Older People In Terms Research Articles

Age 70 and older a criterion for inclusion - not exclusion

Although older people are frequently prescribed more drugs than younger people, they are rarely included in clinical trials. Elderly patients often suffer from multimorbidity and are prescribed many drugs simultaneously. With age, physiological changes occur that can affect the pharmacokinetics and pharmacodynamics of the drugs used, e.g., changes in the duration of action. There are several problematic implications to this, particularly relating to tolerability and possible negative effects for patients. Not only are guidelines for the treatment of elderly patients lacking, but also basic information about efficacy, tolerability, and interactions of drugs that are commonly prescribed to the elderly often missing. Physicians sometimes have no choice but to estimate the correct dosages for the elderly. Evaluations of secondary data and clinical trials, discussion, and analysis of basic research work on the basis of expert analysis. There are very few clinical trials that include people over the age of 70. On the one hand, elderly people receive more drug prescriptions due to multimorbidity, compared with younger people, while on the other hand the risk of adverse drug reaction increases for precisely these individuals. In order to improve treatment safety in older people in terms of duration and dosage, randomized control trials (RCT) are essential to provide evidence of the benefits of a drug to patients. For this reason, the call for clinical trials after as well as before authorization, on patients treated with these drugs-and that especially means elderly patients-is long overdue.

Efficacy of memory training in healthy community-dwelling older people: study protocol for a randomized controlled trial.

BackgroundThere is limited evidence on the efficacy and social utility of cognitive training. To address this, we have designed a randomized controlled trial to assess the effectiveness of memory training workshops for healthy older people in terms of their short- and long-term impact on cognitive function, health-related quality of life, and functionality.Methods/designA randomized controlled trial will be performed in health care centers in Barcelona (Spain) through comparison of a group of individuals participating in memory training workshops (experimental group) with another group with similar characteristics not participating in the workshops (control group). The intervention will consist of twelve 90-minute group sessions imparted once a week by a psychologist specialized in memory training. The groups will each comprise approximately 15 people, for a total number of 230 patients involved in the study. Each session has its own objectives, materials and activities. The content of the intervention is based on memory training from different perspectives, including cognitive and emotional aspects and social and individual skills. Data will be collected at baseline, at 3–4 months and at 6 months. To assess the efficacy of the intervention on cognitive function, health-related quality of life and functionality, a statistical analysis will be performed by fitting a repeated-measures mixed effects model for each main outcome: Self-perceived memory, measured by a Subjective Self-reported Memory Score (from 0 to 10) and by the Memory Failures in Everyday life questionnaire (MFE); Everyday memory, measured using the Rivermead Behavioural Memory Test-3 (RBMT-3) and Executive control abilities, measured in terms of visual-perceptual ability, working memory and task-switching ability with the Trail Making Test (TMT) and with the digit span scale of the Wechsler Adult Intelligence Scale III (WAIS III).DiscussionThe results of this study will be highly useful for social and public health policies related to older people. Given the continuous increase in the prevalence of older people, a large number of interventions targeting memory loss are funded by public resources. To ensure transparency and effective prioritization, research such as the present study is needed to provide evidence of the effectiveness and usefulness of these interventions.Trial registrationNumber: NCT02431182.

A comprehensive grid to evaluate case management’s expected effectiveness for community-dwelling frail older people: results from a multiple, embedded case study

BackgroundCase management is a type of intervention expected to improve the quality of care and therefore the quality of life of frail, community-dwelling older people while delaying institutionalisation in nursing homes. However, the heterogeneity, multidimensionality and complexity of these interventions make their evaluation by the means of classical approaches inadequate. Our objective was twofold: (i) to propose a tool allowing for the identification of the key components that explain the success of case management for this population and (ii) to propose a typology based on the results of this tool.MethodsThe process started with a multiple embedded case study design in order to identify the key components of case management. Based on the results of this first step, data were collected among 22 case management interventions, in order to evaluate their expected effectiveness. Finally, multiple correspondence analyses was conducted to propose a typology of case management. The overall approach was informed by Wagner’s Chronic Care Model and the theory of complexity.ResultsThe study identified a total of 23 interacting key components. Based on the clustering of response patterns of the 22 case management projects included in our study, three types of case management programmes were evidenced, situated on a continuum from a more “socially-oriented” type towards a more “clinically-oriented” type of case management. The type of feedback provided to the general practitioner about both the global geriatric assessment and the result of the intervention turned out to be the most discriminant component between the types.ConclusionThe study design allowed to produce a tool that can be used to distinguish between different types of case management interventions and further evaluate their effect on frail older people in terms of the delaying institutionalisation, functional and cognitive status, quality of life and societal costs.Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-015-0069-1) contains supplementary material, which is available to authorized users.

Older People’s Functional Capacity and Lifestyle Patterns

The study assessed the functional capacity of older people in terms of activities of daily living (ADLs), instrumental activities of daily living (IADLs), and the older adult’s dietary patterns. It also determined the lifestyle pattern of older people in terms of rest, physical activities/exercises, leisure/ stress-reduction activities as well as the older adult’s views on proper nutrition. A descriptive-quantitative design was used. A total of 60 older Malaysian people living in selected Cheras communities were interviewed. The study employed a modified and researcher-made questionnaire, which has four parts: demographic data, functional capacity, lifestyle patterns and Mini Nutritional Assessment Test. Majority of the participants were aged 60 to 80 years (the young old). They consists of 44 men and 16 women, mostly Chinese (60%), followed by Indians (23%) and Malay (17%). Older people from these selected Cheras communities are healthy but there is a need for health campaigns on the importance of consumptions of dairy products as majority of the respondents do not take dairy products. Weighted mean show no assistance needed for activities of daily living (ADLs) and instrumental activities of daily living (IADLs). The older peoples’ physical activities and sleeping patterns, smoking and alcohol consumption are positive. However, health teaching may be given on importance of dairy products consumption, exercise, and leisure, as well as stress reduction activities. Keywords: Functional capacity, lifestyle patterns, nutritional views, dietary patterns, older people, Malaysia

Systematic review of health-related quality of life in older people following percutaneous coronary intervention.

People aged over 60 years represent an increasingly high proportion of the population undergoing percutaneous coronary intervention. While risks are greater for older people in terms of major adverse cardiovascular events and higher mortality for this treatment, it is unclear if the benefits of health-related quality of life outcomes may outweigh risks. A search of the PubMed, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica, and Cochrane databases was conducted for the period from January 1999 to June 2012 using key words "percutaneous coronary intervention"/"angioplasty," "older," "elderly," and "quality of life"/"health-related quality of life." Using a systematic review approach, data from 18 studies were extracted for description and synthesis. Findings revealed that everyone regardless of age reported better health-related quality of life, primarily from the relief of angina and improved physical and mental function. Age itself did not have an independent predictive effect when other factors such as comorbid conditions were taken into account. Assessment of older peoples' health status following percutaneous coronary intervention by nurses and other health professionals is therefore important for the provision of quality care.

The Analysis of the Guidance and Psychological Counselling Needs of Older People in Terms of Several Variables

This study examines the guidance and psychological needs of older people in terms of two variables: current employment status of older people and the place where they have spent most of their lives. The sample group of the study consists of 667 randomly selected independent older people who resided in the city centres of Amasya, Samsun and Sanlıurfa between 2009 and 2010. The study shows that there is a significant difference between current employment status of older people, the type of place where they have spent most of their lives, and the guidance and psychological counselling needs of them.

Empowerment of Senior Citizens via the Learning of Information and Communication Technology

Most East Asian countries have policies to promote digital inclusion, especially among the children of low-income families and persons with disabilities, for the purposes of social development. However, such efforts and their impact among older people have been rather limited. In Hong Kong, only 7 % of those aged 65 or above were Internet users in 2008, compared with 66.7 % of the general public. Providing computer and Internet training programmes to older people is thus crucial in promoting digital inclusion. This paper discusses the experience and results of training older people to use both a computer and the Internet. Based on findings from an earlier qualitative study, we hypothesise that acquiring knowledge of computers and Internet use will have an empowering effect for older people in terms of increasing self-efficacy and enhancing communication with friends and family members. This paper presents two studies of such empowerment among older people in two non-governmental organisations (NGOs). While older people with little computer knowledge showed some effects of empowerment, at the same time, they also became more aware of the marginalisation and exclusion effects of their limited knowledge of computer and Internet usage. However, among users with some prior experience of using a computer, further training failed to show additional positive empowerment results. The results of the two studies call for a re-examination of the training process and experience of older people as well as integration of such training with other strategies to achieve better results in promoting their social inclusion in the information society.

Work restrictions experienced by midlife family care-givers of older people: evidence from six European countries

ABSTRACTThis paper examines differences in work restrictions of midlife family carers of older people in terms of prevalence, gender and explanatory variables, in six European countries: Germany, Greece, Italy, Poland, Sweden and the United Kingdom. A sample of 2,897 carers aged 45–64 was extracted from the EUROFAMCARE (Services for Supporting Family Carers of Older People in Europe: Characteristics, Coverage and Usage) European project database, in order to analyse four possible work restrictions experienced in connection with the activity of care-giving: the reduction of working hours; giving up working; difficulties in career developments and forced occasional work. The results show that work restrictions are experienced differently between countries especially by women: they are reported to a higher degree in the United Kingdom, Germany and Greece, less so in Italy, and seldom in Poland and Sweden. Gender differences within countries are not so marked. Country differences are explained in the light of the different welfare regimes characterising the countries under investigation, in order to elucidate how policy makers may act to improve working carers' conditions through appropriate policies.

Evaluation of selected forms of physical activity of older people - pilot study

Abstract Introduction: Regular physical activity can prevent sharp decline in the level of physical fitness of older people [1]. Both the quantity and quality of physical activity are important [2]. The aim of this study was to evaluate selected forms of physical activity of older people in terms of intensity of effort. Material and methods: In the study participated 10 women at the age of 73.6 ± 6.5 years, from the Third Age University at the University of Physical Education in Warsaw. The study included four forms: gymnastics, Nordic walking, dancing and Tai Chi. The study used IDEEA device (Intelligent Device for Energy Expenditure and Activity) and a pulse recorder (Polar). In addition, each of the woman immediately after class evaluated its intensity with the 20 points Borg Scale. Results: The results indicate a large diversity of physical activity in terms of work done, energy consumption, heart rate. Nordic Walking classes were most intense (2.8 kJ/min, 3.5 kcal/min, 101.5 beats/min) and Tai Chi was least intense (0.5 kJ/min, 1.6 kcal/min , 65 beats/ min). Subjective evaluation of intensity (Borg Scale) of the trainings confirms the values obtained by the objective methods - quite heavy (14 points) in Nordic Walking and very light (10 points) in Tai Chi. Conclusions: There is a need for a reliable analysis of proposed forms for the elderly in Poland. Using multiple measurement tools will help to increase the objectivity of the evaluation and defining their impact on the capabilities of older people. A comprehensive assessment can be used in programming physical activity for older people.

Bereavement care for older people in healthcare settings: qualitative study of experiences

This study aimed to explore the experiences of healthcare staff of caring for bereaved older people, and older people's experiences of bereavement care. Loss through death of close family members, partners and friends inhibits the physical, emotional and social well being of older people. The rising population of older people and pressure on healthcare services to reduce costs indicate the necessity of developing strategies that enable coping and independence. A qualitative design drawing on phenomenological methodology was used to understand interactions between healthcare staff and bereaved older people. The study was set in hospital wards, general practice and community nursing teams, and care homes. Healthcare staff and a sample of recently bereaved older people participated. Purposive sampling took place to recruit staff with a range of roles, and older people who were 65 years of age or more, and bereaved of a family member or friend for between 6 months and 5 years. Participants took part in in-depth interviews, and data were analysed systematically. Thirty-nine participants were recruited, and three key themes arose from the data: (i) Bereavement care depends on an established relationship between healthcare staff and the patient's relatives; (ii) Preparation for the relative's death may not equate to being prepared for bereavement; (iii) The 'Open Door' to bereavement care is only slightly ajar. The study identified the interactions of healthcare staff with bereaved older people in terms of the bereavement journey. Staff demonstrated awareness of difficulties the bereaved person may encounter and showed commitment to providing support. However, lack of flexibility in services restricts meaningful interactions. (i) Healthcare staff may identify gaps in services in terms of preparing relatives and follow-up post-bereavement; (ii) Therapeutic relationships between staff and relatives enable ongoing support; (iii) Development of practice guidelines is a key consideration.

Health Care for Older Persons in Colombia: A Country Profile

Colombia is a country of approximately 42 million inhabitants, with some 2.5 million being aged 65 and older. Currently, life expectancy in Colombia is 72.3. By 2025, the population life expectancy at birth will be 77.6 for women and 69.8 for men. The quality of care that people receive as they age in Colombia varies according to where they live. Individuals living in the highly urbanized areas of Colombia receive high-quality care, whereas elderly subjects living in rural areas and in the southern and northern regions are exposed to unemployment, low income, inequity of access to health care, drug trafficking, and armed conflict. In spite of these problems, characteristics of aging of older people in terms of functionality and healthcare access are similar to those of people living in developing countries around the world. This article reviews the particular characteristics of the elderly population in Colombia, especially the significant changes that have happened in recent years, when social instability and conflict have determined that health resources be redirected to other budget priorities such as defense and security.

Social Theory, Aging, and Health and Welfare Professionals

Health and welfare have emerged as pivotal drivers used to position the identities that older people adopt in contemporary Western societies. Both contain continually changing technologies that function to mediate relations between older people and care professionals. However, they also represent an increase in professional control that can be exerted on lifestyles in old age, and thus, the wider social meanings associated with that part of the life course. The article presents a theoretical analysis of gerontology based on a critical reading of the work of Michel Foucault. It identifies the interrelationship between managerialism and older people in terms of a conceptual toolkit of (a) “medical power,” and (b) “assessment,” “surveillance,” and “resistance”; the key point is that they are relevant in theorizing power relations between health and welfare professionals and user groups such as older people.

Severe Elder Obesity and 1‐Year Diminished Lower Extremity Physical Performance in Homebound Older Adults

To determine whether severe obesity in older people is independently associated with diminished lower extremity physical performance (LEP) in a random sample of homebound older adults that were considered ambulatory. Prospective cohort with 1 year of follow-up (2000-02). In-home assessments of homebound older adults in four North Carolina counties. Random sample of 282 home-delivered meal recipients aged 60 and older who completed both in-home assessments (n = 253) or were nursing home residents (n = 29) at the 1-year follow-up assessment of the Nutrition and Function Study. Objective measures were selected for baseline and 1-year LEP (timed walking, static and dynamic balance, and chair rise) and baseline body mass index (BMI, based on measured weight and knee height). BMI was categorized as underweight/normal (<25.0 kg/m2), overweight (25.0-29.9 kg/m2), moderately obese (30.0-34.9 kg/m2), and severely obese (> or =35.0 kg/m2). Based on summary scores, overall LEP was categorized as poor, intermediate, or good. Sample characteristics included depressive symptomatology, fear of falling, medical conditions, and medication use. Almost 23% of participants were moderately obese and 15% severely obese. Only severe obesity independently increased the odds (odds ratio 2.9-7.0) for diminished performance at 1 year in individual tests and in overall LEP performance. Severe obesity was independently associated with poor LEP at both assessments or with decline in LEP at 1 year. These results highlight the need to distinguish between moderate and severe obesity in older people in terms of relationships with key functional outcomes. The findings identify severe obesity in older people as an important target for future interventions. In particular, this calls for greater understanding of intervention goals, whether to primarily target weight reduction or improvement in physical performance.

A position paper: Creativity, older people and health

One of the most significant features of society in the 21st century is the tendency for people in the later stages of their lives to want to play a more participative role. Seeking to be creative, offering community leadership, taking a second career are just some examples of what is becoming commonplace. However, one of the biggest problems we face is that those who are less visible in the community, such as older and retired people, or people living in isolated rural areas, usually have fewer opportunities to meet people and thus can easily find themselves disengaged from society. This can frustrate their desires to participate in society. Many may then become depressed and lonely, lacking the motivation to become re-engaged with their neighbourhood. They then gradually lose their identity as valuable and valued members of society, and often their health begins to suffer as well, producing personal distress and imposing additional demands on health care. This position paper proposes a qualitative study of an intervention aimed at improving the lives of older people in terms of issues raised by the literature, and describes appropriate methodology and methods for answering these questions, which we see as essentially educational questions within the framework of lifelong learning.

Vaccination in older people.

Vaccinating older people remains a priority in the specialty of public health. However, medical practitioners, pharmacists, carers and family members and the media need to make a special effort to inform and educate older people of the need to protect themselves against certain diseases, such as influenza, pneumococcal pneumonia and tetanus. These conditions pose particular health risks to older people in terms of the high risk of developing serious complications.

Book reviews

An exhaustive manual spanning the last few decades of the human life, this book claims to ‘look beyond the debates of funding and resources’. It therefore gives an idealized and in some areas unattainable standard of practice through not taking these two crucial factors into account. It does, however, voice regret that the disciplines involved in working towards improvements for older people in terms of housing, leisure and communication are not represented.

Reproducing elder male power through ritual performance in Japan.

Most research by gerontologists into the relationship between religion and aging has focused upon the potential health benefits of religious participation among Americans who follow Judeo-Christian oriented forms of worship and belief. This research has shown that both as a social institution and source of existential meaning, religion provides an important resource for older people in terms of fellowship and as a means of coping and adapting to social change and personal loss. Other religious traditions and other aspects of salience of religious participation for older people have been less thoroughly considered. This article investigates a religious ritual in Japan, that, rather than being a source of consolation, is an expression of symbolic capital associated with elder status and, thus, gerontocratic power. The ritual contributes to representing and reproducing the power of older residents in a rural Japanese community, partly due to its being administratively situated within an age-grade system that is a part of neighborhood political organization. Through its performance, the ritual visually reproduces and represents stratified social structures that concentrate power in the hands of male members of the senior age grade.

Managing Old Age: The Disciplinary Web of Power, Surveillance and Normalization

Health and welfare have emerged as key vehicles used to legitimize and position the identities that older people adopt in contemporary western societies. Both health and welfare contain specific yet continually changing technologies that function to mediate relations between older people and the state. Medico-technical and care management discourses have been presented as adding choice and reducing limitations associated with adult aging. However, they also represent an increase in professional control that can be exerted on lifestyles in older age and thus, the wider social meanings associated with that part of the lifecourse. This article presents a theoretical analysis based on a critical reading of the work of Michel Foucault; identifies the interrelationship between managers and older people in terms of power, surveillance and normalization; and highlights how and why older people remain the subjects of legitimizing professional gazes.

Time perception and psychological well-being in the elderly.

Perception of time is a concept that has interested gerontologists for many years, but why "time flies" as the years go by is not well understood. Two hundred and ninety-six institutionalized and community dwelling elderly (X = 75.4 years) were administered a battery of psychological measures to test the relationship between emotional well-being and subjective speed of time. Faster time perceptions were associated with better psychological functioning--less clinical depression, enhanced sense of purpose and control, and "younger" perceived age--while the opposite perception held true for elders with time "on their hands." Time also moved slower for many institutionalized elders. The clinical implications for treating older people in terms of utilizing their time more effectively and meaningfully are discussed.