therefore, as Laynesmith herself admits, she uses the wider knowledge available about the fifteenth century in conjunction with family records to recreate the world of Cecily Neville and present a plausible account of her birth, baptism, and childhood. The other chapters, in contrast, draw upon a large amount of varied and detailed evidence, and bring the duchess to life in a way that speculation alone cannot do. A substantial bibliography and the use of wide-ranging primary evidence demonstrates the book's grounding in solid research and excellent scholarship. Laynesmith writes in a very engaging style, which makes the material lively and beguiling. Rich and vibrant descriptions of the baptism (pp. 8–9) and daily life in Berkhamsted (pp. 171–73) are examples of her ability to vividly re-construct the fifteenth-century world in which the duchess lived, and add much to the enjoyment of the book. At the same time, the chronological structure allows the reader to easily trace the developments in Cecily Neville's life and the events she lived through. It should be noted that not all the events of the period are discussed in great detail since Cecily was not directly involved in all of them. For instance, individual battles such as the battles of St Albans, and the battles of Towton and Bosworth, all of which were crucial military events in the Lancaster–York conflict, are dealt with succinctly but only in relation to...

Age of Migration and the Incidence of Cognitive Impairment: A Cohort Study of Elder Mexican-Americans.

Background and ObjectivesTo explore nativity and age of migration differentials in the incidence of cognitive impairment among older Mexican-Americans.Research Design and MethodsWe employ maximum-likelihood discrete time hazard models to estimate risk ratios of cognitive impairment in a sample of 2,708 Mexican-Americans 65 and older who were cognitively healthy at baseline over a follow-up period of up to 20 years.ResultsLate-life immigrant women have a 46% higher risk of cognitive impairment compared to U.S.-born Mexican-American women. Conversely, midlife immigrant men have a 29% lower risk of cognitive impairment compared to U.S.-born Mexican-American men. The incidence of cognitive impairment did not differ for early-life and midlife immigrant women relative to U.S.-born women or for early- and late-life immigrant men compared to U.S.-born men.Discussion and ImplicationsDifferences in cognitive impairment risk between U.S.-born and foreign-born Mexican-American subgroups may be partly due to health selectivity. Cognitive impairment is more prevalent among immigrant groups which may result in a higher burden on family members and/or high dependency on public resources. Programs are needed that can detect decline at earlier stages and reduce the risk for cognitive impairment among older immigrants entering their last decades of life.

The Rhetoric of Conversion as Emancipatory Strategy in India: Bhimrao Ambedkar, Pragmatism, and the Turn to Buddhism

Bhimrao Ambedkar, famous for being a political ally to the “untouchable” castes and a political sparring partner to Gandhi in India's struggle for independence, is also well-known for his public advocacy for Buddhism. Starting in the 1930s, Ambedkar began arguing that he and his fellow untouchables should convert from Hinduism to escape caste oppression. Ambedkar was also influenced by his teacher at Columbia University, John Dewey. Religious conversion transformed in Ambedkar's rhetorical strategy to a meliorative program. His rhetoric of conversion operated in three stages: reflection on one's religious orientation, renunciation of a problematic orientation, and conversion to a more useful orientation. This study explicates the final phase of Ambedkar's conversion rhetoric, the stage he only expands upon in his oratorical activity during his last decade of life. His rhetorical appeals to convert to Buddhism are found to be performative in nature and to be imbued with a Deweyan ethos of religious rhetoric as an emancipatory device for individuals and communities.

Medical challenges at the end of the first ten decades of life.

Demographic changes worldwide challenge the healthcare system. Advanced age is associated with a number of biological alterations that, together with concomitant comorbidities, increase the risk for functional decline by inducing functional disintegration. In this concept frailty and sarcopenia play an important role. Consequently the preservation of muscle mass and function are prominent targets of medicine in old age. In order to professionally care for persons in their last years of life several other factors influencing medical decisions regarding diagnostic and treatments are important. These factors concern the life expectancy, the person`s functional status the physicians involved in care and the family system. Balancing between over- and undertreatment in very old patients can be optimised by a goal-oriented decision making approach. Very old persons with poor decision making capacity might benefit from decisions made in a team. To be able to manage the challenges associated with the last decade of life, we need physicians who have the knowledge, the appropriate attitude towards frail old patients and the skills to communicate with different groups involved in care. Ideally old age medicine should become an integrative part of a unified national medical curriculum.

The Rhetoric of Conversion as Emancipatory Strategy in India: Bhimrao Ambedkar, Pragmatism, and the Turn to Buddhism

Bhimrao Ambedkar, famous for being a political ally to the “untouchable” castes and a political sparring partner to Gandhi in India’s struggle for independence, is also well-known for his public advocacy for Buddhism. Starting in the 1930s, Ambedkar began arguing that he and his fellow untouchables should convert from Hinduism to escape caste oppression. Ambedkar was also influenced by his teacher at Columbia University, John Dewey. Religious conversion transformed in Ambedkar’s rhetorical strategy to a meliorative program. His rhetoric of conversion operated in three stages: reflection on one’s religious orientation, renunciation of a problematic orientation, and conversion to a more useful orientation. This study explicates the final phase of Ambedkar’s conversion rhetoric, the stage he only expands upon in his oratorical activity during his last decade of life. His rhetorical appeals to convert to Buddhism are found to be performative in nature and to be imbued with a Deweyan ethos of religious rhetoric as an emancipatory device for individuals and communities.

One Can Slow Down the Aging through Antioxidants

Free radicals are natural nanoparticles which are doing their part well defined in the human cell, but then they must be annihilated or eliminated to not destroy the cell or another part of our body. It has been shown that residual free radicals in the body are responsible for the aging. The role to annihilate them is ful-filled by the antioxidants. Antioxidants are a group of compounds produced by the organism or that occur naturally in many foods. Antioxidants work together in the human body to maintain health and vigor, especially during the last decades of life. They do this by protecting us from harm caused by free radicals that can destroy skin and tissues healthy cells of the organism. Antioxidants are chemical compounds with many and varied applications. Naturally present in our diet, through fruits, vegetables, tea or red wine, they are recognized to be good for health. In fact, antioxidants protect our body's proteins and nucleic acids from oxidation. In the industry, antioxidants are also used as food additives to increase the shelf life of food. They are also present in the packaging or the wheels of cars because they prevent synthetic materials from becoming crumbly and brittle. Finally, in the cosmetics industry, creams containing antioxidants are known for their anti-aging properties. An antioxidant is a molecule that decreases or prevents the oxidation of other chemicals. Oxidation is part of an oxidation-reduction reaction that transfers electrons from a substance to an oxidizing agent. This reaction can produce radicals that cause destructive chain reactions. However, whatever the field of application, the unstable nature of antioxidants is a problem: The molecules degrade rapidly and have a particularly limited power of action over time.

Present a Mechatronic System Having Able to Determine the Concentration of Carotenoids

Civilization besides its major advantages (undisputed) brought us some unhealthy habits which unfortunately have managed to penetrate deeply within several generations on the current planetary populations producing great damages to its health. Perhaps it would be the right time to and more people learning to live healthy, to feed ourselves healthy, let's try to break the chain of evil which we grind all already several generations. It has been shown that residual free radicals in the body are responsible for aging. The role to annihilate them is fulfilled by the antioxidants. Antioxidants are a group of compounds produced by the organism or that occur naturally in many foods. Antioxidants work together in the human body to maintain health and vigor, especially during the last decades of life. Antioxidants network offers the advantage of avoiding premature death caused by these deficiencies and sometimes even cure those diseases. The methods generally used for the determination of carotenoids extracted from a natural environment are based on absorption spectrophotometry. These methods may be relatively precise but require a relatively long preparation of the sample to be analyzed. Indeed, because of the other pigments often present in the samples analyzed and extracted at the same time as the carotenoids, the analysis is not very precise on the crude acetone extract, chlorophylls in particular are often troublesome. Saponification and different extraction methods are then necessary to purify the solution, which inevitably leads to loss of carotenoids, thus an error in the assay.

Ageing in humans: separating intrinsic ageing from lifestyle effects

We are an ageing society, with falling birth rates and increasing life expectancy. However healthy life span is not keeping pace and on average older adults can expect to be unwell for the last decade of life. Many factors influence both lifespan and healthspan but in humans one of the key factors is likely to be increasing physical inactivity. To separate out those elements of the ageing phenotype that are due to inactivity from those which are intrinsic to the ageing process, we recruited 125 adults aged 55-79 who had maintained a high level of physical activity through their adult lives. We compared these with age matched healthy older adults who were not involved in regular physical activity and healthy young subjects. The subjects were assessed for key features known to change with ageing including sarcopenia, reduced bone mineral density, adiposity, cardiovascular and lung function as well as markers of immune ageing. We have already reported the physiological data which revealed that many features of ageing including lean body mass, adiposity and muscle strength did not change with age in the physical active group, though other effects were seen such as a decline in lung capacity (FEV1) and maximal heart rate. Here we report that a comparison of immune phenotype in the exercising and non-exercising groups showed that thymic output was significantly reduced in the inactive group compared to both the young subjects (p<0.002) or the physically active older subjects (p<0.009). The numbers of naive T cells was also maintained in the active elders, though the rise in the numbers of senescent T cells was not protected by an active lifestyle. We conclude that an active lifestyle through adulthood can prevent many of the physiological and immune features normally attributed to ageing.

Chronic myeloid leukemia in the Netherlands: a population‐based study on incidence, treatment, and survival in 3585 patients from 1989 to 2012

To assess the impact and results of treatment of CML in the general population, we conducted a population-based, nationwide study on 3585 CML patients diagnosed between 1989 and 2012 in the Netherlands. Patient demographics were obtained from the Netherlands Cancer Registry. Information on age, gender, year of diagnosis, first treatment, and date of death were recorded. Overall survival (OS) was adjusted for death rates in the normal population. Incidence in males decreased slightly from 1.2 per 100.000 person years (PY) in 1989-2000 to 0.9 in 2001-2012. For females, incidence remained stable with 0.7 per 100.000 PY in both periods. Incidence was age dependent and highest in males in the last decades of life. Treatment before 2000 mainly consisted of chemotherapy, while after 2007 TKI use was 88%. Five-year relative survival was only 36% before the introduction of TKIs but significantly increased to 79% after the introduction of TKI. This study gives insight into CML incidence, treatment, and survival in routine care in the Netherlands. Although OS improved since the introduction of TKIs, there is still room for further improvement.

Tai chi Effects on Nursing Diagnosis

Aging is the physiological process, which starts in the conception producing characteristic changes to all the species during their life cycle. In the last decades of life, those changes produce a limit on adaptations of organisms in relation to their environment. Those problems can be processed by three diagnoses –Impaired physical mobility, sedentary lifestyle and impaired memory. The methodology proposes 18 outcomes included in the last version of NOC. Those outcomes are used to assess the intervention of tai chi during the four months developed with a group of 19 women older than 55 years which they presented theses diagnoses. The correlations were studied with Pearson and Spearman. The difference of variables between first sample and the last sample, which were more significant in relation to sedentary lifestyle. This is a pilot experience but it is the first step to the challenge of making standard instruments and scales for the outcomes of the nursing methodology.

"Blaming the Flowers for Wilting": Idealized Aging in a Health Charity Video.

Amid growing concern about the graying population, an emerging theme in public health discourse is that of "successful aging." In this article, we use a governmentality lens to analyze a Canadian health promotion video, titled "Make Health Last: What Will Your Last 10 Years Look Like?" and viewers' responses to its message. The video presents starkly different scenarios of the last decade of life, conveying a neo-liberal rationality in which health in old age is positioned as a matter of individual choice. Our analysis suggests that while viewers generally support the video's message of personal responsibility for health, some are uneasy about implied claims that age-related illness can be prevented by choosing to be healthy. We argue that the video's simplistic messaging about health in later life raises disturbing questions about health promotion campaigns that deny the "normal" aging body and blame the elderly for "deciding" not to remain youthful and healthy.

Selected nutrients and their implications for health and disease across the lifespan: a roadmap.

Worldwide approximately two billion people have a diet insufficient in micronutrients. Even in the developed world, an increasing number of people consume nutrient-poor food on a regular basis. Recent surveys in Western countries consistently indicate inadequate intake of nutrients such as vitamins and minerals, compared to recommendations. The International Osteoporosis Foundation’s (IOF) latest figures show that globally about 88% of the population does not have an optimal vitamin D status. The Lancet’s “Global Burden of Disease Study 2010” demonstrates a continued growth in life expectancy for populations around the world; however, the last decade of life is often disabled by the burden of partly preventable health issues. Compelling evidence suggests that improving nutrition protects health, prevents disability, boosts economic productivity and saves lives. Investments to improve nutrition make a positive contribution to long-term national and global health, economic productivity and stability, and societal resilience.

Trends in epidemiological and clinical characteristics in severe traumatic brain injury: Analysis of the past 25 years of a single centre data base.

To describe the demographic and clinical profiles of a cohort of environmentally representative severe traumatic brain injury (TBI) cases collected for the past 25 years and to analyse the changes that occurred by dividing the analysis period into 3 equal time periods. This was an observational cohort study of consecutive adult patients (>14 years of age) with severe closed TBI (Glasgow Coma Scale score [GCS]≤8) who were admitted during the first 48h after injury to the 12 de Octubre hospital from 1987 to 2012. The most relevant epidemiological and clinical variables reported in the literature were defined and compared in 3 equal time periods (1987-1995, 1996-2004 and 2005-2014). There was a 13% reduction in the frequency of severe TBI from the first to the last time period. An increase in the mean age from 35 to 43 years was observed, whereas the frequency of severe TBI according to sex remained approximately the same during the last decades of life. A distinct change was observed in the injury mechanism; traffic accidents decreased from 76% to 55%, particularly those involving 4-wheeled vehicles. However, falls increased significantly, especially in older women, and contusion and subdural haematoma were the most frequent structural injuries. Motor scores could not be reliably assessed for the last time period because of early intubation and sedative drug use. TBI epidemiology in Western countries has changed. This trend was also observed in our environment as an increase in mean age, which reflected the increase in falls among elderly patients.

Iron deficiency in the elderly population, revisited in the hepcidin era.

Iron deficiency (ID) is relatively common among the elderly population, contributing substantially to the high prevalence of anemia observed in the last decades of life, which in turn has important implications both on quality of life and on survival. In elderly subjects, ID is often multifactorial, i.e., due to multiple concurring causes, including inadequate dietary intake or absorption, occult bleeding, medications. Moreover, because of the typical multimorbidity of aged people, other conditions leading to anemia frequently coexist and make diagnosis of ID particularly challenging. Treatment of ID is also problematic in elderly, since response to oral iron is often slow, with a substantial fraction of patients showing refractoriness and requiring cumbersome intravenous administration. In the last decade, the discovery of the iron regulatory hormone hepcidin has revolutionized our understanding of iron pathophysiology. In this review, we revisit ID among elderly people in the light of the impressive recent advances on knowledge of iron regulation, and discuss how hepcidin may help in diagnosis and treatment of this common clinical condition.

Integrating a palliative approach in a transcatheter heart valve program: Bridging innovations in the management of severe aortic stenosis and best end-of-life practice

Severe aortic stenosis (AS) is the most prevalent structural heart disease and affects primarily older adults in their last decade of life. If the risk for surgery is high, transcatheter aortic valve implantation (TAVI) is the treatment of choice for many patients with suitable anatomy who are likely to derive significant benefit from this innovative and minimally invasive approach. In a large transcatheter heart valve (THV) centre that offers TAVI as one of the treatment options, of 565 consecutive referrals for the assessment of eligibility for TAVI over 18 months, 78 (14%) were deemed unsuitable candidates for TAVI or higher risk surgery by the interdisciplinary Heart Team because of their advanced disease, excessive frailty or comorbid burden. Concerns were raised for patients for whom TAVI is not an option. The integration of a palliative approach in a THV program offers opportunities to adopt best end-of-life practices while promoting innovative approaches for treatment. An integrated palliative approach to care focuses on meeting a patient's full range of physical, psychosocial and spiritual needs at all stages of a life-limiting illness, and is well suited for the severe AS and TAVI population. A series of interventions that reflect best practices and current evidence were adopted in collaboration with the Palliative Care Team and are currently under evaluation in a large TAVI centre. Changes include the introduction of a palliative approach in patient assessment and education, the measurement of symptoms, improved clarity about responsibility for communication and follow-up, and triggering referrals to palliative care services.

Interpreting Oral Pathology at Machu Picchu, Peru

AbstractThis study analyzes oral pathological conditions—caries, antemortem tooth loss, and occlusal macrowear—among adults (N = 70) interred at Machu Picchu, Peru. Previous isotopic diet reconstructions at Machu Picchu suggest substantial early‐life variation that may have narrowed somewhat by the last decade of life. This study seeks to further elucidate the intersection of diet, sex, and health at Machu Picchu by analyzing oral pathological conditions with existing carbon and nitrogen isotopic data. Observed caries prevalence is corrected to control for age and tooth loss, and is described for both anterior and posterior teeth; wear data are scored and reported for individual tooth types. Results indicate caries prevalence consistent with carbohydrate‐rich diets and no significant difference between males and females. However, no significant isotopic parameters are associated with caries prevalence in young adult males, while caries prevalence is significantly associated only with enamel carbonate δ13C in older adult males. Dietary protein sources, but not C4 resources, are associated with caries prevalence in young adult females, and to a lesser degree in older adult females. Significant associations between occlusal wear and caries exist among young adult males and young adult females, but involving different tooth types. These findings suggest differential protein consumption at Machu Picchu between males and females, and separate masticatory and physiological processes shaping caries prevalence between the sexes at the site. This study therefore underscores the role that gender roles may have played in diet variation among this population and the need to account for sex in analyzing oral pathology. Copyright © 2013 John Wiley &amp; Sons, Ltd.

Subclinical Hypothyroidism and Heart Failure Risk in Older People

Although the negative impact of subclinical hypothyroidism (sHT) in terms of cardiovascular risk in young adults is mostly acknowledged it remains to be established in the elderly, especially in the oldest old. We searched Medline for reports published with the following search words: hypothyroidism, sHT, ageing, elderly, L-thyroxin, thyroid, guidelines, treatment, quality of life, cardiovascular risk, heart failure (HF), ischemic heart disease (IHD), endothelial dysfunction. The search was restricted to reports published in English since 1980, but some reports published before 1980 were also incorporated. We supplemented the search with records from personal files and references of relevant articles and textbooks. Parameters analyzed included epidemiology of sHT and thyroid failure the effect of thyroid hormone on ageing process and cardiovascular function as well as the potential benefits of L-thyroxin therapy on quality of life, HF progression and events. TSH levels increase with age, even in older patients without thyroid disease, in whom higher TSH value might favor longevity; better quality of life and lower IHD mortality in the oldest old population has been reported yet. However, at odds with the relationship between sHT and IHD risk and mortality, which shows a clear age dependent feature, vanishing in the last decades of life, the detrimental effect of sHT on HF progression and events remains evident also in older patients, although no data are available in the oldest old population. The lack of specific randomized trials enrolling either old or very old subjects, aimed at evaluate the efficacy of hormonal replacement on overall survival and cardiovascular risk reduction along with the negative effects of possible over-treatment, makes the decision to treat older people a still unresolved clinical challenge. Moreover, the possibility that restoring euthyroidism may be harmful in the elderly should be always taken into account.

Sedentary behavior and physical activity are independently related to functional fitness in older adults

The last decades of life have been traditionally viewed as a time of inevitable disease and frailty. Sedentary living and physical activity may influence capacity to perform activities that are needed to maintain physical independence in daily living. A total of 117 males and 195 females, aged 65–103years, were assessed for physical activity and sedentary time with accelerometers and for functional fitness with the Senior Fitness Test battery. Based on the individual scores for each fitness item, a Z-score was created. Associations between functional fitness with sedentary time and moderate-to-vigorous physical activity (MVPA) were analyzed. A negative association was found between the composite Z-score for functional fitness and the sedentary time, even adjusting for MVPA and other confounders. On the other hand, MVPA was positively associated with the composite Z-score for functional fitness, independently of the sedentary time. In conclusion elderly who spend more time in physical activity or less time in sedentary behaviors exhibit improved functional fitness and other confounders. The results reinforce the importance of promoting both the reduction of sedentary behaviors and the increase of MVPA in this age group, as it may interfere at older ages in order to preserve functional fitness and performance of daily functioning tasks.

Aortic valve calcium load before TAVI: Is it important?

Aortic valve calcium load before TAVI: Is it important?