Proportion Of Older Adults Research Articles

Basal vacuolization of renal tubules in hypothermia: A comprehensive pathological study based on 79 forensic autopsy cases

This study investigated the usefulness of histopathological examination in diagnosing ketoacidosis in hypothermia cases. Out of 79 cases (38 females), 30 showed basal vacuolization (BV), a representative histopathological finding of ketoacidosis, in their hematoxylin and eosin (H&E)-stained specimens. Through the use of both lipid staining with osmium tetroxide postfixation and immunohistochemistry for adipophilin (ADFP-IHC), BV pattern pathology was identified in 43 cases. Serum was available in 75 cases, with 37 having serum β-hydroxybutyrate levels exceeding 1000 μmol/L. Serum β-hydroxybutyrate concentrations showed a significantly negative correlation with age and tended to be lower in outdoor hypothermia cases than in indoor cases. When comparing serum β-hydroxybutyrate levels with histopathological findings, all but one of the BV-positive cases on H&E staining were serologically diagnosed as ketoacidosis. However, when combining multiple staining methods, six cases were histologically positive but serologically negative. Using multiple staining methods increases BV detection sensitivity, but it may also detect findings of unknown pathological significance. Therefore, identifying a distinct BV pattern in H&E-stained specimens is crucial for suspecting ketoacidosis in the usual practice of forensic pathology, and ADFP-IHC is useful for confirming lipid droplet presence. Our results suggest that BV positivity rates are strongly influenced by the case characteristics of the study cohort, particularly the proportion of older adults. Thus, the extent to which BV is complicated by hypothermia should be examined and understood on a country-by-country or region-by-region basis.

Trends and Factors Affecting Functional Limitations on Activities of Daily Living Performance Among Korean Adults With Disabilities, 2008-2020: A Longitudinal Study.

Loss of the ability to perform activities of daily living (ADLs) leads to negative health outcomes such as reduced quality of life, institutionalization, and mortality. In Korea, the proportion of older adults with disabilities is increasing along with rapid population aging. Therefore, providing a comprehensive approach to the prevention and management of ADL limitations in people with disabilities is necessary. This can be accomplished by understanding the trends and factors affecting these limitations over time. This study was developed to examine the longitudinal trend and factors affecting ADL limitations over time among people with disabilities in Korea. Data from 346 people with disabilities in the 2008-2020 Korean Welfare Panel Study were used. Bivariate analysis and a Kendall trend test were performed to determine the longitudinal trends for ADL limitations, and multiple logistic regression was used to evaluate whether relevant variables could predict these limitations. The prevalence of ADL limitations among people with disabilities increased by 16.5% over the 12 years of the study. The highest rate of increase in these limitations over time was found in people with mental disorders (27.8%), those over 65 years of age (27.3%), and those with depression (25.6%). In multiple logistic regression, the odds ratios of the variables were slightly different at each survey wave. However, severe disability and low educational level were consistently found to be associated with ADL limitations over time. The findings provide evidence of a significant relationship between level of disability and/or educational status and ADL limitations in people with disabilities in Korea. To prevent the development of ADL limitations in people with disabilities, comprehensive identification of longitudinal trends and factors affecting ADL limitations is necessary. Early intervention, including integrated services such as home rehabilitation services to prevent ADL limitations, especially for disabled people with severe disabilities and low educational levels, has the potential to delay ADL limitations.

Food Delivery Apps and Their Potential to Address Food Insecurity in Older Adults: A Review.

The proportion of older adults is increasing globally, yet many of them experience food insecurity. Technological innovations, such as increased access to internet- and mobile-based food delivery apps (FDAs), may help mitigate food insecurity. However, this topic has been understudied. This scoping review searched for publications and online technical reports from around the world using interdisciplinary databases like ScienceDirect and internet sources like government websites, respectively. Eligible references were published recently (2019-present) and focused on general technology use, including apps, among older adults (≥50 years) or FDAs for food insecurity or nutritional health generally or specifically among older adults. The search identified 19 studies from 10 countries and extracted relevant information for summary tables. A limited number of studies supported the idea that FDAs can help address food insecurity, but there are important equity considerations for older adults living in rural areas or with constrained physical abilities. Consistently, customized app features and functions increased the intention to use FDAs. In addition, FDAs may have health and environmental impacts, such as food waste and increased access or promotion of ultraprocessed foods. Additional research is needed to elucidate the potential of FDAs to address food insecurity generally and specifically among older adults.

Daily activities of older adults before and during the COVID pandemic.

This study examines how older adults' (65 years old plus) daily activities shifted in the years around the coronavirus disease (COVID) pandemic. Using data from American Time Use Survey, this study compares activities across the pre-pandemic (2019 to March 2020), early-pandemic (May to December 2020), and pandemic-normal (2021) periods. In the first year of the pandemic, there was less time spent on average on leisure outside the home, traveling, and with nonhousehold members, and more time alone and at home, compared with before the pandemic. Moving beyond averages, sequence and cluster analyses find 5 similar typologies of days across the three periods, characterized by days predominated by (a) housework, (b) leisure at home, (c) TV, (d) a combination of leisure at home and outside with TV, and (e) paid work. Duration of time across various daily activities differed, however, even for the same clusters. For example, in days predominated by indoor leisure, adults spent 405min in this activity before the pandemic, 432min during the early-pandemic period, and 549min during the pandemic-normal period. We also observed changes in the proportion of older adults in each cluster. Across the pre-pandemic and early-pandemic periods, the proportion of days predominated by leisure at home increased (9.9%-17.9%) whereas the proportion belonging to days predominated by housework decreased (45.7%-17.6%). COVID-19 shifted the daily life of older adults, and our findings are consistent with selection, optimization, and compensation theory, documenting that older adult adapted across the first 2 years of the pandemic.

Prescribing Appropriate Medicines to Older Adults: A Finnish Experience with the Web-Based Meds75+ Database.

The Finnish web-based Meds75+ database supports rational, safe and appropriate prescribing to older adults in primary care. This article describes the content and updating process of Meds75+ and demonstrates its applicability in everyday clinical practice. Meds75+ contains a classification (A-D) and recommendation texts for 450-500 drug substances when used in the treatment of older adults aged 75 years or older. The content of Meds75+ is continually updated. Each assessment of a drug substance begins with a structured collection of available information and research evidence. After that, an interdisciplinary expert panel discusses the classification and recommendation using a consensus method. A rolling 3-year updating cycle guarantees that all drug substances are reviewed regularly. Most drug substances are classified as class A (41%) (suitable, e.g. bisoprolol) or as class C (37%) (suitable with specific precautions, e.g. ibuprofen). One-fifth (20%) of the substances are in class D (avoid use, e.g. diazepam). Most commonly, older adults have purchased substances affecting the alimentary tract and metabolism (17%), the nervous system (16%) and the cardiovascular system (15%). In Finland, the proportion of older adults using class D substances (37%) has not changed between the years 2019 and 2022. Meds75+ has potential to support safer and more effective use of medications for older adults, since it offers up-to-date information on drug substances for healthcare professionals.

Decline in use of high-risk agents for tight glucose control among older adults with diabetes in New York City: 2017-2022.

This study aimed to examine the prevalence of inappropriate tight glycemic control in older adults with type 2 diabetes and other chronic conditions in New York City, and to identify factors associated with this practice. We conducted a retrospective cohort study using the INSIGHT Clinical Research Network. The study population included 11,728 and 15,196 older adults in New York City (age ≥ 75 years) with a diagnosis of type 2 diabetes, and at least one other chronic medical condition, in 2017 and 2022, respectively. The main outcome of interest was inappropriate tight glycemic control, defined as HbA1c <7.0% (<53 mmol/mol) with prescription of at least one high-risk agent (insulin or insulin secretagogue). The proportion of older adults with inappropriate tight glycemic control decreased by nearly 19% over a five-year period (19.4% in 2017 to 15.8% in 2022). There was a significant decrease in insulin (27.8% in 2017; 24.3% in 2022) and sulfonylurea (29.4% in 2017; 21.7% in 2022) medication prescription, and increase in use of GLP-1 agonists (1.8% in 2017; 11.4% in 2022) and SGLT-2 inhibitors (5.8% in 2017; 25.1% in 2022), among the total population. Factors associated with inappropriate tight glycemic control in 2022 included history of heart failure (adjusted odds ratio [aOR] 1.38), chronic kidney disease ([aOR] 1.93), colorectal cancer ([aOR] 1.38), acute myocardial infarction ([aOR] 1.28), "other" ([aOR] 0.72) or "unknown" ([aOR] 0.72) race, and a point increase in BMI ([aOR] 0.98). We found an encouraging trend toward less use of high-risk medication strategies for older adults with type 2 diabetes and multiple chronic conditions. However, one in six patients in 2022 still had inappropriate tight glycemic control, indicating a need for continued efforts to optimize diabetes management in this population.

Childhood adversity and suicidal ideation in older Korean adults: unraveling the mediating mechanisms of mental health, physical health, and social relationships.

Suicide rates in older adults are much higher than those in younger age groups. Given the rapid increase in the proportion of older adults in Korea and the high suicide rate of this age group, it is worth investigating the mechanism of suicidal ideation for older adults. Generally, adverse childhood experiences are positively associated with suicidal ideation; however, it is not fully understood what mediating relationships are linked to the association between these experiences and current suicidal ideation. The data from 685 older Korean adults were analyzed utilizing logistic regression, path analyses, and structural equation modeling. Based on our theoretical background and the empirical findings of previous research, we examined three separate models with mental health, physical health, and social relationship mediators. After that, we tested a combined model including all mediators. We also tested another combined model with mediation via mental health moderated by physical health and social relationships. The univariate logistic regression results indicated that childhood adversity was positively associated with suicidal ideation in older adults. However, multivariate logistic regression results demonstrated that the direct effect of childhood adversity became nonsignificant after accounting all variables. Three path models presented significant mediation by depression and social support in the association between childhood adversity and suicidal ideation. However, combined structural equation models demonstrated that only mediation by a latent variable of mental health problems was statistically significant. Social relationships moderated the path from mental health problems to suicidal ideation. Despite several limitations, this study has clinical implications for the development of effective strategies to mitigate suicidal ideation. In particular, effectively screening the exposure to adverse childhood experiences, early identification and treatment of depressive symptoms can play a crucial role in weakening the association between childhood adversity and suicidal ideation in older adults.

Sedative load and anticholinergic burden among older adults in Slovenia over a decade: Potential for optimization of pharmacotherapy.

This study investigates the 10-year trend in the sedative and anticholinergic burden among older adults in Slovenia, with the aim of identifying opportunities to optimize pharmacotherapy in this population. A retrospective drug utilization analysis was conducted based on a national anonymized database of dispensed prescriptions from 2009 to 2019. The study employed the sedative load model and the anticholinergic cognitive burden scale to assess the sedative and anti cholinergic burden, respectively. The findings indicate that in 2019, 45.6 % and 40.8 % of older adults (≥ 65 years) used sedative and anticholinergic medications, respectively. A high sedative load and a clinically significant anticholinergic burden were observed in a considerable proportion of older adults (13.2 % and 11.2 %, respectively, in 2019). The age-standardized prevalence of sedative load and anti-cholinergic burden significantly decreased over the 10-year study period by 5.6 % and 1.7 %, respectively (absolute difference), while the prevalence of clinically significant anticholinergic burden remained stable. Notably, the age groups 85-89 years and above 90 years had an increase in the proportion of individuals with a clinically significant anticholinergic burden over the years. These results emphasize the need for targeted interventions, particularly in the oldest age groups, to promote safe and effective medication use among older adults.

Incontinence-associated dermatitis in older adults in residential care settings: a point prevalence study.

To identify, for the first time, the proportion of older adults in extended care settings in Ireland affected by IAD. Cross-sectional, multisite, point prevalence survey, across three community extended care settings for older people in Ireland. Two clinical nurse specialists, using the Scottish Excoriation and Moisture Related Skin Damage Tool, identified the presence of IAD through clinical observation and visual skin inspection. IAD prevalence was calculated for the total population and incontinent population sets using percentages and confidence intervals (CI). The prevalence of incontinence was 86.4% (n=165), a significantly higher proportion were female (P=0.003). The point prevalence of IAD across the total population and incontinent population was 11.5% (22/191; 95% CI, 7.4-19.9%) and 13.3% (22/164; 95% CI, 8.5-19.5%), respectively. Being incontinent was associated with being female, more dependent (Barthel), having possible cognitive impairment, poorer mobility (Braden and Waterlow) and a high risk of pressure ulcers (Waterlow). A logistic regression analysis found no predictor variables for IAD among the variables that met the cut-off point for this analysis. The study provides the first point prevalence empirical data on the occurrence of IAD in Ireland. It can inform decision-making on future planning and budgeting of new quality improvement projects and act as a benchmark for ongoing auditing of IAD.

IJCM_100A: Mountain Heights and Aging Insights: A Comprehensive Geriatric Assessment and Its Correlates in a Mesmerizing Hilly City of Northern India

Background: Global population is experiencing a rapid increase in the proportion of older adults, posing unique challenges to healthcare systems. Objective: To conduct a comprehensive geriatric assessment in Shimla, a hilly city in Northern India Methodology: A total of 408 participants aged 60 years and above were included in the study. Data were collected through structured interviews using a specifically designed questionnaire covering wide range of topics including socio-demographic characteristics, medical history, functional assessment, cognitive function assessment, psychosocial assessment, nutritional assessment, physical examination, fall risk assessment, and polypharmacy assessment. Results: The study involved 408 participants, with an average age of 70 years, comprising 53% males and 47% females. Functional assessment indicated theneed for assistance in various activities of daily living (ADLs) (16-32%) and instrumental activities of daily living (IADLs) (28-42%) Cognitive function assessment using the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) revealed cognitive impairment in 32% and 42%, respectively. The Clock Drawing Test indicated difficulties in time representation and spatial organization in 28%. Psychosocial assessment highlighted the prevalence of symptoms of depression in 36% and f anxiety in 27%. Nutritional assessment revealed that 29% were malnourished, and 34% were at high risk of malnutrition according to the Malnutrition Universal Screening Tool (MUST). Musculoskeletal disorders were found in 42%, while sensory impairments were observed in 28%. The fall risk assessment using the Timed Up and Go (TUG) test and the Berg Balance Scale indicated an increased risk of falls in 36% and 41%, respectively. Polypharmacy assessment highlighted that 82 were taking multiple medications concurrently. Conclusion: The findings emphasize the importance of addressing the specific challenges faced by older adults in such geographical contexts. The results can guide the development of effective healthcare interventions and policies that are tailored to the unique needs of older adults in hilly areas.

Understanding age-related changes: exploring the interplay of protein intake, physical activity and appetite in the ageing population.

Globally, we are currently facing a rapid demographic shift leading to an increase in the proportion of older adults within the population. This raises concerns about the potential increase in age-related diseases and their impact on our ability to provide adequate health and end-of-life care. To apply appropriate interventions, understanding the changes that happen with ageing becomes essential. Ageing is often accompanied by a decrease in appetite and physical activity, which may lead to malnutrition, resulting in decreased muscle mass, physical capabilities and independence. To preserve muscle mass, older adults are advised to increase protein intake and physical activity. However, protein's high satiating effect may cause reduced energy intake. Physical activity is also advised to maintain or enhance older adult's appetite. This review paper aims to discuss appetite-related changes that occur with ageing and their consequences. In particular, it will focus on investigating the relationship between protein intake and physical activity and their impact on appetite and energy intake in the ageing population. Recent studies suggest that physical activity might contribute to maintaining or enhancing appetite in older adults. Nevertheless, establishing a definitive consensus on the satiating effect of protein in ageing remains a work in progress, despite some promising results in the existing literature.

Advancing Aging Research Through a Health Disparities Perspective.

The proportion of older adults in the United States is growing, and the older adult population is also becoming increasingly diverse. However, there are limited data on the aging process and older adults in underserved populations. Equitable participation in research studies on aging, the research workforce, and the healthcare workforce is critical to improving health outcomes for the entire U.S. population. Health disparities frameworks offer researchers and healthcare professionals the tools to develop and evaluate aging research that addresses all levels of analysis and domains of influence. Although there have been efforts to diversify the healthcare and research workforce, significant disparities in representation remain. In this perspective, we discuss existing aging health disparities, health disparities frameworks to use as tools to better conduct aging research, methods to enhance the proportion of underrepresented populations in aging research, and the current gaps in as well as efforts to enhance the diversity of the healthcare and research workforces.

Multidisciplinary understanding of modifiable physical disability risk factors for health professionals: A scoping review protocol.

Physical disability represents a major burden to health and lifespan, particularly as the proportion of older adults within the United States is expected to grow. Prevention efforts for physical disability targets methods and strategies to decrease modifiable risk factors. Potential challenges for health professionals may exist in synthesizing and interpreting this broad spectrum of literature due to the discipline-specific nuance of language used, practice type or specialty, and lack of interdisciplinary resources. This scoping review will map and synthesize the literature across healthcare disciplines to identify modifiable risk factors and the evidence related to their ability to predict physical disability. We will also draw attention to the possibility of modifiable risk factors for physical disability being operationalized as pre-disability in order to strengthen primary and secondary prevention efforts. A planned search strategy using physical disability terminology will be searched in English across MEDLINE, CINAHL, Health Source, PEDro, and REHABDATA by two reviewers in line with our review objectives and inclusion criteria. Eligibility for inclusion include peer-reviewed primary research published in the English language and have established a relationship between a person-level measurable characteristic that is modifiable by changes in lifestyle behaviors and any of the commonly accepted terms used to categorize or describe physical disability. Presentation of results will be using the PRISMA flowchart, with additional mapping and synthesis of evidence for modifiable risk factors for physical disability to clarify divergent terms used in classifying and measuring these factors and their potential for prediction of physical disability. It is anticipated that this scoping review will identify and highlight a variety of modifiable risk factors for physical disability that may aid primary and secondary prevention efforts for health professionals.

The Impact of ICT Usage on Older Adults Residing in Institutional Settings Amidst the Coronavirus Disease Pandemic - Enhancing Emotional Experiences

The proportion of older adults is increasing every year in Slovenia and in developed countries. Older adults living in institutional settings have been faced with several measures intended for the containment of the spread of the coronavirus disease that have increased social isolation and feelings of loneliness. ICT has positive effects on the quality of life and well-being of older people as it mitigates the effects of social isolation. With the research, we wanted to find out how measures to contain the coronavirus disease affect the self-assessment of the experiencing of emotions in older adults living in an institutional environment. We chose a quantitative research method. 128 older adults who met the inclusion criteria participated in a non-random, casual sample. We collected the data using a questionnaire. We used a standardised and validated SPANE positive and negative emotion scale. Based on the research, we conclude that there are statistically significant differences with a risk of less than 5% between male and female residents in experiencing two positive emotions: kindness (p = 0.011) and happiness (p = 0.044) and also for two negative emotions: sadness (p = 0.001) and anger (p = 0.039). In the self-assessment of the experience of negative emotions among residents living in an institutional environment, we note that negative emotions among residents in the age groups up to 80 years and 81 years and older differ statistically significantly in one negative emotion, i.e., sadness (p = 0.002). We do not find statistically significant differences between religious and non-religious residents. Health and social workers working with the older adults need to pay more attention to the use of ICT in the future, because we find that the use of ICT has different effects on the experience of emotions.

DENTAL PATIENT-REPORTED OUTCOMES IN GERIATRIC DENTISTRY : A call for clinical translation

As the proportion of older adults in the world population increases, there is an increasing need to provide adequate dental care for this very heterogeneous group of individuals. The relationship between oral and systemic health, the impact of medication on oral health, and the influence of accessibility to dental care and other social and environmental factors shape the provision of dental care for older adults more than in children, younger, and middle-aged adults.However, while dental care for older adults is shaped by these factors and is often different from the care for other adults, what matters to older dental patients does not differ from what matters to dental patients in general. The four dimensions of oral health-related quality of life (OHRQoL)–Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact–capture dental patients’ suffering from oral disorders. OHRQoL questionnaires can be used to assess this impact and to achieve results that are compatible with adults in general. More than in other age groups, cognitive impairments or dementia limit the usefulness of questionnaires or interviews for oral health impact assessment. In these situations, family members or caregivers can assess the patient's oral health impact, and oral health care providers need to rely more on physical oral health characteristics for clinical decision-making than in other dental patients. While the tools to measure oral health impact change, the targets for dental care stay the same. Prevention and reduction of functional, painful, aesthetical, and broader psychosocial impact related to oral disorders are the central tasks for geriatric dentistry as they are for dentistry in general.The aim of the manuscript is to highlight the importance of patient-reported outcome measures in geriatric dentistry, addressing challenges and opportunities for their application.

FORGING A PATH TO DEVELOPING AGE-FRIENDLY CITIES AND COMMUNITIES IN GHANA: ISSUES AND RECOMMENDATIONS

Abstract The World Health Organization in 2007 launched the Age-friendly Cities and Communities (AFCC) initiative in an effort to make cities around the world more attuned to the needs of older adults. While AFCC initiatives have mostly been undertaken in developed societies around the world, developing countries appear to be excluded in this effort, as there is little to show for in the quest to creating AFCC. One of such countries is Ghana, where the proportion of older adults is expected to increase exponentially in the next decade, thereby heightening the need for AFCC. Utilizing a multiple case study approach, this paper synthesizes the procedures and findings of 16 case studies from around the world published on the eight domains of WHO’s Age-friendly Cities Framework, to make a case for developing AFCC in Ghana. Five important considerations were identified as fundamental to the effort to developing AFCC in Ghana: 1. Strengthening traditional views/perceptions on aging and older adults; 2. Involving key players in age-friendly efforts; 3. Responding to the complex interplay of needs and demands of older adults; 4. Designing policies and social programs to stimulate and enable cities and communities in Ghana to become age-friendly; 5. Developing validated instruments to assess the age-friendliness of cities and communities in Ghana. Designing and implementing AFCC require long-term commitment and devoting considerable resources to the cause. The paper concludes by discussing a culturally-appropriate model and policy recommendations to facilitate the move toward building age-friendly communities and age-inclusive cities in Ghana.

HETEROGENOUS EFFECTS OF MEDICARE BENEFIT FOR ADVANCE CARE PLANNING CONVERSATION BY SOCIODEMOGRAPHIC FACTORS

Abstract Background Although Medicare makes the option of physician-patient advance care planning (ACP) discussion available to everyone starting in 2016, older adults from disadvantaged backgrounds may be less likely to benefit from the policy. Motivated by Fundamental Cause Theory, this study examines the heterogenous policy effect, as a natural experiment, on older adults’ ACP uptake. Methods Data were from Health and Retirement Study 2012-2020 with 15,647 individuals. I used two quasi-experimental models – interrupted time series (ITS) analysis and difference-in-difference (DID) – to study ACP outcomes before and after the policy implementation between older adults who were Medicare-eligible and those who weren’t. I studied the heterogenous effects in stratified samples by race/ethnicity, immigration background, and socioeconomic status. I used coarsened exact matching to address the potential bias that the comparison group is not the ideal counterfactual control unit. Results DID reveals that, in the total population, Medicare expansion was associated with a significant increase (0.05 percentage point) in the proportion of older adults who completed advance directives, but not for having informal conversations. Furthermore, I find no evidence that the Medicare expansion was effective in improving the rates of ACP among Black, Hispanic, Asian or Native American, or non-US-born older adults. Lastly, based on ITS results, the policy only has significant immediate policy effects (level change) on ACP uptake, but not for sustained effects (slope change). Discussions: The current policy reproduced the disparities in ACP. I discuss health policy recommendations to improve the ACP rate among older adults with disadvantaged backgrounds.

THE INTERSECTION OF INSOMNIA AND CENTRALIZED PAIN IN OLDER ADULTS

Abstract The intersection of insomnia and pain with age has been broadly studied but has not been evaluated specifically in centralized pain. The objective of this study was to estimate the effect of age on rates of centralized pain and insomnia in older adults. This was a single center, retrospective, observational cohort study consisting of older adults (≥55 years old) with a diagnosis of centralized pain, insomnia, or both seen at University of Michigan Health from January 1, 2016 – January 1, 2022. The primary outcome was the proportion of older adults with both insomnia and centralized pain, defined as least one centralized pain diagnosis coded in the subject’s electronic health record within one year of insomnia diagnosis. A total of 26,804 patients were included in the analysis. Mean age was 66.84 years (SD 8.79); 66% of patients (n=17,687) were female. Overall, 92.1% of patients (n=24,683) carried ≥1 centralized pain diagnosis, 5.6% of patients (n=1,505) carried a diagnosis of insomnia, and 2.3% (n=616) had both [95% CI 2.1,2.5]. Of older adults with insomnia, 29% (95% CI 27, 31) also carried a centralized pain diagnosis. Of older adults with centralized pain, 2.4% (95% CI 2.3, 2.6) also carried an insomnia diagnosis. Compared to older adults with insomnia alone, those with both insomnia and centralized pain were more likely to be female (p=&amp;lt; 0.001) and older (p=0.014). Insomnia and centralized pain are highly prevalent in older adults and co-occur frequently in those with insomnia. Older adults with insomnia should be screened for centralized pain.

Using Comprehensive Geriatric Assessment in Identifying Care Goals and Referral Services in a Frailty Intervention Clinic.

The proportion of older adults and frail adults in Canada is expected to rise significantly in upcoming years. Currently, a considerable number of older adults do not actively participate in developing their own care plans; prior research has indicated several benefits of patient engagement in this process. Thus, we conducted a mixed methods study that examined the prevalence of rehabilitation goals and identified these for 305 community dwelling older adults referred to a frailty intervention clinic utilizing Comprehensive Geriatric Assessment (CGA) between 2014 and 2018. Top patient concerns included mobility (84%), services, systems, and policies (51%), sensory functions and pain (50%), and self-care or domestic life (47%). The most common referrals or recommendations for patients included further follow-up with a physician or specialist (36%), referral to an onsite falls prevention clinic (31%), and medication modifications (31%). Based upon these findings, we recommend greater utilization of CGA within a team-based approach to improve patient care by allowing for greater collaboration and shared decision-making by health-care providers. Moreover, CGA can be an effective tool to meet the complex and unique health-care needs of frail patients while incorporating patient goals. This is vitally important considering the predicted growth in the population of frail and/or older patients, as well as the current challenges and shortfalls in meeting the health-care needs of this population.

Diagnosis and treatment of obesity disease in older adults

In Japan, the proportion of older adults with obesity is rising, highlighting the need for specialized medical care for older adults with obesity. The Japan Society for the Study of Obesity (JASSO) defines 'obesity' as excessive fat storage in adipose tissue with body mass index (BMI) ≥ 25 kg/m2, and "Obesity Disease" as a condition with health disorders associated with obesity and/or visceral fat accumulation.The term 'high-degree obesity' applies to those with BMI≥ 35 kg/m2, and "Obesity Disease" with high-degree obesity is defined as "high-degree Obesity Disease".While the diagnostic criteria for "Obesity Disease" are same regardless of age group, older adults have unique problems. For example, BMI may not accurately reflect fat mass due to age-related height changes and other factors like edema. There's also an 'obesity paradox' in the older adults, where higher BMI may correlate with reduced mortality, though visceral fat is a risk factor.Weight reduction goal is 3% or more of body weight in 3-6 months for "Obesity Disease" and 5-10% or more for "high-degree Obesity Disease" . Management may include calorie-controlled diets and resistance exercises to prevent bone and muscle loss. Advanced treatment options like bariatric/metabolic surgery are also available for "high-degree Obesity Disease" .Recent guidelines from the Japan Geriatrics Society and JASSO provide insights into managing "Obesity Disease" among older adults, considering specific issues like dementia and functional decline. Future therapy need to evolve and provide individualized approaches to manage obesity for older adults.