Later Years Of Life Research Articles

Hospital Based Early Identification and Intervention for Children with Special Needs: A Conceptual Analysis

A child’s earliest years are important for the simple, but sufficient reason that they come first in a dynamic process of human development. These earliest days are filled with new stimulations and novel experiences that drive his or her cognitive, social, and physical growth. The first 3 years of life are a critical time for brain development, especially if a child is delayed or restricted in development. Early identification leads to early intervention. Intervention or lack thereof, at this stage, therefore, can significantly enhance or impair the quality of life in later years. Early intervention program is intended for infants and toddlers who have a developmental delay or disability below the age of five. Early intervention focuses on the basic developmental skills that typically develop during the first three to five years of life through a variety of therapeutic and support services which will be tailored to meet the child’s individual needs. The parents/caregivers are the major contributors and performers in the Early Intervention Program. Involvement of other team members, include medical people, therapists, child development educators, social workers, and others, will depend on what the child needs. Early intervention supports the families who often experience frustration, stress, disappointment, and helplessness and helps to build a nurturing and supportive environment for the entire family. Early intervention implies for the well-being of the family and the development of the children with special needs.

Moderating Effects of Community Social Capital on Depression in Later Years of Life: A Latent Interaction Model

ABSTRACTObjective: This study tested the stress-buffering model and examined the buffering role of community social capital on late-life depression.Methods: This study used the data from the second wave of National Social Life, Health, and Aging Project (NSHAP, 2010–2012). In the present study, a total of 2,362 older adults aged 65 and older (Mage = 74.5, SD = 6.69) were included. Latent moderated structural equations model was tested by comparing the main effect model and interaction model. Depression, stress, and community social capital were constructed as latent variables for the analyses.Results: The main effect model was acceptable: χ2 (df = 334) = 1596.4, p = .000; RMSEA = .04 (.038 - .042); CFI = .91; and SRMR = .05. And interaction model was significant (D = 35.0, p < .001). The latent constructs of stress (β = . 50, p < .001) and community social capital (β = −.14, p < .001) not only had a direct effect on depression, but their interaction was also significant (β = −.21, p < .01).). The group with a high level of social capital presented a relatively stable slope in the prediction of stress on depression, suggesting their resilience, while the group with a low level of community social capital demonstrated a steep slope, indicating heighten vulnerability to depression when faced with stress.Conclusions: The findings support the hypothesis of stress buffering model and identify the protective effects of community social capital on depression of older adults.Clinical Implications: Older adults with lower community social capital are particularly vulnerable to depression. The results highlight that practitioners and policymakers should pay more attention to finding ways to enhance community resources to improve older adults’ mental health.

The impact of exercise and nutrition on the regulation of skeletal muscle mass

The maintenance of skeletal muscle mass and strength throughout life is a key determinant of human health and well-being. There is a gradual loss of both skeletal muscle mass and strength with ageing (a process termed sarcopenia) that increases the risk of functional dependence, morbidity and mortality. Understanding the factors that regulate the size of human muscle mass, particularly during the later years of life, has therefore become an area of intense scientific inquiry. The amount of muscle mass is determined by coordinated changes in muscle protein synthesis (MPS) and muscle protein breakdown (MPB). In this review, we assess both classical and contemporary work that has examined how resistance exercise and nutrition impact on MPS and MPB. Special consideration is given to the role of different sources of dietary protein (food vs. supplements) and non-protein nutrients such as omega-3 fatty acids in regulating MPS. We also critically evaluate recent studies that have employed novel 'omic' technologies such as dynamic protein profiling to probe for changes in rates of MPS and MPB at the individual protein level following exercise. Finally, we provide suggestions for future research that we hope will yield important information for the development of exercise and nutritional strategies to counteract muscle loss in a variety of clinical settings.

Predictors of remission to antidepressants in late-life depression: a systematic review.

Late-life depression is a heterogeneous mood disorder frequently associated with many adverse conditions, including decreased cognitive function and an elevated risk for comorbid medical disorders, as well as with an elevated mortality rate. Late-life depression encompasses both late-onset as well as early-onset depression that occurs or continues into later years of life. Conventional treatment often required several trials of antidepressants before an effective regimen can be found for an individual. This is associated with persistent depressive symptoms, a disability in activities of daily living and an increased risk of suicide and worsening of medical comorbidities. Thus, in the elderly, it is particularly important to identify predictors of treatment remission to reduce these risks. The purpose of this paper was to review the current status of knowledge regarding predictors of remission to antidepressants among older depressed patients. Patients with high number of cardiovascular risk factors, poor performance in working memory, verbal fluency tests and executive functioning, reduced volumes of cerebral structures (hippocampus, anterior cingular cortex, orbitofrontal cortex) were more likely to reach remission. Reduction of depression score during the first weeks of treatment was correlated with remission. However, more studies are needed to confirm these results.

Defining outcomes following congenital diaphragmatic hernia using standardised clinical assessment and management plan (SCAMP) methodology within the CDH EURO consortium.

Treatment modalities for neonates born with congenital diaphragmatic hernia (CDH) have greatly improved in recent times with a concomitant increase in survival. In 2008, CDH EURO consortium, a collaboration of a large volume of CDH centers in Western Europe, was established with a goal to standardize management and facilitate multicenter research. However, limited knowledge on long-term outcomes restricts the identification of optimal care pathways for CDH survivors in adolescence and adulthood. This review aimed to evaluate the current practice of long-term follow-up within the CDH EURO consortium centers, and to review the literature on long-term outcomes published from 2000 onward. Apart from having disease-specific morbidities, children with CDH are at risk for impaired neurodevelopmental problems and failure of educational attainments which may affect participation in society and the quality of life in later years. Thus, there is every reason to offer them long-term multidisciplinary follow-up programs. We discuss a proposed collaborative project using standardized clinical assessment and management plan (SCAMP) methodology to obtain uniform and standardized follow-up of CDH patients at an international level.

Loneliness among older European adults: results from the survey of health, aging and retirement in Europe

Previous research has suggested that individuals are mostly prone to loneliness in their later years of life because of exposure to several risk factors typical of old age. The current study aims to examine possible demographic, health and social determinants of loneliness among older adults in Europe. Data on a nationally representative sample of 5074 Europeans aged ≥ 65 years were drawn from the first wave of the Survey of Health, Aging and Retirement in Europe (SHARE, 2004/2005). Frequency of feelings of loneliness was examined according to adverse health conditions, stressful life events and social isolation indicators. Female gender, older age, lower socioeconomic status, living unpartnered, being childless and having no activity involvement were significantly associated with frequent feelings of loneliness (p < 0.001). The proportion of the respondents who declared enduring loneliness most of the time compared with none of the time was significantly higher among Southern Europeans relative to their Northern counterparts (p < 0.001). Recent departure of offspring from the parental nest was a significant predictor of loneliness in both the second (ORs = 2.08; 95% CI 1.24–3.48) and the third (ORs = 1.75; 95% CI 1.03–2.96) multiple regression models. In this sample of older Europeans, several demographic characteristics, specific adverse health conditions, stressful life events and social isolation indicators were associated with feelings of loneliness. Policy initiatives for the alleviation of loneliness in older age should therefore aim at improving psychosocial and health-related difficulties faced by this population.

Clinical Practice Guidelines for Management of Dementia.

Indian Psychiatric Society (IPS) published Clinical Practice Guidelines (CPGs) for management of dementia, in the year 2007. (http://www.indianjpsychiatry.org/cpg2007.asp). The current version of the CPG is an update of the earlier version of CPGs for management of dementia There were three separate CPGs for management of dementia, one each for Reversible Dementias, Alzheimer's Disease and Vascular Dementia, Please note that the present CPG on dementia deals all types of dementia together. The current version of the CPGs for dementia in elderly must be read in conjunction with the previous version of CPGs for dementia. The focus of the present CPG is to provide suggestions and clinical tips to differentiate dementia syndrome from other clinical conditions, identify the subtypes of dementia and then offer suggestions for management. These guidelines only provide a broad framework for assessment, management and follow-up of older people with dementia. While most of the recommendations are evidence based, these guidelines should not be considered as a substitute of professional knowledge and clinical judgment. The recommendations made as part of these guidelines should be tailored to address the clinical needs of the individual patient and the treatment setting.

Prevalence of Osteoporosis in Apparently Healthy Adults above 40 Years of Age in Pune City, India.

Purpose:The aim of study was to assess the prevalence of osteoporosis and changes in bone mass with increasing age and compare bone health status of apparently healthy men, premenopausal and postmenopausal women.Methods:Data were collected on anthropometric and sociodemographic factors in 421 apparently healthy Indian adults (women = 228), 40–75 years of age, in a cross-sectional study in Pune city, India. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry at two sites-lumbar spine (LS) and left femur. Individuals were classified as having osteoporosis or osteopenia based on the World Health Organization criteria of T-scores.Results:Mean age of study population was 53.3 ± 8.4 years. Of the total women, 44.3% were postmenopausal with 49.2 ± 3.5 years as mean age at menopause. Postmenopausal women showed a rapid decline in BMD with age till 50 years while men showed a gradual decline. Premenopausal women showed no significant decline in BMD with age (P > 0.1). Significantly lower T-scores were observed at LS in men compared to premenopausal (P < 0.05). At left femur, T-scores were lower in men compared to premenopausal women (P < 0.05) but not postmenopausal women (P > 0.1). The prevalence of osteoporosis in men at LS was lower than postmenopausal women but higher than premenopausal women.Conclusion:In Indian men, a low T-score compared to women indicates higher susceptibility to osteoporosis. In women, menopause causes a rapid decline in BMD. Therefore, both Indian men and postmenopausal women require adequate measures to prevent osteoporosis during later years in life.

Prehypertension and Hypertension in Medical Students of Northern Border University in Arar, Saudi Arabia

Aim of the work: hypertension is the commonest cardiovascular disorder. Prehypertension in adolescents and young adults is a risk factor for developing hypertension in later years of life. The objective of this study was to determine the prevalence rate and risk factor associated with prehypertension and hypertension in the medical students of Northern Border University in Arar city, Saudi Arabia. Methods: this cross-sectional study included 232 students. The study subjects were selected by systematic random sampling method. This study included 232 medical students (136 male and 96 female). The study period was from 1 March to 31 May 2017. Students were given a predesigned and pretested questionnaire to collect the relevant data. Results: Fifty (52.1%) of females and 58.8% of males were pre-hypertensive and 1.5% from males were hypertensive. Family history of hypertension was positive in 66.7% of hypertensive or pre-hypertensive students (P 0.05), 31.8% were smokers (P>0.05), 10.6% were drug addicts (P>0.05), 18.2% only performing muscular exercise (P>0.05), 62.1% consume >5g salt /day (P 0.05). Conclusion: in medical students of the Northern Border University, 52.1% of females and 58.8% of males were pre-hypertensive and 1.5% of males were hypertensive. Risk factors included obesity, family history, sedentary life and excess salt intake. So health-care providers should recognize the increased risk of prehypertension and hypertension and should seek to identify and manage the modifiable risk factors in those students.

A pilot study of venous duplex ultrasound parameters in healthy children.

The spectrum of chronic venous disease (CVD) in adults is well documented, whereas there is a paucity of data published commenting on pediatric CVD. We previously identified that there is often venous reflux present in cases of pediatric lower extremity edema despite an alternative confirmed diagnosis. To further assess the clinical significance of this venous reflux, this study aimed to elicit venous parameters in healthy pediatric controls. Healthy pediatric volunteers aged 5 to 17years were recruited for venous reflux study. A comprehensive venous reflux study was performed with the patient standing. Vein diameter, patterns of valvular reflux, and accessory venous anatomy were examined in the deep and superficial venous systems. Eighteen children including 10 boys and 8 girls were studied. Five volunteers were aged 5 to 8years, six volunteers were aged 9 to 12years, and seven volunteers were aged 13 to 17years. Great saphenous vein (GSV) diameter at the saphenofemoral junction significantly increased with age. Deep vein valve closure time (VCT) did not differ significantly between groups, whereas GSV VCT was significantly higher in the 9- to 12-year age group. Incidental venous insufficiency was identified in 60% of children aged 5 to 8years (n= 3), 50% of children aged 9 to 12years (n= 3), and 57% of children aged 13 to 17years (n= 4). All superficial venous reflux was confined to the GSV; there were no cases of isolated deep venous reflux. Reflux was identified at multiple GSV stations in 60% of children. There was no significant difference in incompetent GSV VCT in comparing children with and without deep venous reflux. Accessory superficial veins were identified in 20% of children aged 5 to 8years (n= 1), 50% of children aged 9 to 12years (n= 3), and 43% of children aged 13 to 17years (n= 3). The presence of an accessory saphenous vein was not associated with deep venous reflux in any patient, and only 29% of those with accessory saphenous venous anatomy had evidence of superficial venous (GSV) reflux. The GSV continues to grow in diameter through the teenage years. Incidental valvular incompetence and GSV reflux are common. The presence of accessory saphenous veins is similarly common and not associated with venous reflux. The clinical significance and natural history of this incidental venous reflux remain unclear. Future research should determine whether these changes seen in the pediatric age group lead to CVD during later years of life.

SEXUALIDADE NA VELHICE

Diante do atual crescimento da população idosa e do aumento da expectativa de vida, surge a necessidade de a sociedade refletir sobre a sexualidade no processo de envelhecimento. O assunto, entretanto, é revestido de mitos, tabus e preconceitos. Sua abordagem integral deve considerar as questões psicológicas, sociais, culturais que destacam os aspectos sentimentais, emocionais e afetivos. A revisão de literatura da área aponta que na velhice podem se unir o prazer dos sentidos, a experiência vivida, a sabedoria, a despreocupação e a capacidade de alcançar a intimidade.

Periodontitis, Microbiomes and their Role in Alzheimer’s Disease

As far back as the eighteenth and early nineteenth centuries, microbial infections were responsible for vast numbers of deaths. The trend reversed with the introduction of antibiotics coinciding with longer life. Increased life expectancy however, accompanied the emergence of age related chronic inflammatory states including the sporadic form of Alzheimer’s disease (AD). Taken together, the true challenge of retaining health into later years of life now appears to lie in delaying and/or preventing the progression of chronic inflammatory diseases, through identifying and influencing modifiable risk factors. Diverse pathogens, including periodontal bacteria have been associated with AD brains. Amyloid-beta (Aβ) hallmark protein of AD may be a consequence of infection, called upon due to its antimicrobial properties. Up to this moment in time, a lack of understanding and knowledge of a microbiome associated with AD brain has ensured that the role pathogens may play in this neurodegenerative disease remains unresolved. The oral microbiome embraces a range of diverse bacterial phylotypes, which especially in vulnerable individuals, will excite and perpetuate a range of inflammatory conditions, to a wide range of extra-oral body tissues and organs specific to their developing pathophysiology, including the brain. This offers the tantalizing opportunity that by controlling the oral-specific microbiome; clinicians may treat or prevent a range of chronic inflammatory diseases orally. Evolution has equipped the human host to combat infection/disease by providing an immune system, but Porphyromonas gingivalis and selective spirochetes, have developed immune avoidance strategies threatening the host-microbe homeostasis. It is clear from longitudinal monitoring of patients that chronic periodontitis contributes to declining cognition. The aim here is to discuss the contribution from opportunistic pathogens of the periodontal microbiome, and highlight the challenges, the host faces, when dealing with unresolvable oral infections that may lead to clinical manifestations that are characteristic for AD.

Brown Adipose Tissue and Disease: New Insights from Historical Data

At birth Perirenal Adipose Tissue (PrAT) exhibits a brown-like phenotype and then becomes phenotypically white with ageing and obesity, potentially contributing to the onset of chronic disease. Little is known about the composition of PrAT in the later years of life and whether it is modulated by different types of disease.

Minimal intervention management of the older patient.

With an aging population, dentists need to be aware of the risks which come to their elderly patients from retained teeth and exposed root surfaces. Oral health problems in the later years of life are multifactorial, with lifestyle, plaque and salivary factors remaining paramount. Root surface caries is likely to present a challenge in patients with a strong history of past coronal caries (and who have the attendant lifestyle risk factors) as well as in elderly patients who suddenly develop salivary hypofunction. Following a maximum interception approach means that specific efforts are needed to profile salivary, plaque and lifestyle risk factors and ensure that the dentition can be cleaned by the patient and maintained in a way which gives comfort and function as well as aesthetics. Discussions around long-term objectives for oral health are important when there is a sudden decline in general health in the later years of life. It may be appropriate to use tooth surface protection for strategic anterior teeth and apply the shortened dental arch concept where patients cannot readily maintain their own oral health because of frailty or medical conditions. Glass ionomer materials can be used both for root surface protection and for conservative restoration where a minimally invasive preparation has been undertaken. In other cases, arrest of lesions using silver fluoride or CPP-ACP topical treatments can delay or obviate the need for restorative interventions, and forms part of the management of patients in high care units in nursing homes. Involving all members of the healthcare team in supporting oral health is an important strategy to ensure that oral health issues are not overlooked. The challenge is to promote evidence-based self-care. A key message is to promote oral health as part of overall health.

Clinicopathological Phenotype and Genetics of X-Linked Dystonia-Parkinsonism (XDP; DYT3; Lubag).

X-linked dystonia–parkinsonism (XDP; OMIM314250), also referred to as DYT3 dystonia or “Lubag” disease, was first described as an endemic disease in the Philippine island of Panay. XDP is an adult-onset movement disorder characterized by progressive and severe dystonia followed by overt parkinsonism in the later years of life. Among the primary monogenic dystonias, XDP has been identified as a transcriptional dysregulation syndrome with impaired expression of the TAF1 (TATA box-binding protein associated factor 1) gene, which is a critical component of the cellular transcription machinery. The major neuropathology of XDP is progressive neuronal loss in the neostriatum (i.e., the caudate nucleus and putamen). XDP may be used as a human disease model to elucidate the pathomechanisms by which striatal neurodegeneration leads to dystonia symptoms. In this article, we introduce recent advances in the understanding of the interplay between pathophysiology and genetics in XDP.

Assessment of Bone Mineral Density Using Calcaneal Ultrasound Bone Densitometer in College-Going Boys and Girls of District Gurdaspur, Punjab

ABSTRACTAttainment of high bone mineral density in younger age is essential for the maintenance of healthy bones in later years of life to escape the morbidity and economic burden associated with i...

Marital and Cohabiting Union Dissolution in Middle and Later Life.

This study examined the timing and risk factors for subsequent union disruption among individuals who were in a marital or cohabiting union at age 45, focusing particularly on the role of prior union history and children. Using retrospective data on union histories from the 2007 Canadian General Social Survey ( n = 17,194), the results of life-table analysis revealed that individuals in cohabiting relationships faced a greater risk of union disruption in middle or later life than those who were married. Cox proportional hazard models showed that both union biography (duration, remarriage/repartnership) and family biography (children born inside/outside union, child age) influenced union dissolution through separation or divorce, but their impact differed depending on union type and gender. These findings suggest that when it comes to marriage and cohabitation, the middle and later years of life are neither a clear continuation nor a complete departure from earlier patterns.

The Influence of Pain, Perceived Health Status, Suicidal Ideation, Disabilities in Daily Living, Depression, Social Support on Subjective Happiness in Female Solitary Elderly

Objectives: The purpose of the study is to analyze predictive factors that influence subjective happiness to provide basic data about improvements in quality of life in old age and successful senescence. Methods/Statistical Analysis: The research method is a descriptive research study. The subjects were 150 solitary elderly women over the age of 65 living in D gu, D metropolitan city and data collection was done for 5 weeks from August 8, 2016 to September 9, 2016 and analysis was done through descriptive statistics, t-test, ANOVA, Pearson’s correlation coefficients and stepwise multiple regression analysis using SPSS/WIN 18.0 program. Findings: Between subjective happiness, Pain (r=-.502, p<.001), Suicidal ideation (r=-.507, p<.001), and Disabilities in daily living (r=-.535, p<.001) showed statistically significant level to average negative correlation and Depression (r=-.800, p<.001) showed high negative correlation. Between subjective happiness, Perceived health status (r=.587, p<.001), and Social support (r=.709, p<.001) showed average simple correlation. Factors influencing subjective happiness was in the order of Depression (B=-.059, p=.000), Social support (B=.011, p=.003), Disabilities in daily living (B=-.111, p=.004), and Age (B=.126, p=.009), with the total explanatory power of 70.3%. Improvements/Applications: To improve subjective happiness in solitary elderly women and for them to lead a successful life in later years, there needs to be emotional support, establishment of social support system, and development of intervention to reduce disabilities in daily life.

Factors Related to Physical Activity Among the Elderly Population in Rural Thailand.

Physical activity in later years of life is not only essential to healthy aging and independent functioning, but it also helps prevent chronic diseases. We aimed this cross-sectional study to assess the prevalence of physical activity and associated factors among rural elderly Thais. We conducted this study on a sample of 300 elderly in 2 rural districts of Phranakornsiayutthaya province in Thailand. The mean age of participants were 67.5±6 years and 42% of them did not perform physical activity. Prevalence of vigorous and moderate intensity physical activity was 43.7% and 48.7%, respectively. About 43.7% elderly used any active transport and spent 2.81 hours on sedentary activities, daily. Females and those with enough income were 3.64 and 0.59 times, respectively, less likely to be physically active (P < .05). Our study concluded that almost half of the rural Thai elderly were physically inactive. Also male and wealthy elderly were less likely to be engaged in physical activity. We recommend for improved efforts to involve rural Thai elderly in physical activity by offering them opportunities for locally relevant recreational and leisure time physical activities, with special focus on males and higher income elderly.

Prevalence of Overweight, Obesity And Its Associated Risk Factors Such as Hypertension And Type 2 Diabetes Among Rural Adults Of Ranga Reddy District in Telangana State

Overweight and obesity in young adults is rising and increases the chances of hypertension, type 2 diabetes and cardiovascular diseases in the later years of life. The widespread data and causes of obesity are required for their primary prevention. The present study was carried out to determine the widespread of overweight, obesity and its associated risk factors such as Hypertension and Type 2 Diabetes among rural adults of Ranga Reddy District in Telangana state. Adults (Total- 210 of which 110 are Males and 100 are Females) in the age group of 20 - 50 years were examined for overweight, obesity, Hypertension and Type 2 Diabetes from their height, weight, waist, hip, BP and GRBS measurements. The observations have shown that the combined overall total widespread rate of overweight and obesity, according to body mass index and waist hip ratio classification, in the present study is 57.61 % and 86.19 % respectively. Moreover, 71.42 % were found to be detected for pre-hypertension and hypertension and almost 19.04 % were found to be to be detected for pre-diabetes and diabetes. The frequency of central obesity and the risk factor such as hypertension was high among adult males when compared to adult females, whereas frequency of general obesity and the risk factor such as diabetes was higher among adult females when compared to adult males.