Problem In Older Adults Research Articles

The prevalence of undernutrition and associated factors in older obese patients.

Both obesity and malnutrition are common health problems in older adults. The aim of our study is to investigate the prevalence of undernutrition and related factors in older obese patients. 1911 older outpatients who underwent comprehensive geriatric assessment were included in this cross-sectional study. Body mass index (BMI) was categorized as follows: 'Underweight' = BMI < 18.5, 'Normal weight' = 18.5 ≤ BMI < 25, 'Overweight' 25 ≤ BMI < 30, and 'Obesity' ≥ BMI 30. Mini-Nutritional Assessment scores > 23.5, 17-23.5, or < 17 were categorized as well-nourished, malnutrition risk, and malnutrition, respectively. Those who were not well-nourished were considered undernutrition. Of 1911 patients, with a mean age of 77.34 ± 8.0years, 931 (48.7%) were obese. Of whom 6.0% were malnourished and 26.3% were at risk of malnutrition. Age, females, widowed and those living with their children, the number of drugs used, and the presence of heart failure, Parkinson's disease, and dementia, decreased calf circumference and muscle strength were higher in obese patients with undernutrition than obese well-nourished patients (p < 0.05). After adjustment for the aforementioned factors, basic and instrumental activities of daily livings, and Tinetti scores were lower, and falls and Geriatric Depression Scale-15 scores were higher in those with undernutrition compared to those with well-nourished among older obese patients (p < 0.05). Half of the older patients were obese and undernutrition was observed in one out of every three older obese patients. Undernutrition was associated with decreased functional capacity, impairment in balance and gait functions, falls, and depressed mood. Therefore, we recommend to screen older obese patients for nutritional status.

A systematic review of loneliness and social isolation among Hispanic/Latinx older adults in the United States

Loneliness and social isolation are growing public health problems in older adults, associated with physical and mental comorbidity and increased mortality. In the United States, Hispanic/Latinx individuals constitute the largest racial/ethnic minority. Studies retrieved from PsycInfo, Embase, and PubMed were examined. The initial search yielded 1476 publications. Using the updated PRISMA Flow guidelines, a total of 17 studies met our review criteria. Eight studies assessed loneliness, six evaluated social isolation, and three investigated both. The reports varied in the details of methodology, preventing meta-analyses. Differences in the experience of loneliness and social isolation between Hispanic/Latinx and White adults are not consistent. Of the three studies of loneliness or social isolation among Hispanic/Latinx groups of different national origins, two reported significant differences. Loneliness was associated with greater overall comorbidity, but two studies found higher risk of metabolic and cardiovascular disorders in Hispanic/Latinx with loneliness. Social isolation was generally associated with worse physical health, being older, male, and unmarried, and having lower education and income, and more smoking, along with frailty and cognitive impairment. We make specific suggestions for future research on loneliness and social isolation in Hispanic/Latinx adults and offer guidelines for clinical management.

Oral health problems and risk of incident disability in two studies of older adults in the United Kingdom and the United States.

BackgroundPreventing oral health problems can be crucial for maintaining physical independence in older adults. We aimed to examine the associations of a range of oral health problems with incidence of disability in older adults.MethodsWe used prospective data from the British Regional Health Study (BRHS) (N = 2147, 71–92 years), and the Health, Aging and Body Composition (HABC) study (USA) (N = 3075, 71–80 years). Oral health measures included tooth loss, periodontal disease, self‐rated oral health, and self‐reported dry mouth. Participants were followed for onset of disability over a follow‐up period of 3 years. Onset of disability was assessed through new cases of mobility limitations, activities of daily living (ADL), and instrumental activities of daily living (IADL). Logistic regression was performed to calculate the odds of incident disability.ResultsIn the BRHS, tooth loss was associated with greater odds of mobility limitations and ADL difficulties. Periodontal disease was associated with greater incidence of mobility limitations. Self‐report of ≥3 dry mouth symptoms was associated with increased odds of incident mobility limitations and ADL difficulties (OR = 2.08, 95% CI 1.27–3.42; OR = 1.73, 95% CI 1.03–2.90). Fair/poor self‐rated oral health was associated with greater incidence of IADL difficulties. In the HABC study, complete tooth loss was associated with greater incidence of mobility limitations (OR = 1.86, 95% CI 1.13–3.06), and fair/poor self‐rated oral health was associated with increased odds of incident ADL difficulties (OR = 1.42, 95% CI 1.04–1.94).ConclusionsOral health problems in older adults, particularly tooth loss, self‐reported dry mouth and self‐rated oral health were associated with greater incidence of disability. Poor oral health plays a potentially important role in the development of disability in older populations, which in turn is an essential part of quality of life and healthy aging.

Psychosocial factors in adherence to pharmacological treatment and diabetes mellitus control in patients over 65

AimTo explore the influence of anxiety/depression symptoms and social risk in patients older than 65 years with type 2 diabetes mellitus (T2DM) both in non-adherence to pharmacological treatment (Non-AdhT) and in poor control of T2DM. DesignCross-sectional study. Setting and participantsAdults over 65 years of age with T2DM treated at the Madrid Primary Care Service. Main measurementsData collection: Electronic Health Record database. Variables: Poor control of T2DM (HBA1c) and Non-AdhT (Morisky-Green test); main clinical variables: symptoms of depression/anxiety and social risk. Global multivariate logistic regression models and disaggregated by sex were used to Non-AdhT and poor T2DM control. ResultsData were obtained on 884 subjects. Non-AdhT prevalence: 4.4%; prevalence of poor T2DM control: 37.2%. Multivariate logistic regression models for No-AdhT in men showed a higher risk if they had symptoms of anxiety/depression (OR: 3.88; 95%CI: 1.15–13.07); and in women, if they had social risk (OR: 5.61; 95%CI: 1.86–16.94). Multivariate logistic regression models for poor control of T2DM in men revealed a higher risk if they did not have AdhT (OR: 3.53; 95%CI: 1.04–12.02). ConclusionsIn people over 65 years with T2DM, although Non-AdhT is low, the prevalence of poor T2DM control is high. Symptoms of depression or anxiety are a risk factor to Non-AdhT in men, while social risk has the same effect in women. Non-AdhT in men increases the risk of poor T2DM control. From a gender perspective, it is important to detect social and mental health problems in older adults with diabetes and to reinforce strategies to improve their adherence to drug treatment in these patients.

Precision Health Care for Older Adults: The Geri-FORCE Case Management System

Health problems in older adults are often concomitant with multiple comorbidities and geriatric syndromes that involve the psychological and social domains. Traditional models of disease care address the health problems of older adults inadequately. Therefore, we applied a case management framework (assess, plan, act, coordinate, evaluate and interact) to discuss how to implement an elderly-centered approach to integrated care that integrates comprehensive, multidisciplinary, and continuous care. The Geriatrics Formulated by Outcome Related Care & Empowerment (Geri-FORCE) was developed by the Formosan Association of Care and Education for the Seniors to help establish a geriatric case management system grounded in precision health care. We propose developing an informatics technology system for older adults that integrates the Geri-FORCE model with case management. This system should accurately identify the main health problems in older adults and provide a care plan that is patient-tailored, integrated, and continuous. We expect that the developed Geri-FORCE case management system will improve quality of care and promote health while reducing care burdens and costs.

Impact of cardiovascular evaluations and interventions on fall risk in older adults: a protocol for a scoping review and evidence map

IntroductionCardiovascular disorders are increasingly recognised as important fall risk factors in older adults. Falls are a major public health problem in older adults, and therefore, effective interventions for reducing falls...

Urology and Geriatrics in Korea: Present Status and Future Directions.

Globally, the population aged 65 years and over is growing faster than all other age groups. South Korea, in particular, is one of the most rapidly aging societies worldwide. With the increase in the older population, the incidence of urologic diseases has increased significantly along with that of chronic diseases. Urologic diseases are an important component of the health problems faced by an aging society. Among those, urinary incontinence and voiding dysfunction cause significant health and quality of life problems in older adults. To properly manage these diseases, especially in the field of urology, it is necessary to propose appropriate policies for the health care of older people. Accordingly, the significance of geriatrics, particularly geriatric urology, has increased. Although geriatric urology in South Korea began relatively recently, the founding of the Korean Society of Geriatric Urological Care represents a significant step in the development of geriatric urology as a subspecialty. The goal of this review is to elaborate on the concept of geriatrics and to provide an overview of geriatric urology with a focus on its current status in South Korea. Furthermore, future challenges in the face of rapid demographic changes are reviewed.

Cardio-cerebral syndrome in patients with chronic heart failure

The article discusses the pathogenesis and manifestations of the cardio-cerebral syndrome in patients with heart failure (HF). HF is one of the significant problems of older adults due to its high prevalence. The mechanisms of the effect of HF on the development of acute and chronic cerebral ischemia, often accompanied by cognitive impairment and mood disorders, are considered. For an optimal integrated approach to managing patients with cardiocerebral syndrome, it is advisable to involve cardiologists, neurologists, and psychiatrists.

Association Between Fear of Falling and Frailty in Community-Dwelling Older Adults: A Systematic Review.

Background/ObjectiveFear of falling (FoF) and frailty are common problems in older adults. FoF can lead to self-imposed restriction of activities and then further decline in physical capacities that predispose older adults to frailty. Evaluating the association of these two geriatric syndromes may be the first step for understanding their complex relationship and might ultimately lead to establishing therapeutic goals and guiding treatments for older adults with frailty. This systematic review was conducted to provide evidence regarding the association between FoF and frailty.MethodsAll the articles that provided information on the association between FoF and frailty were selected from PubMed, Scopus, CINAHL, and EMBASE in search of relevant papers. Articles reporting information on the association between FoF (exposure) and frailty (outcome), with older adults (age ≥60 years) living in the community (ie, living either at home or in places of residence that do not provide nursing care or rehabilitation) were included. Only original articles with observational design (cross-sectional or longitudinal/cohort) were included. The methodological quality of included articles was evaluated independently by the two assessors through the Newcastle-Ottawa Scale (NOS) and the Joanna Briggs Institute (JBI) critical appraisal checklist for longitudinal and cross-sectional studies, respectively.ResultsThe initial searches found 4,342 articles, of which 10 articles were included in this review: 7 cross-sectional and 2 longitudinal studies, and 1 study with cross-sectional and longitudinal analyses. The total sample was composed of 6,294 community-dwelling older adults (61.8% women). Among the longitudinal studies, adjusted odds ratios ranged from 1.18 (95% CI = 1.02; 1.36) to 9.87 (95% CI = 5.22; 18.68), while the adjusted odds ratios of the cross-sectional studies ranged from 1.04 (95% CI = 1.02; 1.07) to 7.16 (95% CI = 2.34; 21.89).ConclusionFoF increases the risk of frailty in community-dwelling older adults. The knowledge of this association is of utmost importance in clinical practice, since it can help health professionals in the development of rehabilitation, prevention, and health promotion protocols. In addition, these findings can contribute to the development of public health policies and actions aimed at reducing the FoF and consequently the frailty.ProsperoCRD42021276775.

Polypharmacy and Hyperpolypharmacy in Older Individuals with Parkinson’s Disease: A Systematic Review and Meta-Analysis

Background and Aim: Polypharmacy (concomitant use of 5–9 medicines) and hyperpolypharmacy (concomitant use of over 10 medicines) were observed to be more frequent in older adults (≥65 years) and associated with adverse outcomes. Their prevalence and risk in older patients with Parkinson’s disease (PD) remain unknown. We aimed to synthesize the extant evidence on the prevalence and risk of polypharmacy and hyperpolypharmacy in older adults with PD. Methods: A systematic literature search was performed in PubMed/MEDLINE, Scopus, and Embase databases to identify pertinent studies published from 2000 to July 2021. Observational studies reporting the prevalence and association with disease of polypharmacy/hyperpolypharmacy in older adults with PD were meta-analyzed. Pooled prevalence and odds ratio (OR) with 95% confidence intervals (CIs) were calculated. Results: Out of the total 499 studies identified, 6 fulfilled the inclusion criteria and comprised 7,171 participants. The overall prevalence of polypharmacy and hyperpolypharmacy was 40% (95% CI: 37–44) and 18% (95% CI: 13–23), respectively. A meta-analysis of 4 studies indicated a significant association between polypharmacy (OR: 1.94, 95% CI: 1.26–2.62; p < 0.001) and PD. Hyperpolypharmacy was also strongly associated with PD (OR: 3.11, 95% CI: 2.08–4.14; p < 0.001). Conclusion: Polypharmacy (40%) and hyperpolypharmacy (18%) are highly prevalent and eventually increase the risk of drug-related problems in older adults with PD. Therefore, interventions that ensure rational geriatric pharmacotherapy are of critical importance for the older population with neurogenerative disorders.

Association between age-related cataract and blepharoptosis in Korean adults: a population-based study

Cataract and blepharoptosis are both commonly encountered ophthalmic problems in older adults. Since they share similar risk factors, it is plausible that there may be an association between the two conditions. We examined data from the Korean National Health and Nutrition Examination Survey (KNHANES) 2010–2012 to determine if there is an association between age-related cataract and blepharoptosis. Multivariable adjusted logistic regression analysis was conducted to examine the odds ratio (OR) and 95% confidence interval (CI) for association of each specific type of cataract with presence of blepharoptosis. Of the 10,387 eligible participants, 4782 (46.0%) had cataract and 1419 (15.8%) had blepharoptosis. There were more participants with blepharoptosis in the cataract group, compared with those in the no cataract group. After adjusting for potential confounders, participants with blepharoptosis had a higher risk of total cataract (OR: 1.557, 95% CI 1.201–2.019) and nuclear subtype cataract (OR: 1.305, 95% CI 1.050–1.620). Blepharoptosis was associated with significantly higher odds of cataract in obese participants when compared with non-obese participants (p for interaction = 0.0236). Our study revealed a positive association between age-related cataract and blepharoptosis; it suggests that thorough ophthalmic assessment is needed when assessing patients who are planning cataract or blepharoptosis surgery.

Interface of Law and Psychiatric Problems in the Elderly.

Interface of Law and Psychiatric Problems in the Elderly.

Caring for Aging Skin: Preventing and managing skin problems in older adults.

This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home. The articles in this new installment of the series provide simple and useful instructions that nurses should reinforce with family caregivers who perform wound care tasks. Each article also includes an informational tear sheet-Information for Family Caregivers-that contains links to instructional videos. To use this series, nurses should read the article first, so they understand how best to help family caregivers, and then encourage caregivers to watch the videos and ask questions. For additional information, see Resources for Nurses.

Effect of Inspiratory Muscle Training Versus Core Stability Training on Balance Problems in Older Adults

We proposed to compare the implications of inspiratory muscle training versus core stability on the stability of the elderly. A total of 75 older individuals were randomly and evenly split into three groups: (A) the core stability group (n=25) received core stability training plus traditional balance exercises, (B) the IMT group (n=25) received IMT training plus traditional balance exercises, (C) the control group (n=25) was assigned to undergo conventional balancing exercises. The evaluation process included both pre-and post-testing, which encompassed the measurement of the time taken to complete the Time Up and Go (TUG) test, as well as the 30 Second Chair Stand Test (30CST). Following eight weeks of training, there was a significant rise in TUG in group A (P&lt;0.05) and 30CST in both groups A and B (P&lt;0.05 and p=0.002), respectively. Post-training, a significant disparity in the TUG and 30CST scores across the three groups was found, with corresponding pvalues of 0.038 and 0.006. So it was concluded that Core muscle stability training with a traditional balance program improves stability in the elderly more than IMT training with a traditional balance program or traditional balance program alone.

Non-operative treatment for lumbar spinal stenosis with neurogenic claudication: an updated systematic review

ObjectivesNeurogenic claudication due to lumbar spinal stenosis (LSS) is a growing health problem in older adults. We updated our previous Cochrane review (2013) to determine the effectiveness of non-operative treatment...

Determinants of Intention to Use Digital Technology for Older Adults by Environmental Dimensions

Due to the COVID-19 pandemic, it is common to hear news of older adults being socially isolated due to difficulties in purchasing or accessing online services and in interacting with family or friends through video calling apps. Despite an increasing ease of access to digital devices, such access far from universal. Thus, digital inequality has become a serious problem for older adults. To understand why digital inequality issues are so relevant for older adults, we must understand older adults' entire life contexts and the potential of digital technologies in their lives. With these understandings, the purpose of this study was to explore the technology acceptance process and identify key precursors to acceptance of digital technology using the Technology Acceptance Model (TAM) 3 as a framework. This study used data from the 2018 Digital Divide Survey of the Ministry of Science and ICT. A total of 1,662 older adults (aged 55+) were analyzed using structural equation modeling with bootstrap sampling. Model fit indices (CFI = .928; SRMR = .074; RMSEA = .044) suggested an acceptable fit. Results indicated that two environmental dimensions, personal environment (self-efficacy and value recognition) and social environment (social norms and social support systems), had a significant impact on the intention to use technology both directly and indirectly. Furthermore, perceived usefulness and perceived ease of use mediated between environmental domains and the intention. This study indicates that providing appropriate digital support for older adults is important to achieve greater digital inclusion.

Research Confirms Effectiveness of Oral Health Preventive Practices

Lack of insurance or funds for dental services, lack of access to dental offices, fear of dentists, and avoidance of dental offices during COVID can lead to oral health problems in older adults. Brushing, flossing, and drinking fluoridated water can protect teeth when dentists are unavailable. Limiting intake frequency of carbohydrates and chewing sugarfree gum after eating add protection. A recent systematic review and meta-analysis confirmed the effectiveness of sugarfree gum in reducing caries, in children and adults who chewed sugarfree gum compared with those who did not chew. Chewing sugarfree gum significantly reduced caries increment, with a prevented fraction of 28 percent, roughly equivalent to the prevented fractions for fluoride toothpastes and supplements. A follow-up systematic review provides further evidence that chewing sugarfree gum reduces the numbers of Streptococcus mutans in the oral cavity. Finally, chewing sugarfree gum could alleviate symptoms of xerostomia and may reduce caries.

Risk Factors of Sleep Disturbance in Older Adults With Dementia: An Actigraphy-Based Validation Study

Sleep disturbance is a common and significant symptom experienced by older adults with dementia. Early detection and timely treatment of sleep disturbance are critical to prevent adverse consequences including decreased quality of life for persons with dementia and increased caregiver burden. While direct observations and sleep diaries are often unreliable, actigraphy is a cost-effective method in measuring sleep problems in older adults with dementia and provides reliable and rich sleep data. Therefore, this study aimed to examine sleep disturbance objectively measured by actigraphy and its risk factors in community-dwelling older adults with dementia in Korea. This is a prospective study consisting of a two-wave dataset. The model was fitted using Wave 1 data (n=151) and then validated using Wave 2 data (n=59). Independent variables were demographics, cognitive and physical function, depressive symptoms, physical activity level, and neuropsychiatric symptoms measured by Neuropsychiatric Inventory(NPI), and clinical factors including dementia type, sedative use, and comorbidities. Sleep disturbance was defined as less than six nighttime sleep hours and sleep efficacy less than 75%. Using the Youden’s Index, the sample was dichotomized into sleep disturbance group (n=83) and sound sleep group (n=68). The results of the generalized linear mixed model showed that the risk factors for sleep disturbance included vascular dementia, age, step count, and having three neuropsychiatric symptoms (i.e., delusions, depression, and disinhibition). Individuals with dementia at risk for sleep disturbance should be identified to prioritize early prevention strategies and individualized interventions. Particularly, management of delusion, depression, disinhibition is critical in preventing disturbed sleep.

Descriptive Epidemiology of Fall-Related Injuries Among Older Adults in Ontario, Canada

The number of older adults is growing rapidly in the province of Ontario meaning there will be more fall-related injuries (FRIs) in coming decades. Falls are the leading cause of injury-related hospitalizations in Canada. The purpose of this study was to describe the prevalence, circumstances, types, and locations of FRIs among older adults in Ontario. Using a population-based retrospective design, we analyzed secondary data from three health administrative databases (NACRS, DAD, RPDB) for 2010-2014. Older adults (≥ 65 years) admitted to an emergency department (ED) with a combined diagnosis of ICD-10-CA codes for a fall (W00-W19) and injury (S00-S99 or T00-T14) were selected. Descriptive statistics were performed in R and rates were reported per 100,000 population. There were 304,610 FRI ED admissions (3,089/100,000) and 143,210 patients (47.0%) were subsequently hospitalized (1,452/100,000). Females accounted for 63.0% ED and 61.2% hospital admissions. Age-specific rates increased with age at both ED (2,208/100,000 in 65-69 group, 6,552/100,000 in 90+ years old) and hospital (698/100,000 in 65-69 group, 4,364/100,000 in 90+ years old). Females had higher rates of ED (3,503 vs. 2,572/100,000) and hospital (1,598 vs. 1,270/100,000) admissions than males. The most common injury types at the ED were fractures (1,234/100,000), superficial injuries (719/100,000), other or unspecified injuries (572/100,000), open wounds (498/100,000), and sprains, strains, and tears (162/100,000). FRIs are a considerable problem for older adults and better injury prevention strategies are needed for all female age groups, the 90+ year age group of both genders, and fractures.

Oral Health, Cognitive Function, and Mortality: Findings From National Surveys

Poor oral health, diabetes mellitus (DM), and cognitive impairment are common problems in older adults. Using national surveys, this symposium aims to present new findings regarding the impact of the co-occurrence of DM and poor oral health on cognitive function, cognitive decline, and mortality. This symposium will also cover the topic of dental care use among adult populations in the U.S. Using data from the Health and Retirement Study (HRS) (2006- 2018), the first study shows that adults with both DM and edentulism had the worst cognitive function, followed by those with edentulism alone, and those with DM alone. Using the same HRS data, the second study found that co-occurrence of DM and edentulism had a higher risk of more rapid cognitive decline with advancing age than the presence of each condition alone. The third study used data from the 2006-2016 HRS linked with mortality files, and revealed that the risk of diabetes and edentulism on mortality may vary across racial/ethnic groups. Using the Behavioral Risk Factor Surveillance System survey (2002-2018), the fourth study examined disparities of dental service utilization among racial/ethnic groups (Whites, Hispanics, Blacks, Asians, American Indians or Alaska Natives, and Native Hawaiian or other Pacific Islanders). Age differences in dental services were also compared between older adults and other younger and middle-aged populations. This symposium highlights the role of oral health in improving cognitive health. Policies and programs are needed to increase dental care access, a critical way to help maintain good oral health.