Population Of Older Persons Research Articles

Age-friendly initiatives – GHANA

The global increase in the population of older persons has profound inter-sectoral implications, necessitating the development of age-friendly initiatives at the global and national levels. While progress has been relatively slower across Sub-Saharan African countries, highlighting existing commendable initiatives is essential to identify the current gaps and promote the development of strategies and interventions to promote age-friendly societies. This mini-review highlights some of the key initiatives in Ghana in the areas of policy, healthcare, finance, social services, education and research and in promoting dementia-friendly communities.

Understanding the Health Capacity to Work among Older Persons in Rural and Urban Areas in the People’s Republic of China

The People’s Republic of China is aging rapidly at one of the most rapid paces in the world. The resulting decline in the share of the population that is of working age creates challenges for both the economy and society, making it relevant to explore the health capacity to work among older persons. Using census data and data from the China Health and Retirement Longitudinal Study, this paper applies two widely used methods to estimate the additional health capacity to work. The results confirm large untapped work capacity in the population of older persons, but the additional health capacity to work is unevenly distributed among different groups: Women and urban residents have more additional work capacity than men and older persons in rural areas. Pension systems and variation in types of work contribute to the urban–rural difference.

Aging and Disability: An Exploration of Barriers and Facilitators to Community Living

Demographic data projections for the United States indicate a significant increase in the population of older persons with disabilities. The Americans with Disabilities Act (ADA) mandates community access for individuals with disabilities, including older individuals who are aging with or aging into disabilities. However, there is limited research regarding the knowledge and the use of the ADA among this population specific to their perceptions and experiences regarding barriers and facilitators to community access and participation as mandated under the Act. The purpose of this qualitative focus group study was to explore the perceptions and experiences of a sample of older adults with disabilities regarding their community access, and their knowledge and utilization of the provisions of the ADA to facilitate community participation. Analysis of results identified three predominant themes within this sample of older adults: experiences with structural and attitudinal barriers to community access leading; fear of loss of autonomy and independence in the community, and how they deploy; coping and advocacy strategies to address barriers. Recommendations for improving ADA knowledge, access, and utilization among the population, as well as senior service providers, are also addressed.

Assessing quality of life among older persons using WHOQOL-BREF tool – a pilot study in Chandragiri, Municipality

Introduction: The population of older persons is increasing globally, and Nepal is also showing a similar trend. WHOQOL-BREF is a widely used tool for assessing the Quality of Life (QoL), whose Nepali version is also available but is not validated in the local context. Thus, a pilot study was conducted among older people using WHOQOL-BREF to assess its internal consistency and establish its reliability and validity in the local context. Method: It was a cross-sectional quantitative study done among 30 older persons of Chandragiri Municipality-04, Kathmandu. The interviews were done in the Nepali language using a semi-structured questionnaire with a WHOQOL-BREF Nepali version after finalizing it through pretesting done among 7 older persons in Patan Hospital, Lalitpur. Result: Pre-testing revealed comprehension issues with WHO-BREF questionnaire items (1, 4, 11, 21). Modifications were made based on participant feedback.The overall alpha reliability in this pilot study was 0.75, compared to 0.84 in the field study by WHO. The alpha reliability for the domains was also comparable and slightly lower than the WHO field study. The cut-off scores based on Q1 and Q2 were determined as 80 and 66 respectively. Conclusion: The Nepali version of WHOQOL–BREF displayed sufficient alpha reliability, signaling it as a dependable instrument to use in the local context. Thus, the main study planned among older persons in Bheemdatta municipality seems to be feasible using the WHOQOL-BREF Nepali version.

Morbidity Pattern Among Elderly in an Urban Area of Burla, Odisha.

Population aging is an inevitable demographic reality that is associated with improvements in the health and medical care system. With longevity and declining fertility rates, the population of older persons is growing faster than the general population globally. The elderly population is more prone to various kinds of morbidity due to decreasing immunity and the risk of advancing age. To describe the morbidity pattern of the elderly in an urban area of Burla. Community-based cross-sectional study was carried out for one year from 1st July 2021 to 30th June 2022. A total of 385 individuals aged 60 years and above residing in Burla were included in the study. Patient-wise data collection was done by a predesigned, pretested structured questionnaire. The chi-square test for categorical variables at a 95% confidence interval and significance set at 0.05 were used as measures of association in the analysis of factors associated with morbidity. The most common health problem involved was musculoskeletal (68.6%), followed by cardiovascular (57.1%), eye (47.3%), endocrine (25.2%), respiratory (21.3%), digestive (20.5%), skin (16.1%), ear (15.3%), general and unspecified health problems (30.7%), and urological (5.5%) and 4.5% had neurological problems. Elderly population has a high frequency of numerous morbidities, so it is important to educate the elderly population about prevalent age-related health issues as well as preventive care.

Cognition and Political Ideology in Aging.

The impact of cognitive function and decline on political ideology is unknown. We studied the relationship between cognition and both political orientation and political policy choices in a population of older persons. Longitudinal investigation. A retirement community and its surroundings in Southern California. 151 members of a longitudinal investigation of aging and dementia in the oldest-old (the 90+ Study), mean age 95 years. Participants self-reported their political ideology (7-point scale from extremely liberal to extremely conservative) and policy preferences for federal spending on public schooling, aid to the poor, and protecting the environment, as well as on preferences on immigration rates, death penalty, and university admission. The same political survey was mailed to participants twice: at time one and 6-months later. Cognitive function based on neurological examination and cognitive testing was classified as normal (55%), cognitive impairment/not dementia (CIND) (33%), or dementia (12%). We calculated rank correlations between ideology and policy choices, stratified by cognitive status, and agreement between Surveys 1 and 2. Political ideology/orientation was highly consistent over a six-month period (84% agreement) among the 122 who returned the second survey, with no significant relationship to cognitive status. Among cognitively impaired (CIND and dementia), however, there was significant loss of consistency between an individual's political orientation and their policy choices. Level of political engagement was high for participants, with more than 90% voting in the 2016 presidential election. In this population of older persons, political identification on the liberal-conservative spectrum was resilient despite cognitive decline, but its meaning and function were changed. For the cognitively impaired it remained a self-defining label, but no longer operated as a higher order framework for orienting specific policy preferences. There appeared to be loss of coherence between the political orientation and political policy choices of cognitively impaired individuals. Given the high level of political engagement of these individuals, these results have substantial public policy implications.

Лікування артеріальної гіпертензії в осіб похилого віку

Стаття присвячена стратегії ведення хворих похилого віку з артеріальною гіпертензією на підставі рекомендацій Міжнародного товариства з гіпертензії, Європейського товариства кардіологів, Європейського товариства з гіпертензії, Американського товариства з гіпертензії, Американської колегії терапевтів і Американської академії сімейних лікарів. За результатами епідеміологічних і клінічних досліджень показано вплив підвищеного артеріального тиску на серцево-судинні ускладнення та смертність в популяції осіб віком понад 65 років. Завдяки аналізу рандомізованих контрольованих досліджень представлені переконливі дані стосовно необхідності диференційного контролю артеріального тиску залежно від ступеня артеріальної гіпертензії та чинників серцево-судинного ризику. В порівняльному аспекті подано методологію ініціації антигіпертензивної терапії в осіб різних вікових груп. Відтворено дискусійні питання досягнення цільового рівня артеріального тиску в динаміці медикаментозного лікування гіпотензивної спрямованості у хворих віком 65–79 років та понад 80 років. Розглянуто вимоги індивідуальної лікувальної тактики хворих з артеріальною гіпертензією похилого віку з урахуванням анамнезу, фізичного та психічного стану, клінічних виявів, коморбідного перебігу, наявності ускладнень, ураження органів-мішеней.

PERSON-CENTERED CARE RELATED TO RESOURCE USE, RESIDENT QUALITY OF LIFE, AND STAFF JOB STRAIN IN SWEDISH NURSING HOMES

A critical challenge facing aged care systems throughout the world is to meet the complex care needs of a growing population of older persons. Although person-centred care has been advocated as the “gold standard” and a key component of high quality of care, the significance of care utilization in person-centred units as well as the impact of person-centred care on resident quality of life and staff job strain in nursing home care is yet to be explored. Thus, the aim was to explore person-centred care and its association to resource use, resident quality of life and staff job strain. The study is based on a cross-sectional national survey and data on 4831 residents and 3605 staff were collected by staff in 2014, deriving from nursing homes in 35 Swedish municipalities. In this study, descriptive statistics and regression modelling were used to explore this association. The preliminary results showed that person-centred care was positively associated to resource use (i.e care hours) and resident quality of life in Swedish nursing homes, when controlling for resident age, gender and cognitive status. Person-centred care was negatively associated to staff perception of job strain. This indicates that person-centred care provision seem to increase resource use (i.e. slightly more care hours utilized) but also beneficially impact resident quality of life as well as alleviate care burden in terms job strain among staff.

High parathyroid hormone levels are associated with poor balance in older persons: A cross-sectional study

ObjectivesA high level of parathyroid hormone (PTH) was recently identified as a risk factor for falling. As balance instability is one of the major risk factors for falls, we aimed to investigate whether high PTH concentrations are associated with poor balance in older persons. Study designCross-sectional study with 127 community-dwelling older adults (75% female), aged 65–96 years, at the Falls and Fracture Clinic, Western Health-Sunshine Hospital, Melbourne, Australia. Patients with clinical conditions that could affect balance (e.g. Meniere’s disease), denosumab users, and those with advanced kidney failure were excluded. Main outcome measuresWe assessed dynamic balance by timed “up and go” (TUG)and four-square step tests, and by gait parameters; and static balance by posturography on a force platform. Blood tests provided values of PTH, vitamin D, calcium, albumin, and creatinine. Standard questionnaires were applied to assess clinical condition, medications and nutritional status, and to screen for depression. ResultsFor dynamic balance, elevated PTH concentrations resulted in increased time to complete the TUG test (β = 0.13; 95%CI: 0.01–0.26), indicating worse performance. For static balance, increased PTH was associated with increased instability in the center of pressure while standing with eyes closed on a hard surface (β = 0.38; 95%CI: 0.03–0.73). Both models were controlled for vitamin D, renal function, nutritional and depressive status, age, sex, and number of medications. ConclusionIncreasing concentrations of PTH in this population of older persons had an independent negative association with both static and dynamic balance, which could place them at risk of falls. However, longitudinal studies are still required.

Temporal stability of urinary cadmium in samples collected several years apart in a population of older persons.

There is growing evidence that urine cadmium is a temporally stable biomarker indicative of long-term cadmium exposure; however questions remain with regard to generalizability to older persons, the impact of changes in smoking behavior, and the degree of temporal stability when repeat sample collection spans years instead of weeks or months. Using archived samples from cohorts of older men (Osteoporotic Fractures in Men (MrOS-US)) and women (Study of Osteoporotic Fractures (SOF)) (mean age = 80 at study visit 2), we analyzed two morning urine samples each from 39 men and 18 women with a diverse self-reported smoking history. For MrOS, samples were collected approximately 6 years apart, and 4 years apart for SOF. Intra-class correlations were computed to assess temporal stability, and adjusted for age and body mass index. The median creatinine-adjusted urinary cadmium levels (0.39 μg/g for men, 0.89 μg/g for women) were similar to levels expected for these age/sex groups in the US according to the National Health and Nutrition Examination Survey. The overall intra-class correlation was high (ICC = 0.85; 95% CI: 0.76-0.91) and similar between cohorts (MrOS: ICC = 0.74; 95% CI: 0.58-0.86; SOF: ICC = 0.81; 95% CI: 0.59-0.93), but slightly lower among those who stopped smoking between visits of sample collection (ICC = 0.64; 95% CI: 0.31-0.87) or among former smokers who quit prior to the first sample collection (ICC = 0.68; 95% CI: 0.25-0.93). We report good-to-excellent reproducibility of urine cadmium using morning urine samples collected 4-6 years apart from older men and women, but slightly lower correlations among those with a history of smoking. Single measures of urine cadmium are a reliable biomarker in older men and women.

Prevalence of malnutrition using harmonized definitions in older adults from different settings – A MaNuEL study

Malnutrition is widespread among older people and related to poor outcome. Reported prevalences vary widely, also because of different diagnostic criteria used. This study aimed to describe prevalences in several populations of older persons in different settings using harmonized definitions. Available studies within the Joint Programming Initiative (JPI) Knowledge Hub 'Malnutrition in the Elderly' (MaNuEL) were used to calculate and compare prevalences of malnutrition indicators: low BMI (<20kg/m2; age-specific BMI <20 if age 65-<70 and <22kg/m2 if age ≥70 years), previous weight loss (WL), moderate and severe decrease in food intake, and combined BMI <20kg/m2 and/or WL in participants aged ≥65 years. Fifteen samples with in total 5956 participants (59.3% women) were included: 7 consisting of community-dwelling persons, 2 studies in geriatric day hospitals, 3 studies in hospitalized patients and 3 in nursing homes. Mean age of participants ranged between 67 and 87 years. Up to 4.2% of community-dwelling persons had a BMI <20kg/m2, 1.6 and 9% of geriatric day hospital patients, 4.5-9.4% of hospital patients and 3.8-18.2% of nursing home residents. Using age-specific cut-offs doubled these prevalences. WL was reported in 2.3-10.5% of community-dwelling persons, 6% and 12.6% of geriatric day hospital patients, 5-14% of hospitalized patients and 4.5-7.7% of nursing home residents. Severe decrease in food intake was recorded in up to 9.6% of community-dwelling persons, 1.5% and 12% of geriatric day hospital patients, 3.4-34.2% of hospitalized patients and 1.5-8.2% of nursing home residents. The criteria age-specific BMI and WL showed opposing prevalences across all settings. Compared to women, low BMI and moderate decrease in food intake showed low prevalences in men but similar prevalences were observed for weight loss and severe decrease in food intake. In half of the study samples, participants in a younger age group had a higher prevalence of WL compared to those of an older age group. Prevalence of BMI <20kg/m2 and WL at the same time did not exceed 2.6% in all samples. The highest prevalences were observed based on combined definitions when only one of the three criteria had to be present. Prevalences for different criteria vary between and within the settings which might be explained by varying functional status. The criteria used strongly affect prevalence and it may be preferable to look at each criterion separately as each may indicate a nutritional problem.

The Rights of Older Persons and the Need for a New Convention

. Issues regarding the rights of older persons are not new, however they have been traditionally dealt with in a piecemeal and reactive manner as opposed to a proactive and holistic manner. Thus, with the increasing prominence of human rights and its application to deal with issues surrounding other vulnerable and disadvantaged groups such as persons with disability, minorities, women and migrant workers there is a need to use this same approach to address problems facing older persons. A question that can be asked is why there is a renewed interest in the rights of older persons. The answer to this question lies to the rapid demographic changes taking place, which has necessitated renewed interest in the human rights of older persons. An increase in the population of older persons will have a human rights effect since it will expose them to more abuses and discrimination, which will eventually force governments and society to respond. Strengthening the rights of older persons is the best response to these challenges, hence, a UN convention on the rights of older persons.

Orthostatic hypotension in older persons is not associated with cognitive functioning, features of cerebral damage or cerebral blood flow

Particularly in old age, orthostatic hypotension has been related to worse cognitive functioning, possibly caused by reduced cerebral blood flow (CBF). This study investigates whether orthostatic hypotension in older people is associated with cognitive dysfunction and, if so, whether this association is mediated by cerebral vascular damage and/or decreased CBF. Four hundred and twenty participants of the Discontinuation of ANtihypertensive Treatment in Elderly People (DANTE) Study Leiden (mean age 81 years, all using antihypertensive medication and with mild cognitive deficits), and MRI data from 214 participants of the nested DANTE MRI sub-study. Orthostatic hypotension was defined as either a SBP decrease at least 20 mmHg and/or a DBP decrease of at least 10 mmHg within 3 min of standing up. Cognitive functioning was assessed using a battery of six cognitive tests covering global cognition, memory function, executive function and psychomotor speed. Cerebral vascular damage and CBF were assessed using MRI. The prevalence of orthostatic hypotension was 47% (n = 199). Compared with the group without orthostatic hypotension, participants with orthostatic hypotension showed no differences in any of the cognitive functions, features of cerebral small vessel disease, microstructural integrity or CBF. In this population of older persons, the presence of orthostatic hypotension was not associated with decreased cognition. In addition, no differences were found in the supposedly underlying cerebral vascular mechanisms.

The third millennium dementia epidemic

The global dementia epidemic now and in the future is mainly caused by the steady increase in the population of older persons, where around 2 billion people will be 60 years of age and older by 2050.(1,2) As a consequence, in that year there will be 135 million people with dementia, particularly in low- and middle-income countries where 60% of the more than 47 million cases (2015 estimate) are living now.(2)

ВОЗРАСТНАЯ СТРУКТУРА, НОЗОЛОГИЧЕСКИЕ ФОРМЫ, СОПУТСТВУЮЩИЕ ЗАБОЛЕВАНИЯ ГОСПИТАЛИЗИРОВАННЫХ ПАЦИЕНТОВ ТЕРАПЕВТИЧЕСКОГО ОТДЕЛЕНИЯ СТАЦИОНАРА ЭКСТРЕННОЙ МЕДИЦИНСКОЙ ПОМОЩИ

The article adduces the results of the analysis of the age structure, nosologic form, accompanying diseases of patients hospitalized in therapy departments of Samarkand branch republican research centre of emergency medicine. An analysis of hospitalized patients suggests that the main place is occupied by person’s hospitalized elderly, and a significant place in this age is given to a chronic pathology of the cardiovascular system. Serious place is also occupied by acute inflammation of the airways, possibly reflecting the immunological trouble in the population of older persons.

PECULIARITIES OF MORTALITY FROM NEOPLASMS IN THE KRASNOYARSK TERRITORY

Objective. To determine the characteristics of mortality from cancer in the Krasnoyarsk territory and the possible causes of their formation. Methodology. Dynamics of the standardized mortality rates from cancer in 1989-2014 in the Krasnoyarsk territory, the Russian Federation and the Siberian Federal District was analyzed. Cancer mortality structure by age (per five-year intervals) and causes for 2000-2002 and 2012-2014 were also analyzed. Mortality dynamics and rates were compared for age groups up to 70 years and 70 years and older. Results. Trends in mortality of men and women in country and the District were reliably described by linear equations, which predicted a further reduction in mortality. The best mathematical description of mortality dynamics in the Krasnoyarsk territory were obtained using polynomial equations of second order, which predicted a further increase in mortality rate. The increase of mortality in the Krasnoyarsk territory was not on the whole age scale but only for age group of 70 years and older. For the Krasnoyarsk territory the expected average age of men who died from cancer in 2014 almost reached the average Russian level while their life expectancy lagged behind the average figure for the country at 1.7 years. Women of the Krasnoyarsk territory died from cancer at a later age than in the country as a whole (69.97 against 69.46) but their life expectancy was a year and a half less than average Russian figure. In the Krasnoyarsk territory cancer mortality structure by causes did not fundamentally change since the beginning of the millennium despite the significant increase in proportion of older persons in population. At the same time there was a threefold increase in male mortality and a twofold increase in female mortality from non-defined and benign neoplasms over a ten year period. In the Krasnoyarsk territory the proportion of age group of 70 years and older in mortality from nondefined and benign neoplasms increased from 14.6% among men and 16.9% among women in 2000-2002 to 45.6% and 51.3% in 2012-2014. Conclusion. The peculiarity of mortality from neoplasms in the Krasnoyarsk territory (high level and growth only in age group of 70 years and older, pronounced increase in mortality from benign and non-defined neoplasms) may be due to overdiagnosis of death from cancer among the elderly.

Emergency Preparedness of Persons Over 50 Years Old: Further Results From the Health and Retirement Study.

This article conceptualized emergency preparedness as a complex, multidimensional construct and empirically examined an array of sociodemographic, motivation, and barrier variables as predictors of levels of emergency preparedness. The authors used the 2010 wave of the Health and Retirement Study's emergency preparedness module to focus on persons 50 years old and older in the United States by use of logistic regression models and reconsidered a previous analysis. The models demonstrated 3 key findings: (1) a lack of preparedness is widespread across virtually all sociodemographic variables and regions of the country; (2) an authoritative voice, in the role of health care personnel, was a strong predictor of preparedness; and (3) previous experience in helping others in a disaster predisposes individuals to be better prepared. Analyses also suggest the need for caution in creating simple summative indexes and the need for further research into appropriate measures of preparedness. This population of older persons was generally not well prepared for emergencies, and this lack of preparedness was widespread across social, demographic, and economic groups in the United States. Findings with implications for policy and outreach include the importance of health care providers discussing preparedness and the use of experienced peers for outreach. (Disaster Med Public Health Preparedness. 2017;11:80-89).

The impact of a progressive muscular relaxation exercise programme for reducing insomnia in an elderly population: results from a preliminary study at two elderly homes in the Colombo District of Sri Lanka

Late life insomnia is associated with various physical and psychological conditions, which warrants particular attention. This study aimed at exploring the impact of a programme of relaxation and deep breathing exercises in reducing insomnia in a population of older persons. A group controlled experimental study design was used with a sample of 98 (84 females) older persons, aged over 65 years, in two elders’ homes. The intervention consisted of progressive muscular relaxation exercises and deep breathing exercises conducted over a 12 week period. Pre- and post-intervention data was collected by the Sinhala version of the Athens Insomnia Scale (AIS). Independent sample t-tests and Paired sample t-tests were performed. Results revealed a significant reduction in insomnia after the intervention in the experimental group, but not in the control group. Hence, this study indicates that relaxation exercises significantly reduce insomnia and increase the quality of sleep among older persons. The fact that such a cost effective and easy to implement programme was effective in the treatment of insomnia is an encouraging outcome of this study. Such programmes are useful in countries such as Sri Lanka where monetary and trained human resources are scarce.

Validity of the three apathy items of the Geriatric Depression Scale (GDS-3A) in measuring apathy in older persons.

The Geriatric Depression Scale (GDS)-3A, a three-item subset of the GDS-15, is increasingly used as a measure for apathy in research settings to assess factors associating with this neuropsychiatric syndrome. We aimed to assess how accurately the GDS-3A discriminates between presence and absence of apathy in two populations of community-dwelling older persons, using the Apathy Scale as reference standard. Baseline data were used from 427 participants of the Discontinuation of Antihypertensive Treatment in Elderly people (DANTE) Study Leiden and 1118 participants of the PROactive Management Of Depression in the Elderly (PROMODE) Study, all ≥75 years and with available GDS-3A and Apathy Scale measurements. A cut-off score of ≥14 was used for presence of apathy according to the Apathy Scale. Areas under the receiver operating characteristic curve (AUC) were calculated. Based on the likelihood ratios for GDS-3A scores, a cut-off of ≥2 was used for presence of apathy according to the GDS-3A to calculate test characteristics. The AUC was 0.68 (95% confidence interval 0.62-0.73) in the DANTE Study and 0.72 (0.67-0.77) in the PROMODE Study. In the DANTE Study sensitivity was 29.3% (21.4-38.1) and specificity was 88.5% (84.4-91.8), whereas in the PROMODE Study sensitivity was 32.8% (24.5-41.1) and specificity 92.6% (90.9-94.2). Stratification on population characteristics did not yield more favourable test characteristics. The GDS-3A has low sensitivity and high specificity as a measure of apathy in two populations of older persons. Using the GDS-3A in research might yield estimates biassed towards the null in case of non-differential misclassification. Copyright © 2016 John Wiley & Sons, Ltd.

Using Reality Therapy to Facilitate Successful Aging in Clinical Practice

Within the next 15 years, the population of older persons in the United States is expected to reach 20% of the population by 2030. Undoubtedly, there will be an increase in the number of older persons with mental health issues as well as issues simply related to aging. The purpose of this article is twofold. It will briefly examine how the counseling profession has addressed the needs of the aging population. Second, it will provide an introduction to reality therapy as a flexible theoretical approach that can be tailored to individuals throughout the life span. This approach can help older persons in making choices that are need fulfilling and tailored to match their dreams and identified wants.