Non-institutionalized Elderly People Research Articles

Estimulação multissensorial e cognitiva em idosos institucionalizados e não institucionalizados: estudo exploratório*

RESUMO Investigou-se, empregando testes cognitivos, a duracao dos efeitos beneficos do Programa de Estimulacao Multissensorial e Cognitiva. Os participantes do estudo foram idosos institucionalizados e nao institucionalizados, sem historico de traumatismo crânio-encefalico, acidente vascular encefalico ou depressao primaria, com acuidade visual 20/30 ou superior, que participaram regularmente do Programa de Estimulacao Multissensorial e Cognitiva descrito em estudo anterior. Foram realizadas reavaliacoes aos dois, quatro, seis, oito e 12 meses apos a finalizacao do Programa, empregando-se o Mini Exame do Estado Mental e testes selecionados da Bateria Cambridge de Testes Neuropsicologicos Automatizados: Triagem Motora; Processamento Rapido de Informacao Visual; Tempo de Reacao; Aprendizagem Pareada; Memoria de Trabalho Espacial; e Pareamento com Atraso. Os resultados apontaram diferencas significativas entre os grupos, revelando taxa de declinio cognitivo maior nos idosos institucionalizados. Sugere-se que esse efeito esteja associado ao ambiente pobre de estimulos sensoriais, motores e cognitivos, assim como o estilo de vida sedentario e o isolamento dos idosos das instituicoes de longa permanencia. Alem disso, a analise das curvas Receiver Operating Characteristic, seguida dos calculos de especificidade e eficiencia estimadas para cada teste, revelaram que os testes da bateria Cambridge para memoria e aprendizado espacial pareado, assim como para memoria espacial de trabalho, permitem a distincao entre os grupos em todas as janelas de reavaliacao. Tomados em conjunto, os resultados sao de interesse para o planejador de politicas publicas, para recomendar programas regulares de estimulacao sensorial, motora e cognitiva para idosos institucionalizados, promovendo a reducao da taxa de progressao do declinio cognitivo senil.

Bone Mineral Density in the Noninstitutionalized Elderly: Influence of Sociodemographic and Anthropometric Factors.

Objective. Analysis of bone mineral density (BMD) in the elderly and its associated factors according to sex. Methods. A cross-sectional study is presented herein, with a random sample of 132 noninstitutionalized elderly people. Individuals who did not use diuretics were excluded. BMD was obtained from examination of total body densitometry and its association with sociodemographic variables, lifestyle, anthropometric, and body composition was verified. Results. Mean BMD for men was 1.17 ± 0.12 g/cm2 and for women was 1.04 ± 0.11 g/cm2. Higher education was associated with higher BMD values in men (p < 0.05). There was a reduction in BMD in the age group 75–79 years of age in women and over 80 years of age in men (p < 0.05). Underweight was associated with significantly low BMD for both sexes (p < 0.01), while normal weight was associated with low BMD in women (p < 0.001). Discussion. The elderly with low schooling and in older age groups are more probable to also present low BMD. Lower levels of body mass index also indicated towards low BMD.

Cognitive Decline After Entering a Nursing Home: A 22-Year Follow-Up Study of Institutionalized and Noninstitutionalized Elderly People

ObjectiveThe objective of this study is to compare cognitive decline of elderly people after entering an institution with that of elders living in the community with similar clinical conditions. DesignThe Personnes Agées QUID (PAQUID) cohort is a prospective population-based study which included, at baseline, 3777 community-dwelling people aged 65 years and older. Participants were followed-up for 22 years. Among those who were nondemented and living at home at baseline, 2 groups were compared: participants who entered a nursing home during study follow-up (n = 558) and those who remained living at home (n = 3117). Cognitive decline was assessed with Mini-Mental State Examination (MMSE), Benton visual retention test, and verbal fluency Isaacs Set Test. ResultsAfter controlling for numerous potential confounders, including baseline MMSE and instrumental activities of daily living scores, incident dementia, depressive symptoms, and chronic diseases, nursing home placement was significantly associated with a lower score on MMSE between the last visit before and after institutionalization (difference of 2.8 points, P < .0001) and greater further cognitive decline after institutionalization (difference of 0.7 point per year, P < .0001). Similar results were found for the Benton memory test. In a second series of analysis in which the persons who became demented over the study follow-up were excluded, the results remained unchanged. ConclusionsThe present study suggests that institutionalized elderly people present a greater cognitive decline than persons remaining in the community. The reasons of that decline remain unclear and may be related to physical and psychological effects of institutionalization in elderly people.

Determinants of Trends in Loneliness Among Dutch Older People Over the Period 2005-2010

This study aims to investigate the influence of socio-demographic, health, and municipal characteristics on trends in loneliness among community-dwelling elderly people. Data were gathered from 4,868 and 4,773 non-institutionalized elderly people aged 65 years and above in a health survey in 2005 and 2010, respectively. Crude and adjusted multilevel models were analyzed to study the independent associations of study year and socio-demographic, health, and municipal characteristics with loneliness. Overall and across municipalities, loneliness estimates did not significantly differ between 2005 and 2010. However, among the sub-group with activity limitations, loneliness was higher in 2010 compared with 2005. This study indicates a constant trend in loneliness in the total population and across sub-groups with the exception of participants with one or more activity limitations, where loneliness increased. Individual socio-demographic and health characteristics were explanatory factors for variation in loneliness over time, whereas municipal characteristics were not.

“Postural first” principle when balance is challenged in elderly people

Human cognitive processing limits can lead to difficulties in performing two tasks simultaneously. This study aimed to evaluate the effect of cognitive load on both simple and complex postural tasks. Postural control was evaluated in 128 noninstitutionalized elderly people (mean age = 73.6 ± 5.6 years) using a force platform on a firm support in control condition (CC) and mental counting condition (MCC) with eyes open (EO) and eyes closed (EC). Then, the same tests were performed on a foam support. Sway path traveled and area covered by the center of foot pressure were recorded, low values indicating efficient balance. On firm support, sway path was higher in MCC than in CC both in EO and EC conditions ( p < 0.001). On foam support, sway path was higher in CC than in MCC in EC condition ( p < 0.001), area being higher in CC than in MCC both in EO ( p < 0.05) and EC (p < 0.001) conditions. The results indicate that cognitive load alters balance control in a simple postural task (i.e. on firm support), which is highlighted by an increase of energetic expenditure (i.e. increase of the sway path covered) to balance. Awareness may not be increased and the attentional demand may be shared between balance and mental task. Conversely, cognitive load does not perturb the realization of a new complex postural task. This result showed that postural control is prioritized (“postural first” principle) when seriously challenged.

Personality factors and self-perceived health in Chi-lean elderly population

Empirical evidence suggests that the stability of personality itself contributes to successful ageing and is associated with longer life. The aim of this study was to investigate the association between personality traits and the self-perceived health status, stratified by medical conditions in a representative sample of non-institutionalized elderly people in Chile. The data used for this study come from the fourth waves (2009) of the Chilean Social Protection Survey (SPS-2009). Included were a total of 2655 subjects aged 65 and over. The results showed that higher scores of all five personality factors were associated with good health. Those with the perception of poor health were more likely to be female, with lower education level and older than those with good health. With the exception of agreeableness, strong and significant associations with self-perceived health were demonstrated for extraversion, conscientiousness, emotional stability and openness, among elderly with medical conditions. Among elderly without medical problems, significant associations with self-perceived health were demonstrated only for extraversion, agreeableness and emotional stability. This study has shown that there is a consistent association between personality factors and self-perceived health throughout the older population. Our results suggest that extraversion and openness traits could be acting as “protector” factors and agreeableness and conscientiousness traits as “resilient” factors, facing to the health problems among elderly people.

Images of Aging in Institutionalized and Non-Institutionalized Elderly People

Aim : The aim of this study was to assess and compare images and stereotypes of aging in institutionalized and non-institutionalized elderly people. This is a descriptive study using a survey. Method : The instruments used were a sociodemographic questionnaire and the ImAges scale. A total of 120 elderly people, aged between 65 and 99 years, participated in this study. Results : Statistically significant differences were found, for the scale’s three factors, between institutionalized and non-institutionalized older adults. In the factor “dependence, sadness and old-fashioned”, the institutionalized participants presented a higher number of negative images and stereotypes (M = 51.8; DP = 6.01) than the non-institutionalized participants (M = 49.0; DP = 7.85), these differences were significant (t(118) = -2.16; p < 0.05). In the “maturity, activity and affectivity” factor, there were also significant differences (t(118) = 2.04; p < 0.05), the non-institutionalized participants present higher rates of positive images and stereotypes (M = 20.2; DP = 3.28), when compared to institutionalized participants (M = 19.0; DP = 3.310). Conclusion : The results suggested that institutionalized older adults presented more negative aging images than non-institutionalized.

Effect of oral health dental state and risk of malnutrition in elderly people

To determine the risk of malnutrition in both institutionalized and non-institutionalized elderly people of the region of Murcia in Spain. A cross-sectional study was carried out on 465 participants (213 men and 252 women) aged 65 years or older, and representative of the population of the region of Murcia in Spain. The nutritional condition was determined with the Mini Nutritional Assessment screening tool. The following clinical oral health variables were recorded: number of teeth in the mouth, use of removable dentures and hygiene. The prevalence of malnutrition was 7% in the study population, whereas the risk of malnutrition was 49%. A greater prevalence was recorded in the older and in the institutionalized participants. There were no significant differences in terms of malnutrition or the risk of malnutrition between the participants with or without dentures or between the dentate or edentulous participants. Age and institutionalization are parameters to be taken into account for detecting the risk of malnutrition in elderly people.

Prevalence of overweight and obesity in elderly people from Vitória-ES, Brazil

The scope of this study was to estimate the prevalence of overweight and obesity and its association with socio-economic status in a sample of non-institutionalized elderly people from Vitória-ES, Brazil. This was a cross-sectional survey with a sample of 882 elderly people aged 60 and over. Obesity and overweight were assessed using the body mass index (BMI) and waist circumference (WC). All subjects answered a personal and socio-demographic questionnaire in relation to age, gender, marital status, physical activity, number of children, chronic diseases and smoking. Associations between categorical variables were tested using chi-square analysis with a 5% significance level. The prevalence of overweight and obesity was high (41.8% and 23.4%, respectively) and 50.7% of the elderly had a substantially increased waist circumference. About 4.3% of the individuals had diabetes, 50.4% had hypertension and 14.9% were found to have both diseases. It was observed that both the BMI and WC were significant associated (p<0.05) with sex, marital status, the presence of diseases and with cigarette smoking.

Resilience and coping as predictors of general well-being in the elderly: A structural equation modeling approach

Objectives: The aims of this article are: (a) to test for the validity of the three constructs involved in the structural model; (b) to test for the effects of both coping strategies and resilient coping on well-being in a sample of elderly, by means of a structural model with latent variables; (c) to empirically study whether a brief scale of resilient coping could predict well-being over and above that predicted by the coping resources. Methods: The research is a survey design. The sample consisted of 225 non-institutionalized elderly people living in the city of Valencia (Spain). The three constructs measured were: well-being, resilient coping, and coping strategies. Results: The analyses consist of a series of alternative structural models with latent variables with resilience, problem-focused coping, and emotion-focused coping as the potential predictors of well-being as measured by Ryff's well-being scales. Due to parsimony reasons, the model retained is that with a single predictor of well-being: resilient coping. Conclusion: A latent variable measuring resilient coping is able to predict a significant and large part of the variance in well-being, without the need of including coping strategies. Results impact on well-being literature of the elderly is discussed.

The relationship between nutrient intake, dental status and family cohesion among older Brazilians

The aim of this study was to investigate the relationship between inadequate nutrient intake, oral health and family cohesion. This was a cross-sectional study with a sample of 887 non-institutionalized elderly people from Vitória, Espírito Santo State, Brazil. Oral examination was performed by trained and calibrated examiners and three measurements were considered: number of posterior occluding pairs of natural teeth (POP), number of teeth and overall dental status. Nutrient intake was assessed by a 24-hour diet recall interview. The elderly person's perception of family cohesion was assessed using the family adaptability and cohesion scale. People with no POP were more likely than those with 5 or more POP to have inadequate intake of vitamin C (OR = 2.79; 95%CI: 1.16-6.71), calcium (OR = 3.74; 95%CI: 1.69-8.25), riboflavin (OR = 2.49; 95%CI: 1.10-5.64) and zinc (OR = 3.43; 95%CI: 1.07-10.94). There was no association between elderly people's perceptions of family cohesion and inadequate intakes. It was concluded that oral health is related to inadequate intake of important nutrients among non-institutionalized elderly people.

Evaluation design for a complex intervention program targeting loneliness in non-institutionalized elderly Dutch people.

BackgroundThe aim of this paper is to provide the rationale for an evaluation design for a complex intervention program targeting loneliness among non-institutionalized elderly people in a Dutch community. Complex public health interventions characteristically use the combined approach of intervening on the individual and on the environmental level. It is assumed that the components of a complex intervention interact with and reinforce each other. Furthermore, implementation is highly context-specific and its impact is influenced by external factors. Although the entire community is exposed to the intervention components, each individual is exposed to different components with a different intensity.Methods/DesignA logic model of change is used to develop the evaluation design. The model describes what outcomes may logically be expected at different points in time at the individual level. In order to address the complexity of a real-life setting, the evaluation design of the loneliness intervention comprises two types of evaluation studies. The first uses a quasi-experimental pre-test post-test design to evaluate the effectiveness of the overall intervention. A control community comparable to the intervention community was selected, with baseline measurements in 2008 and follow-up measurements scheduled for 2010. This study focuses on changes in the prevalence of loneliness and in the determinants of loneliness within individuals in the general elderly population. Complementarily, the second study is designed to evaluate the individual intervention components and focuses on delivery, reach, acceptance, and short-term outcomes. Different means of project records and surveys among participants are used to collect these data.DiscussionCombining these two evaluation strategies has the potential to assess the effectiveness of the overall complex intervention and the contribution of the individual intervention components thereto.

Psychoactive Drugs as Risk Factors for Functional Decline Among Noninstitutionalized Dependent Elderly People

To analyze the association between use of psychoactive drugs and functional decline among noninstitutionalized dependent elderly people. Cross-sectional study. A total of 161 community-dwelling elderly people with functional dependence. The data were analyzed using logistic regression with adjustment for age models. The independent variables were the following: use of psychoactive drugs (antidepressants, anticonvulsants, anxiolytics, antipsychotics, or sedatives), cognitive decline (Mini-Mental State Examination score<20), and daytime sleepiness. The dependent variables were the following: dependence relating to activities of daily living (ADLs) and dependence relating to instrumental activities of daily living (IADLs). Data on 131 individuals of mean age 77.5 years were analyzed. Psychoactive drugs were used by 33.6%. Age-adjusted univariate analysis showed associations between psychoactive drug use and both ADLs and IADLs. However, in multivariate analysis, only ADLs showed a significant association with psychoactive drug use, independent of cognitive decline and daytime sleepiness (OR=2.67; 95% CI: 1.04-6.85; P=.04). There is a greater risk of impairment of ADLs among noninstitutionalized elderly people using psychoactive drugs. These results indicate the need for rational use of medication groups among this population with greater risk of functional impairment.

Oral and dental health of non-institutionalized elderly people in Spain

With aging of the populations, the oral health and hygiene of elderly people has become an important public health issue. In this cross-sectional study we investigated the prevalence of tooth decay and other periodontal diseases in a representative cohort of 480 non-institutionalized adults ≥65 years from the province of Valencia, Spain. Using a World Health Organization standard for an adult oral survey methodology, we obtained data on remnant teeth with the decayed, missing and filled teeth (DMFT) index, a Community Periodontal Index of Treatment Needs (CPTIN), attachment loss, and temporo-mandibular articulation (TMA) status. The prevalence of these conditions were compared by age and gender, using the Chi-square, and Student's t-, and ANOVA statistical tests. The mean number of remaining teeth were 17.1 in the total sample, which was higher for women (17.9 versus 15.7 in men; p = 0.04). This mean number decreased as age increased ( p < 0.05). The overall DMFT index was 19%, showing a persistent increase with age from 14% (65–69-year) to 23% (≥80-year) ( p = 0.118). Only 6% of participants had no periodontal pathology, while 26% had bleeding gums and 57% had calculus, while attachment loss was observed in 31%. TMA malfunction with a click was present in 6%, was painful in 5%, and was associated with reduced mouth-opening in 2%. The prevalence of oral health pathologies was high among these elderly people, who would benefit from optimal oral health care.

Valores subjetivos de las dimensiones de calidad de vida en adultos mayores

The present study analyzes the subjective importance of five quality-of-life dimensions among non-institutionalized elderly people (>65 years old). A Thurstonian design for paired comparisons was used to estimate subjective values for five quality-of-life dimensions (health, autonomy, housing, family and social support networks, and social activities) in a sample of 404 persons (168 men and 234 women) aged 65-94 years old. The most important dimension was health, which was given the highest subjective value, followed by personal autonomy. The third most important dimensions were housing adapted to age-related needs and support networks, with practically equivalent values. The least important dimension was social activities. Significant differences between genders were detected in educational level and income, but the rank order of the dimensions and the subjective values assigned to them were equivalent for men and women.

Serum albumin levels as an independent predictor of 4-year mortality in a community-dwelling 80-year-old population

Although serum albumin levels are associated with mortality in non-institutionalized elderly people under 80 years old, as well as in the institutionalized very elderly, little is known about the relationship in community-dwelling very elderly people. We, therefore, examined the association in a Japanese population of 80-year-old community residents. Serum albumin levels were measured in 672 (267 men, 405 women) out of 1282 80-year-old individuals. Over the following 4 years, the dates and causes of death were recorded from resident registration cards and official death certificates. Of the above individuals, 107 subjects died (58 men, 49 women: 27 due to cancer, 27 cardiovascular disease, and 22 pneumonia). Survival rates were compared among 4 groups (highest >or=45 g/L, higher than 43-44 g/L, lower than 41-42 g/L, lowest <or=40 g/L). After adjustment for confounding factors, total death or cardiovascular death in the lowest albumin group was 3.1 times and 10.7 times more incident than in the highest albumin group, but there were no differences among groups as regards deaths due to cancer or pneumonia. Serum albumin levels are an independent predictor of mortality due to all-cause or cardiovascular disease, but not of mortality due to cancer or pneumonia in very elderly Japanese community residents.

Death Anxiety in Institutionalized and Non-Institutionalized Elderly People in Spain

To know the level of death anxiety using the Templer Death Anxiety Scale (DAS) (1970) (Ramos's Spanish adaptation, 1982)) we chose subjects older than 65 years (N = 227) to study, on one hand, the existing relation between cognitive-affective reactions toward death and the perception of the passing of time and, on the other, a group of variables which include the place of residence, age, gender, life reflection, health disorders, psychological problems, religious aspects, and socio-demographics features. To undertake this, a questionnaire was administered in which the participants answered according to their degree of agreement to several alternatives. The data indicates, by means of an analysis of variance, significant differences between these variables and death anxiety, with the exception of the religious aspects and civil state.

Prevalence and correlates of influenza vaccination among non-institutionalized elderly people: An exploratory cross-sectional survey

Background Worldwide pandemics of influenza virus caused extensive morbidity and mortality around the world and influenza vaccination is the most effective method for preventing influenza virus infection and its potentially severe complications. A large proportion of the Hong Kong elderly population has not undergone influenza vaccination. An exploration of the correlates will provide significant information to help identify ways of improving vaccination uptake among Chinese elderly people. Objectives To explore the prevalence and correlates of influenza vaccination Hong Kong Chinese elderly people aged 65 or above. To investigate any differences in attitudes toward influenza vaccination among Hong Kong elderly people with different levels of cognitive and physical functioning. Design An exploratory cross-sectional survey with two objective assessments was employed. Settings: Fifteen elderly centers in Hong Kong Special Administrative Region. Participants: A total of 816 Hong Kong Chinese elderly participants were recruited. Methods Face-to-face interviews were adopted to explore the demographic characteristics, perceptions, health status, knowledge, and resources of, and the influence of disease outbreaks on, influenza vaccination. Two objective validated instruments, the Chinese Mini-Mental State Examination (CMMSE) and the Barthel Index-Modified Chinese Version (MCBI) were used to assess the cognitive status and physical functioning of the participants. Results Approximately two in three individuals (62.4%) had undergone influenza vaccination. Lower cognitive and physical functioning scores were found among the non-vaccinated participants. Multivariate logistic regression analyzes revealed the significant correlates associated with influenza vaccination to be consideration of vaccination in the subsequent years (aOR = 7.877; p < 0.001); consideration of vaccination if all people aged 65 or above were eligible to receive free vaccination (aOR = 3.024; p = 0.002); the belief that there is a need to receive influenza vaccination following the Severe Acute Respiratory Syndrome (SARS) and avian influenza (aOR = 2.413; p = 0.001); receiving advice from nursing staff of elderly centers (aOR = 7.161; p < 0.001); the medical staff of elderly centers (aOR = 3.771; p < 0.001) or family members or friends (aOR = 3.023; p = 0.001). Conclusions The prevalence of elderly Chinese people undergoing influenza vaccination remains suboptimal. The government can promote vaccination by educating the public about the advantages, by publicizing locations where vaccinations are available, and having nursing, other medical staff, family and friends encourage elderly people to be vaccinated. A high vaccination coverage rate must be ensured to achieve international goals.

Relationship between blood pressure and depression in the elderly. The Three-City Study

To examine the relationship between blood pressure and depression in a large sample of noninstitutionalized elderly people. Cross-sectional community-based study in 9294 participants aged 65 years and over, living at home, in three French cities (Bordeaux, Dijon and Montpellier). Participants were categorized as depressive, based on three different markers of depression. Multiple linear regression analyses of the relation between depression and mean systolic and diastolic blood pressure values were conducted, taking into account potential confounders like age, sex, education, smoking, alcohol consumption, body mass index and history of cardiovascular events. Our working sample had a mean age (SD) of 73.7 (5.0) years, and included 60.7% of women. Overall, 31% of participants met the criteria for depression, 77.5% had hypertension, and 49.5% were on antihypertensive drugs. Analyses showed lower systolic and diastolic blood pressure values in depressive individuals compared with nondepressive ones, in both men (systolic blood pressure 148.2 versus 151.8 mmHg, P < 0.002; diastolic blood pressure 83.0 versus 84.7 mmHg, P = 0.003) and women (systolic blood pressure 141.7 versus 144.7 mmHg, P < 0.0001; diastolic blood pressure 80.7 versus 81.4 mmHg, P < 0.02). These associations were independent of age and of use of antihypertensive or psychotropic agents. In a large sample of elderly individuals from the general population, depressive individuals had lower blood pressure values than nondepressive ones, independent of medications and of history of cardiovascular events.

Health Attitudes and Behaviour as Predictors of Self-rated Health in Relation to Mortality Patterns (17-year Follow-up in a Polish Elderly Population - Cracow Study)

The aim of this 17-year Cracow (Poland) study was to examine and identify the determinants most responsible for the relationship between self-rated health and mortality in non-institutionalized elderly people. Base-line data were collected in a simple random sample of 2,605 Cracow residents, aged 65 years and over. The vital status of all individuals under study was established by monitoring city records. Death certificates were obtained for the deceased and coded according to the underlying cause of death. Predictors related to self-rated health, developed using the results of principal component analysis, were modelled on three indexes: individual predisposition (to disease based on family history), caring about health in the past, and attitudes toward health. Cox multivariate analysis confirmed the significant role of self-rated health in the mortality patterns of women (HR = 1.18). Those who cared greatly about health in the past had a lower mortality risk than those who cared poorly (HR = 1.19). In men, a positive attitude towards health remained an independent predictor of mortality (HR = 1.20). Multivariate regression models found self-rated health to be a significant independent predictor of mortality only in women with a low level of individual predisposition (hazard ratio for self-rated health = 1.35) and in those with a positive attitude towards health (hazard ratio for self-rated health = 1.16).