Population Of Older Adults Research Articles

Psychometric Properties of the World Health Organization Quality of Life Scale for Older Adults (WHO-QoL-Old) in a Mexican Population.

The present study aimed to contribute to analyzing the psychometric properties of the WHO Quality of Life Scale for Older Adults (WHO-QoL-Old) in a sample of older adults in Michoacán, Mexico. 111 older adults from Michoacán, Mexico, participated in the study. Confirmatory factor analysis (CFA) was conducted to test the fit of various models. Data analysis was performed using R Studio, considering the ordinal nature of the items in the model estimation method. Internal consistency was evaluated using the alpha coefficient (α) and McDonald's omega coefficient (ω). The CFA indicated that the six-correlated-factor model proposed theoretically showed a very good fit (χ2: 397.11, p < 0.001; CFI: 0.958; SRMR: 0.079; RMSEA: 0.079). The factors within the model demonstrated acceptable internal consistency, with an alpha coefficient ranging from 0.739 to 0.874 and an omega coefficient ranging from 0.748 to 0.882. It is concluded that the WHO-QoL-Old scale presents good psychometric properties for the Mexican older adult population.

The Association Between Cognitive Function and Oral Health in Home Dwellers and Nursing Home Residents: The HUNT Study.

To evaluate the relationships of cognitive function and care dependency with oral health in a Norwegian older adult population. This cross-sectional study included 2623 participants aged 70 and older from the fourth wave of the Trøndelag health study (HUNT4 70+) and the city of Trondheim (Trondheim 70+). Neurocognitive disorders (NCDs) were diagnosed by clinical experts according to the DSM-5 framework. Care dependency referred to nursing home residency. Oral health was assessed by using the Revised Oral Assessment Guide-Jönköping (ROAG-J). Individuals were considered as 'having oral problem' if the score was two or three in at least one of the nine ROAG-J items. Poisson regression was used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs). The prevalence of having oral problems was 19% higher in participants with NCDs than those with normal cognitive function after adjusting for potential confounders (PR 1.19, 95% CI: 1.09-1.29). Further analysis showed a higher prevalence of having oral problems for home dwellers with NCDs (PR 1.23, 95% CI: 1.13-1.33) and nursing home residents (PR 1.32, 95% CI: 1.20-1.45) compared to home dwellers with normal cognitive function. NCDs were associated with an increased prevalence of oral problems in this Norwegian older adult population. The study suggests the need for increasing oral care for home dwellers with NCDs and nursing home residents.

Impact of medical-nursing combined policy pilot on hospitalization frequency of middle-aged and older patients with chronic diseases: a quasi-experimental study based on China Health and Retirement Longitudinal Study.

To address the growing burden of older adult care, the Chinese government has introduced a policy that integrates medical care with elder care, launching two batches of national pilot projects. A majority of the older adult population suffers from one or more chronic diseases, with many experiencing multiple chronic conditions, necessitating support from both elder care and medical services. Using panel data from the China Health and Retirement Longitudinal Study (CHARLS) spanning 2011 to 2020, this study employs the difference-in-difference (DID) model to analyze the impact of the integrated medical-nursing policy on the physical health of older patients with chronic diseases. The study found that the average annual number of hospitalizations for older individuals with one or more chronic diseases was 0.276. The integrated medical-nursing policy reduced hospitalizations by 0.0405. Additionally, the average annual hospitalization rate for older individuals with two or more chronic diseases was 0.339, higher than the former group. The integrated medical-nursing policy reduced hospitalizations by 0.0738 in this group. The pilot study demonstrates that the implementation of the integrated medical-nursing policy has significantly improved the physical health of older patients with chronic diseases. The government should promote these policies on a larger scale, explore various forms of integrated medical care, and provide more comprehensive medical and elder care services for older patients with chronic diseases.

Correlates and Brain Substrates of Happiness in Community-Dwelling Older Adults in India.

Happiness has been shown to influence many health-related outcomes in older adults. Identifying correlates and brain substrates of happiness across countries and cultures is an important goal, as the global older adult population continues to increase. We used univariate and multiple regression to examine associations between happiness and several demographic, health, and lifestyle variables in 665 older adults (39% female) from Kerala, India. We also used Bayesian regression to examine associations between cortical thickness and happiness in a sub-sample of 188 participants that completed MRI scanning. Happiness was significantly associated with several variables. In our multiple regression model, which included all significant univariate predictors, self-rated health, depression, anxiety, apathy, social network size, social network diversity, and social support significantly predicted happiness. Demographic indicators (age, sex, education, marital status, residence, and employment status/type), cognitive impairment, comorbidities, and leisure activities were not significantly associated with happiness in the multiple regression model. Cortical thickness in several brain regions was positively associated with happiness scores, including frontal, temporal, parietal, occipital, and cingulate regions. Understanding the key correlates is critical for identifying both modifiable factors that can be targeted in well-being interventions and fixed characteristics that identify those at-risk for reduced happiness. The widespread pattern of brain regions associated with happiness is consistent with the multifactorial nature of happiness and, given that the regions identified do not overlap with those vulnerable to cortical thinning, can help explain why subjective well-being, unlike other cognitive functions, is largely resistant to age-related decline.

Diagnostic value of effusion adenosine deaminase, γ-interferon release assay and effusion lactatedehy drogenase/effusion adenosine deaminase for tuberculous pleural effusion in patients aged 60 years and above.

China is experiencing rapid growth in its population of older adults, which may lead to increased susceptibility to tuberculous pleural effusion (TPE) due to age-related changes in the immune system. This study aimed to investigate the diagnostic potential of multiple biomarkers in individuals aged 60 years and above with pleural effusion. A total of 519 adult patients from Ningbo First Hospital were included in the study, with 7 biomarkers and their ratios in serum and pleural effusion analyzed using logistic regression analysis. Effusion Adenosine Deaminase(ADA), γ-Interferon Release Assay(IGRA), and Effusion lactatedehy drogenase(LDH)/Effusion ADA were identified as valuable parameters for differentiating TPE from non-TPE, particularly in individuals aged 60 years and older. Effusion ADA, IGRA, and Effusion LDH/Effusion ADA were identified as valuable parameters for the differential diagnosis of TPE from non-TPE, showing good diagnostic performance in individuals aged 60 years and older. The combined diagnosis of these three indexes achieved the highest diagnostic accuracy for TPE in this age group, with an AUC of 0.925, sensitivity of 85.23%, and specificity of 89.57%. Overall, the study highlights the importance of using multiple indicators for a combined diagnosis to improve diagnostic efficacy in detecting tuberculous pleurisy in older individuals as for young patients.

Genome-wide association study of subfoveal choroidal thickness in a longitudinal cohort of older adults

To identify genetic influences on subfoveal choroidal thickness of older adults using a genome-wide association study (GWAS). We recruited 300 participants from the population-based Korean Longitudinal Study on Health and Aging (KLoSHA) and Korean Longitudinal Study on Cognitive Aging and Dementia (KLOSCAD) cohort studies and 500 participants from the Bundang age-related macular degeneration (AMD) cohort study dataset. We conducted a GWAS on older adult populations in the KLoSHA and KLOSCAD cohorts. Single nucleotide polymorphisms (SNPs) associated with choroidal thickness were identified with P values < 1.0 × 10−4 in both the right and left eyes, followed by validation using the Bundang AMD cohort dataset. This association was further confirmed by a functional in vitro study using human umbilical vein endothelial cells (HUVECs). The ages of the cohort participants in the discovery and validation datasets were 73.5 ± 3.3 and 71.3 ± 7.9 years, respectively. In the discovery dataset, three SNPs (rs1916762, rs7587019, and rs13320098) were significantly associated with choroidal thickness in both eyes. This association was confirmed for rs1916762 (genotypes GG, GA, and AA) and rs7587019 (genotypes GG, GA, and AA), but not for rs13320098. The mean choroidal thickness decreased by 56.7 μm (AA, 73.8%) and 31.1 μm (GA, 85.6%) compared with that of the GG genotype of rs1916762, and by 55.4 μm (AA, 74.2%) and 28.2 μm (GA, 86.7%) compared with that of the GG genotype of rs7587019. The SNPs rs1916762 and rs7587019 were located close to the FAM124B gene near its cis-regulatory region. Moreover, FAM124B was highly expressed in vascular endothelial cells. In vitro HUVEC experiments showed that the inhibition of FAM124B was associated with decreased vascular endothelial proliferation, suggesting a potential mechanism of choroidal thinning. FAM124B was identified as a susceptibility gene affecting subfoveal choroidal thickness in older adults. This gene may be involved in mechanisms underlying retinal diseases associated with altered choroidal thickness, such as age-related macular degeneration.

Determinants of Visual Impairment Among Chinese Middle-Aged and Older Adults: Risk Prediction Model Using Machine Learning Algorithms.

Visual impairment (VI) is a prevalent global health issue, affecting over 2.2 billion people worldwide, with nearly half of the Chinese population aged 60 years and older being affected. Early detection of high-risk VI is essential for preventing irreversible vision loss among Chinese middle-aged and older adults. While machine learning (ML) algorithms exhibit significant predictive advantages, their application in predicting VI risk among the general middle-aged and older adult population in China remains limited. This study aimed to predict VI and identify its determinants using ML algorithms. We used 19,047 participants from 4 waves of the China Health and Retirement Longitudinal Study (CHARLS) that were conducted between 2011 and 2018. To envisage the prevalence of VI, we generated a geographical distribution map. Additionally, we constructed a model using indicators of a self-reported questionnaire, a physical examination, and blood biomarkers as predictors. Multiple ML algorithms, including gradient boosting machine, distributed random forest, the generalized linear model, deep learning, and stacked ensemble, were used for prediction. We plotted receiver operating characteristic and calibration curves to assess the predictive performance. Variable importance analysis was used to identify key predictors. Among all participants, 33.9% (6449/19,047) had VI. Qinghai, Chongqing, Anhui, and Sichuan showed the highest VI rates, while Beijing and Xinjiang had the lowest. The generalized linear model, gradient boosting machine, and stacked ensemble achieved acceptable area under curve values of 0.706, 0.710, and 0.715, respectively, with the stacked ensemble performing best. Key predictors included hearing impairment, self-expectation of health status, pain, age, hand grip strength, depression, night sleep duration, high-density lipoprotein cholesterol, and arthritis or rheumatism. Nearly one-third of middle-aged and older adults in China had VI. The prevalence of VI shows regional variations, but there are no distinct east-west or north-south distribution differences. ML algorithms demonstrate accurate predictive capabilities for VI. The combination of prediction models and variable importance analysis provides valuable insights for the early identification and intervention of VI among Chinese middle-aged and older adults.

How Time, Living Situation, and Stress Related to Technology Influence User Acceptance and Usability of a Socialization Service for Older Adults and Their Formal and Informal Caregivers: Six-Month Pilot Study.

Considering the growing population of older adults, addressing the influence of loneliness among this demographic group has become imperative, especially due to the link between social isolation and deterioration of mental and physical well-being. Technology has the potential to be used to create innovative solutions to increase socialization and potentially promote healthy aging. This 6-month study examined the usability and acceptability of a technology-based socialization service and explored how stress and living situation affect older adults' and their ecosystem's perceptions of technology, investigating cross-sectional and longitudinal differences among and across user groups. Participants were recruited in Tuscany and Apulia (Italy) through a network of social cooperatives and a research hospital, respectively. A total of 20 older adults were provided with the same technology installed on a tablet and on a smart television. The technology has three functionalities: video calling, playing games, and sharing news. Additionally, 20 informal caregivers (IC) and 13 formal caregivers (FC) connected to the older adults were included in the study. After both initial training in the use of the system (T0) and 6 months of using the system (T6), questionnaires on usability, acceptability, and technostress were filled in by older adults, IC, and FC. Nonparametric or parametric tests were conducted to investigate group differences at both time points and changes over time. Additional analyses on older adults were done to assess whether differences in usability and acceptability were related to living situation (ie, alone or with someone). Furthermore, correlation analyses were performed between usability, acceptability, and stress toward technology at T0 and T6. At both T0 and T6, older adults had lower usability scores than IC and FC and higher anxiety than IC. Over time, there was a significant decrease in older adults' attitudes toward technology score, depicting a negative attitude over time (T0 median 4.2, IQR 0.5; T6 median 3.7, IQR 0.8; Cohen d=0.7), while there was no change for IC and FC. At T0, those living alone had lower acceptability than those living with someone but this difference disappeared at T6. People or participants living with someone had a decline in anxiety, attitudes toward technology, enjoyment, and perceived usefulness. Stress toward technology affected usability and acceptability in the older adult group entering the study (ρ=-.85) but this was not observed after 6 months. In the IC group, stress affected trust at T0 (ρ=-.23) but not at T6. At the start of the study, older adults judged the system to be less usable and more stressful than did the caregivers. Indeed, at first, technostress was correlated with usability and acceptability; however, with repeated use, technostress did not influence the perception of technology. Overall, getting accustomed to technology decreased anxiety and stress toward technology.

Individualized treatment of diabetes mellitus in older adults.

The population of older adults with diabetes mellitus is growing but heterogeneous. Because geriatric syndromes, comorbidity or multimorbidity, the complexity of glucose dynamics, and socioeconomic conditions are associated with the risk of severe hypoglycemia and mortality, these factors should be considered in individualized diabetes treatment. Because cognitive impairment and frailty have similar etiologies and risk factors, a common strategy can be implemented to address them through optimal glycemic control, management of vascular risk factors, diet, exercise, social participation, and support. To prevent frailty or sarcopenia, optimal energy intake, adequate protein and vitamin intake, and resistance or multi-component exercise are recommended. For hypoglycemic drug therapy, it is important to reduce hypoglycemia, to use sodium glucose cotransporter-2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists, taking into account the benefits for cardiovascular disease and the risk of adverse effects, and to simplify treatment to address poor adherence. Glycemic control goals for older adults with diabetes should be set according to three categories, based on cognitive function and activities of daily living, using the Dementia Assessment Sheet for Community-based Integrated Care System 8-items. This categorization can be used to determine treatment strategies for diabetes when combined with the Comprehensive Geriatric Assessment (CGA). Based on the CGA, frailty prevention, treatment simplification, and social participation or services should be implemented for patients in Category II and above. Measures against hypoglycemia and for the prevention of cardiovascular disease and chronic kidney disease should also be promoted. Treatment based on categorization and CGA by multidisciplinary professionals would be an individualized treatment for older adults with diabetes. Geriatr Gerontol Int 2024; ••: ••-••.

Efficacy and safety of linaclotide in treatment-resistant chronic constipation: A multicenter, open-label study.

This study aimed to evaluate the efficacy and safety of linaclotide in patients with chronic constipation (CC) or irritable bowel syndrome with constipation (IBS-C) who did not respond to treatment with magnesium oxide (MgO). This study was designed as a multicenter, open-label, single-arm, exploratory study. Patients with CC or IBS-C who took MgO and those meeting the medication initiation criteria were administered linaclotide at a daily dosage of 500 μg for 12 weeks. The primary endpoint was a change in the Japanese version of the Patient Assessment of Constipation Quality of Life (JPAC-QOL) score from baseline, which was evaluated by using a paired t-test. The patients' mean age (± standard deviation) was 67.6 ± 13.82 years. The full analysis set included 61 patients. The JPAC-QOL total score was 1.60 at baseline and 0.70 at 12 weeks, with a significant mean change of -0.89 ± 0.721 (p < 0.001). Several secondary endpoints also showed improvement. The frequency of spontaneous bowel movement (SBM) and complete SBM increased by 2.70 ± 7.254 (p < 0.01) and 2.81 ± 5.254 times, respectively (p < 0.001). The Bristol Stool Form Scale, abdominal bloating severity, and straining severity scores improved by 1.33 ± 1.274 (p < 0.001), -0.16 ± 0.563 (p < 0.05), and -0.46 ± 0.795 (p < 0.001) points, respectively. The safety analysis set included 65 patients, 7 of whom had diarrhea, which improved with dose reduction and drug withdrawal. The study was conducted in an older adult population, similar to real clinical practice. Linaclotide may be an option for treating CC that shows an inadequate response to conventional therapy.

Pressure and cold pain threshold reference values in a pain-free older adult population.

More sex-specific pain sensitivity normative values from population-based cohorts in pain-free older adults are required. The aims of this study were (1) to provide sex- and age-specific normative values of pressure and cold pain thresholds in older pain-free adults and (2) to examine the association of potential correlates of pain sensitivity with pain threshold values. This study investigated sex-specific pressure (lumbar spine, tibialis anterior, neck and dorsal wrist) and cold (dorsal wrist) pain threshold estimates for older pain-free adults aged 41-70years. This cross-sectional study used participants (n = 212) from the Raine Study Gen1-26year follow-up. The association of pain thresholds, with correlates including sex, test site, ethnicity, waist-hip ratio, smoking status, health-related quality of life, depression, anxiety and stress symptoms, sleep quality, socioeconomic status and physical activity levels, was examined. Values for pressure and cold pain thresholds for older pain-free adults are provided, grouped by vicennium, sex and test site (pressure). Statistically significant independent correlates of increased pressure pain sensitivity were test site, ethnicity and sex. Only lower waist/hip ratio was a statistically significant, independent correlate of increased cold pain sensitivity. This study provides robust sex- and age-specific normative values for pressure pain threshold and cold pain threshold for an older adult pain-free population. Combined with existing values, these data provide an important resource in assisting interpretation of pain sensitivity in clinical pain disorders and provide insights into the complex association of pain sensitivity with correlates that can be used in research.

Effect of group play therapy as holistic geriatric interventional modality on feelings of loneliness among older people: A randomized control trial.

Previous research has identified loneliness as a significant social stressor among the older adult population, and highlights the scarcity of empirical research on the efficacy of group play therapy as a method for addressing loneliness in this demographic. This study aimed to explore the impact of group play therapy on reducing feelings of loneliness among older individuals. A randomized clinical trial was carried out in 2018 on 60 older adult participants from two governmental health centers in Mashhad, Iran. The intervention group received adult-centered play therapy for 12 sessions over 6 weeks, with each session lasting 60 min. The therapy protocol combined traditional and modern games, structured into three stages: warm-up, working and closing. The University of California, Los Angeles (UCLA) scale was used to measure feelings of loneliness at baseline and after the intervention. Data analysis was carried out using SPSS version 21. There was a significant decrease in feelings of loneliness in the intervention group compared with the control group (P < 0.001). Additionally, a significant difference in feelings of loneliness was observed within the intervention group between baseline and follow up (P < 0.001). Group play therapy, involving a combination of traditional and modern games, can reduce feelings of loneliness among older adults. This method can promote healthy aging and improve mental health issues, such as loneliness, among older people. These findings can be utilized in healthcare centers and nursing homes for older adults. Geriatr Gerontol Int 2024; 24: 1067-1076.

Prevalence and factors associated with sarcopenia among urban and rural Indian adults in middle age: A cross-sectional study from Western India.

Sarcopenia is the age-related loss of muscle mass and function. India has 8.6% of the global elderly (>60 years) population, and this is expected to increase to 20% by 2050. Around 70% of Indians live in rural areas where lifestyle factors like diet and physical activity differ from urban areas. Understanding age, sex and location-specific sarcopenia prevalence in India is crucial. Thus, our aim was to assess the prevalence and determinants of sarcopenia in urban and rural community-dwelling men and women aged 40 years and older, representing the next generation of older Indian adults. This cross-sectional study included 745 adults (400 women) from urban and rural areas near Pune, Western India. Assessments included socio-demography, diet by-24-hr recall, physical activity, anthropometry (height, weight), muscle mass measurement by dual-energy X-ray absorptiometry, muscle strength (hand grip) & muscle function by Short Physical Performance Battery (SPPB). Sarcopenia was defined by Asian Working Group on Sarcopenia-2019 guidelines Mean age of participants was 53±7.6yrs. Overall prevalence of sarcopenia was 10% and of severe sarcopenia was 4.2%. Sarcopenia prevalence was higher in rural (14.8%) than urban (6.8%) participants and in men (12.5%) than women (8%, all p<0.05). Muscle mass, grip strength and SPPB score were all higher in urban than rural participants (p<0.05). Older age, rural residence, inadequate protein intake, and lower socio-economic status were independently associated with sarcopenia. In this middle-aged group, sarcopenia prevalence was similar to that observed in older Western populations, over 100% higher among rural than urban participants, and higher amongst men than women. Age, location, protein intake and socioeconomic status were factors associated with sarcopenia. Given this rapidly increasing population of older adults in India there is an urgent need to plan strategies for early sarcopenia diagnosis and management, especially in rural populations.

Understanding dementia in minority ethnic communities: The perspectives of key stakeholders interviewed as part of the IDEAL programme.

Future populations of older adults in the UK, those aged 65+, will demonstrate increased diversity in terms of their ethnic identity resultant from the ageing of the post-war migrants from India, Pakistan, Bangladesh, and the Caribbean. As a consequence, there will be an increase in the numbers of older adults from these communities living with age-related chronic diseases such as dementia. In response to these demographic changes, we need to develop a research, policy and practice agenda that is inclusive and provides evidence for the development of culturally diverse and effective models of service delivery. This requires engagement with three key stakeholder groups: (a) people with dementia; (b) their carers; and (c) the wider community. As part of the IDEAL research programme on living well with dementia, we undertook semi-structured interviews with twelve community leaders, defined as known and trusted individuals active in their respective communities, and six community members (two people living with dementia and four carers). We explored their understandings, experiences, and views of about dementia. Our analysis identified two overarching themes. The migrant lifecourse highlighted issues of not belonging, discrimination and racism. This framed our second theme, the cultural context of dementia, which addressed dementia knowledge and attitudes, service provision and service access, and how being part of a minority ethnic community made a difference to these experiences. Our study highlights how lifecourse experiences of negative hostile social and policy environments and services can be profound and long-lasting and provide a prism through which accessing dementia care is experienced. Our findings argue for the inclusion of diverse views and lifecourse experiences within the context of developing a dementia strategy for research, policy and practice that is appropriate for a multicultural and heterogenous society.

A quantification of gastric and duodenal fluid volumes in older adults using MRI

Older adults are an inherently heterogeneous population with various underlying pathologies, medication use, and habits. In this study, the variability of this population was studied for the gastric and duodenal fluid volumes, as the amount of gastrointestinal volumes could play an essential role in the dissolution of drugs. The fluid volumes were retrospectively quantified by using magnetic resonance imaging (MRI). In 265 included fasted older individuals, the gastric fluid volume was 28.9 ± 21.1 mL (arithmetic mean ± standard deviation). No significant covariate-effect on stomach fluid volume was observed for various medication use, pathologies, and habits (e.g. hypertension, smoking, proton-pump inhibitors (PPIs), and aspirin). The gastric fluid volume remained constant with increasing age and had a high variability. The volumes and the variability were, however, not higher than the gastric values reported in healthy younger adults. The duodenal fluid volume was 16.6 ± 10.0 mL and a slight but statistically significant decrease with age was seen. In addition, cystic pancreas, obesity, diuretics, and PPI use demonstrated a moderate but significant correlation with the duodenal fluid volume. The findings of this study could be considered when developing and testing new drug candidates for the older adult population. For example, the volumes including their variability could be used as an input in physiologically based pharmacokinetic modelling approaches to predict drug exposure in this population.

Evaluation of "Age-Friendly City" Indicators in Golestan Province From the Perspective of the Older Adult Population

Objectives: To evaluate age-friendly city indicators from the perspective of the older adults in Golestan province in 2023. Design: A descriptive-analytical cross-sectional study. Setting(s): Golestan province, Iran. Participants: Individuals aged 60 years and above. Outcome measures: A sample of 310 participants was selected using proportional stratified sampling. Data were collected with a validated age-friendly city questionnaire. Results: The mean age of the participants in this study was 70.34±7.73 years (ranging from 60 to 99), with 64.5% being male. Among the three examined components, the component of respect and social security had the highest average among the older adults (4.65±17.72), followed by social participation (4.79±16.30) and civic engagement and employment (4.052±12.20). Agefriendly city indicators demonstrated statistically significant differences in variables such as city of residence (P=0.02), support source (P=0.009), income level (P=0.001), and marital status (P=0.05). Conclusions: None of the examined age-friendly city components in Golestan province met the necessary standards. Recommendations include enhancing efforts by service organizations to improve conditions for older adults.

Nutrient Intake in an At-risk Older Adult Population Who Attend Congregate Meal Centers

Nutrient Intake in an At-risk Older Adult Population Who Attend Congregate Meal Centers

Early Supported Discharge for Older Adults Admitted to Hospital after Orthopaedic Surgery: A Systematic Review and Meta-Analysis

Abstract Background Early supported discharge (ESD) aims to link acute and community care, allowing hospital inpatients to return home, continuing to receive the necessary input from healthcare professionals that they would otherwise receive in hospital. Existing literature demonstrates the concept having a reduced length of stay in stroke inpatients and medical older adults. This systematic review aims to explore the totality of evidence for the use of ESD in older adults hospitalised with orthopaedic complaints. Methods A literature search of Cochrane Central Register of Controlled Trials in the Cochrane Library (CENTRAL), EMBASE, CINAHL and MEDLINE in EBSCO was carried out on January 10th, 2024. Randomised controlled trials or quasi-randomised controlled trials were the study designs included. For quality assessment, The Cochrane Risk of Bias Tool 2.0 was used, and GRADE was applied to evaluate the certainty of evidence. Acute hospital length of stay was the primary outcome. Secondary outcomes included the numbers of fallers and function. A pooled meta-analysis was conducted using RevMan software 5.4.1. Results Seven studies with a population of older adults post orthopaedic surgery met inclusion criteria, with five studies included in the meta-analysis. Study quality was predominantly of a high risk of bias. Statistically significant effects favouring ESD interventions were only seen in terms of length of stay (REM, MD = -5.57, 95% CI -7.07 to -4.08, I2 = 0%, P &amp;lt; 0.00001). No statistically significant effects favouring ESD interventions were established in secondary outcomes. Conclusion In the older adult population with orthopaedic complaints, ESD can have a statistically significant impact in reducing hospital length of stay. This review identifies an insufficient existing evidence base to establish the key benefits of ESD for this population group. There is a need for further higher quality research in the area, with standardised interventions and outcome measures used.

Bridging the Gap: A Competency Framework for Hospital Doctors Caring for Older Adults

Abstract Background Our ageing population has resulted in an increasing number of older adults requiring healthcare services. This growing demand within a population of varying needs requires that all hospital doctors, regardless of specialty, possess fundamental Geriatric Medicine competencies. However, a consensus on these competencies is lacking with no overarching competency framework available. We aimed to address this gap by synthesising a competency framework for all hospital doctors caring for older adults. Methods Our first step involved a comprehensive scoping review of international literature identifying the proposed competencies for hospital doctors caring for older adults. These findings were validated and expanded through a national group concept mapping study inviting multiple stakeholders. An iterative process refined the identified competencies, categorising them into domains, and synthesising a final competency framework using Microsoft Excel. Results This study synthesised 110 Geriatric medicine competencies within seventeen competency domains. The scoping review highlighted medication, cognitive, and chronic disease management and the group concept mapping identified interpersonal communication, medicolegal, and delirium management as most critical. The iterative process further refined the framework, emphasising competencies pertaining to cognitive impairment, depression, falls, and acute inpatient management of older adults. Conclusion This synthesis highlights the broad range of competencies necessary for effective care of older adults by all hospital doctors. The identified competencies reflect the heterogeneous nature of the older adult population, encompassing both fundamental but also specialised skills. Further research is now essential to determine the optimal educational interventions for ensuring all hospital doctors are equipped with these essential competencies.

Prevalence of sarcopenic obesity among older adults in communities of China: A multicenter, cross-sectional study.

This study investigated the prevalence of sarcopenic obesity (SO) among older adults in Chinese communities and its association with chronic diseases. We conducted a post-hoc analysis of a 2014-2015 multicenter cross-sectional study involving adults aged ≥60 years from three representative cities in China. The Asian Working Group for Sarcopenia diagnostic criteria and Chinese local cutoffs were employed to define SO. Data on medical history, lifestyle, quality of life, and cognitive function were collected. The overall prevalence of SO was 3.58% in men and 2.88% in women among 2821 participants. There was a notable increase in prevalence with age, with rates reaching 6.58% for men and 4.40% for women aged 70-79 years. In the group aged ≥80 years, the prevalence rate increased significantly, reaching 13.16% for men and 18.18% for women. Those with SO had higher body mass index (25.29 ± 1.55 kg/m² vs 24.16 ± 2.48 kg/m²; P < 0.001) and triceps skinfold thickness (21.17 ± 5.93 mm vs 19.34 ± 6.87 mm; P < 0.05) than the normal group. The prevalence of cardiovascular disease (15.38% vs 6.59%; P < 0.01), hypertension (56.04% vs 38.93%; P < 0.01), and stroke (7.69% vs 2.25%; P < 0.01) was also significantly higher in the SO group. Logistic regression showed that those with SO were more likely to have cardiac disease (odds ratio [OR] = 2.20; P = 0.016) and stroke (OR = 2.61; P = 0.039). The prevalence of SO increases with age among the older adult population in China, notably after age 80 years. SO individuals were more likely to have cardiac disease and stroke. It is important to focus on early identification and management strategies.