Risk Factors In Older Adults Research Articles

Depression and associated risk factors in older adults with diabetes: the 2010-2011 Korean national health and nutrition examination survey

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Nutritional status and body fat mass: Determinants of sarcopenia in community-dwelling older adults.

Sarcopenia is defined as the old age syndrome characterized by profound decline in muscle mass and function. This study aimed to investigate the prevalence of sarcopenia and its risk factors in older adults. Totally, 501 older people aged 65 years and older were recruited. Sarcopenia was defined according to the criteria of the Asian Working Group for Sarcopenia (AWGS). For obtaining Skeletal Muscle mass Index (SMI), body composition was evaluated using Bioelectrical Impedance Analysis (BIA). Muscle strength and physical performance were measured by Handgrip Strength (HGS) and Gait Speed (GS), respectively. Nutritional status, physical activity level, and biochemical indicators were assessed, as well. The prevalence of sarcopenia was 20.8%. Multiple logistic regression models of the predictors of decline in the components of sarcopenia showed that older age, low Body Mass Index (BMI), and serum albumin level were associated with a higher risk of low SMI. Low serum albumin level and older age were also predictive of low HGS. Besides, old age, high body fat mass, and low BMI were the risk factors of low GS. Conversely, increased Calf Circumference (CC) was protective against low SMI and GS. Finally, older age, male gender, low BMI, decreased mini-nutritional assessment score, low serum albumin level, and high body fat were associated with a higher risk of sarcopenia, whereas higher CC reduced its risk. The prevalence of sarcopenia is high among elderly individuals. This study underlined that sarcopenia might develop in older adults with impaired nutritional status and high body fat mass. Further studies could evaluate the effects of appropriate nutritional interventions on sarcopenia management and prevention.

Adherence to DASH-Style Dietary Pattern Impacts on Adiponectin and Clustered Metabolic Risk in Older Women.

While dietary patterns are related to the age-related progression of chronic diseases, to what extent different dietary patterns influence inflammatory and metabolic risk factors in older adults remains to be elucidated. Additionally, potential moderating effects by physical activity (PA) become important to clarify. Here, we hypothesize that dietary patterns are linked to inflammatory and metabolic biomarkers and that these links are independent of PA. The present study aims to explore links between two dietary constructs and biomarkers of systemic inflammation and metabolic health in older women, while considering time spent in moderate-to-vigorous PA (MVPA). A cross-sectional analysis of a sample of 112 community-dwelling older women (65–70 years old) was performed. Dietary constructs based on the Dietary Approach to Stop Hypertension (DASH) and the dietary inflammatory index (DII) were determined from food records. MVPA was objectively assessed using accelerometry. Metabolic outcomes (waist circumference, systolic/diastolic blood pressures and levels of glucose, triglycerides and high-density lipoprotein (HDL)-cholesterol) and inflammatory biomarkers (C-reactive protein (CRP), fibrinogen and adiponectin) were determined using standardized procedures and a clustered metabolic risk score was derived. Adherence to DASH-style diet was significantly (p < 0.05) associated with a lower clustered metabolic risk, where women in the highest adherence group had a significantly (p < 0.05) lower waist circumference and blood glucose level compared to those in the lowest group. Further, a significantly higher (p < 0.05) adiponectin level was observed in the high DASH adherence group compared to those with low adherence. Notably, adjustment by waist circumference did not alter links with either adiponectin or blood glucose level. Importantly, all observed links remained significant after further adjustment for time in MVPA. Finally, no significant associations were observed when the dietary pattern was defined by the DII. The findings of this study demonstrate that DASH-style diets promote a systemic anti-inflammatory environment, while also mitigating clustered metabolic risk in older women. A key finding is that favourable impacts of the DASH-style diet are independent of time spent in moderate-to-vigorous PA, which further strengthens healthy eating behaviours as a key target for clinical and public health interventions designed to prevent age-related metabolic abnormalities.

Multifactorial exercise and dance-based interventions are effective in reducing falls risk in community-dwelling older adults: A comparison study

BackgroundFalls and injuries related to falls in older adults are a significant health care issue that affects the elderly population. Research suggests that exercise interventions can be effective in improving falls risk factors. Research questionAre there differences in falls risk reduction between two exercise interventions (The Lebed Method - TLM and Stay Active and Independent for Life – SAIL) for community-dwelling older adults? MethodsA quasi-experimental pre- and post-test design was used for this study. One hundred and sixty-three older individuals aged between 60–79 years of age participated in the study. Assessments of falls risk (using the physiological profile assessment), simple reaction time, bilateral knee extension strength, proprioception, balance, visual acuity, and mobility (using timed-up-and-go, TUG) were performed. Analysis of covariance was conducted to compare the differences between the two interventions. Pre-intervention assessments were used as the covariate. ResultsSAIL participants’ falls risk were reduced more than TLM. Reaction and TUG times were faster for SAIL participants. However, those individuals who participated in TLM had greater knee extension strength for both legs compared to SAIL participants. SignificanceOverall, both interventions were effective in reducing falls risk for older adults. The greater number of improved falls risk factors attained with the SAIL program suggests that multifactorial interventions may be more effective at reducing falls risk. However, since TLM also showed better improved strength, both dance-based and multifactorial interventions can be effective at reducing falls risk factors for older adults.

Abstract MP47: Diabetes, Prediabetes, and Short-Term Cardiovascular Risk and Death in Older Adults

Background: Studies in middle-age adults have established prediabetes and diabetes as major cardiovascular disease (CVD) risk factors. Whether these associations persist among older adults is less clear. Methods: Older adults in the Atherosclerosis Risk in Communities (ARIC) Study who attended visit 5 (2013-2015; n = 5,791; ages 66-90) were followed for recurrent global CVD events (fatal or non-fatal myocardial infarction, stroke, and heart failure) and all-cause mortality. We used Cox proportional hazards and negative binomial regression to quantify and compare the independent associations of prediabetes (hemoglobin A1c [A1c]: 5.7-6.3%) and diabetes (prior diagnosis, medication use, or A1c ≥ 6.4%), traditional CVD factors, subclinical CVD (assessed using high sensitivity cardiac troponin [hs-cTnT]), and short-term risk of clinical outcomes in this older population. Results: Over a median follow-up of 4.6 years, there were 5,442 global CVD events (32% with at least one event) and 660 deaths. Diabetes, but not prediabetes, was significantly associated with both outcomes ( Table ). After adjustment for traditional risk factors, diabetes of shorter duration was no longer significantly associated with global CVD; however, diabetes of longer duration, renal disease, and subclinical CVD remained significantly associated with both outcomes. Higher risks of global CVD events and mortality were observed in Blacks compared to Whites. Conclusions: Prediabetes and short-term diabetes were not major independent predictors of short-term CVD events or death in older adults, especially compared to hypertension, kidney disease, long-term diabetes, and subclinical and prevalent CVD. Our results support focusing on these latter risk factors in older adults.

Effect of a Risk Reduction Intervention Strategy on Caregiver's Knowledge, Attitude and Practice related to Fall Prevention

Falls are the main cause of morbidity and disability in the older adults. The risk doubles or triples in the presence of history of previous falls. This study aimed to assess the frequency of falls and associated risk factors in older adults and the effect of a risk reduction intervention strategy on knowledge, attitude and practice related to falls prevention among the caregivers of older adults. One group pre-–post-test study design was used. A total of 60 older adults and 60 caregivers were selected using simple random sampling method. Data were collected using the fall assessment questionnaire for frequency of falls among older adults. Majority, i.e., 42 (70%) of the older adults had no fall and 18 (30%) of the older adults had falls during the last 5 years. The overall mean score of pre-test knowledge of the caregiver was 14.08 and the post-test was 37.90, and the difference was statistically significant (P < 0.001). The mean score of pre-test practice was 9.45 whereas the post-test was 17.53, and the difference was statistically significant (P < 0.001). In the current study, 40 (66.7%) caregivers had favourable attitude at both before and after intervention. There was a significant difference (P < 0.001) in the overall mean of existence of short-term modifiable risk factors before and after the risk reduction intervention strategy.

Validation of a single factor representing the indicators of metabolic syndrome as a continuous measure of metabolic load and its association with health and cognitive function.

The metabolic syndrome (MetS) is a cluster of risk factors for cardiovascular disease associated with reduced physical fitness, higher disease burden, and impaired cognitive functions. Little is known about the operation of these risk factors in older adults when considered comprehensively without relying on the cut-off values of the single MetS components. The three main aims of the current study were to: (i) establish a latent metabolic load factor (MetL), using confirmatory factor analysis (CFA), and representing a continuous measure of MetL, defined by indicators that are commonly used to separate MetS groups from healthy individuals; (ii) examine the associations of this MetL factor with objective health, and cognitive function in men and women; (iii) compare the magnitude of these associations to those observed for the individual indicators used to define the MetL factor as well to the classical categorized MetS vs. non-MetS groups. The current analysis is based on cross-sectional data from 1,609 participants of the Berlin Aging Study II (mean age = 68.5 years, SD (3.7); 50.1% female). We applied structural equation modeling (SEM) to establish a latent MetL factor defined by the five indicators commonly used to diagnose MetS. The latent MetL factor was associated with physician-assessed morbidity and kidney function (estimated glomerular filtration rate, eGFR) in both men and women, but not with hand grip strength and lung function (Forced Expiratory Volume in 1 Second (FEV1)). In addition, we found a negative association between MetL and fluid intelligence among men. A continuous latent variable approach representing the common variance of MetS indicators is well suited to foster our understanding of human aging as a systemic phenomenon in which risk factors are operating on either side of the normal versus pathological divide.

Increased Risk of Diabetes Mellitus Among Adult Survivors of B-Cell Non-Hodgkin Lymphoma

▪IntroductionImprovements in multi-modal therapies have increased survival rates for older adults diagnosed with B-cell Non-Hodgkin Lymphoma (B-NHL). Despite this success, B-NHL survivors are at an increased risk for developing long-term and late complications of these therapies thereby compromising survival. Several studies have reported an increased risk in diabetes mellitus (DM) among long-term survivors of Hodgkin lymphoma and pediatric cancers. However, there are limited data on the risk of DM and its risk factors in older adults following treatment for B-NHL. Using data from the Utah Population Database, we evaluated the association between treatment for B-NHL and DM risk and furthermore compared this risk to a matched Utah general population. We hypothesized that the risk of DM among B-NHL survivors would be significantly increased compared to the general population.MethodsAdult (age >18 years at diagnosis) survivors of primary B-NHL living in Utah at the time of diagnosis between 1997-2013, without a previous diagnosis of DM, and matched (1:4) to individuals without a prior history of DM from the Utah general population for birth year, birth state, and sex were included. New DM diagnoses were identified for all-time, 0-1, 1-5, and 5-10 years following a diagnosis of B-NHL. Adjusting for sex, race, baseline body mass index (BMI), and Charlson Comorbidity Index (CCI) scores, multivariate Cox proportional hazard analysis was performed to estimate the adjusted hazard ratio (aHR) of DM in B-NHL survivors compared with that in matched non-B-NHL individuals. Risk factors for DM were evaluated, including age at diagnosis, race, sex, BMI at baseline, family history of DM, cancer stage at diagnosis, and treatment modality. The risk of developing DM during all-time, 0 to 1, 1 to 5, and 5 to 10 years follow-up after adjusting for demographic variables was analyzed by age (< 40, 40-65, and >65 years) at diagnosis of B-NHL.ResultsThe study population included 3,970 B-NHL survivors and 19,821 matched individuals from the general population. At the time of diagnosis, the majority of B-NHL patients were age 60 or greater (61.4%), had diffuse large B-cell lymphoma (46%) or follicular lymphoma (26.4%), distant cancer stage (50.1%), and received chemotherapy (27.5%). DM was diagnosed in 897 (22.6%) B-NHL survivors and 3,253 (16.4%) non-B-NHL adults. The majority in both groups were male (B-NHL: 55.5%; controls: 55.5%), white (B-NHL: 97.4%; controls: 93.8%), overweight [BMI 25-29.9 kg/m2 (B-NHL: 40.7%; controls: 40.6%)] or obese [BMI ≥30 kg/m2 (B-NHL: 21.8%; controls: 18.5%)]. The risk of developing DM among B-NHL survivors compared to the control group was significantly increased over all time (HR, 1.34; 95% CI 1.24 - 1.44) and the 0 to 1 year follow-up period (HR, 1.28; 95% CI 1.15 - 1.43)(Table 1). Multivariable analysis for DM risk showed that age 40-65 years and BMI ≥25 were factors independently associated with developing DM at all-time, 0 to 1, 1 to 5, and 5 to 10 years after diagnosis of B-NHL. Male sex and a family history of DM were significantly associated with development of DM during all time, 1 to 5, and 5 to 10 year follow-up periods. Distant cancer stage at diagnosis was a significant risk factor for DM at all time and 1 to 5 years while receipt of chemotherapy only or chemotherapy with radiation were significantly associated with development of DM at 5 to 10 years after diagnosis of B-NHL (estimated aHR and CIs are shown in Table 2). There was no significant association between race and the development of DM.ConclusionAdult survivors of B-NHL have an overall significantly higher risk of developing DM in the first year and over all time following a diagnosis of B-NHL compared to the general population. Age 40 to 65 years and BMI ≥25 were significant risk factors for DM across all follow-up periods while treatment with chemotherapy only or chemotherapy with radiation significantly increased the risk of DM 5-10 years after diagnosis of B-NHL. Race did not appear to be a risk factor for DM but this result may reflect the homogeneity of our study population. These findings contribute important information to the existing literature regarding the risk of developing DM in adult B-NHL survivors and provide foundation for the development of screening and management guidelines for DM in the B-NHL survivor population. DisclosuresNo relevant conflicts of interest to declare.

Lack of Relationships Between Serum Prolactin Concentrations and Classical Cardiovascular Risk Factors in Eastern Croatian Older Adults.

BackgroundRelationships between serum prolactin concentrations and various CV risk factors in older adults have rarely been assessed. The aim of this study was to examine the relationships between serum prolactin concentrations and CV risk factors in older patients with multiple CV risk factors.Material/MethodsThis case-control study included 92 patients, 50–89 years old (median, 69 years), with multiple CV risk factors. We used data from general practice electronic health records and biochemical laboratory tests. Patients were divided according to categories of CV risk factors.ResultsSerum prolactin concentrations were significantly higher in elderly people (≤65 vs. >65) and in men (70.65±58.02 vs. 150.82±114.05 mIU/L), as well as in patients with lower renal function (156.70±127.23 vs. 72.53±37.25 mIU/L, the bottom vs. top quartile of creatinine clearance), higher serum homocysteine and TSH concentrations, and in those who used NSAID and statins. Parameters indicating chronic inflammation (CRP) and renal function decline (creatinine clearance) were significantly and independently correlated with increased serum prolactin concentrations in multiple regression analysis.ConclusionsWhen assessing the relationships between prolactin and CV risk factors in older people with multiple CV risk factors, the effect of renal function decline and chronic inflammation should receive attention.

Mortality and associated risk factors for older adults admitted to the emergency department: a hospital cohort

BackgroundOlder emergency department patients are more vulnerable than younger patients, yet many risk factors that contribute to the mortality of older patients remain unclear and under investigation. This study endeavored to determine mortality and factors associated with mortality in patients over 60 years of age who were admitted to the emergency departments of two general hospitals in Mexico City.MethodsThis is a hospital cohort study involving adults over 60 years of age admitted to the emergency department and who are beneficiaries of the Mexican Institute of Social Security and residents of Mexico City.All causes of mortality from the time of emergency department admission until a follow-up home visit after discharge were measured. Included risk factors were: socio-demographic, health-care related, mental and physical variables, and in-hospital care-related. Survival functions were estimated using Kaplan-Meier curves. Hazard ratios (HR) were derived from Cox regression models in a multivariate analysis.ResultsFrom the 1406 older adults who participated in this study, 306 (21.8%) did not survive. Independent mortality risk factors found in the last Cox model were age (HR = 1.02, 95% CI, 1.005–1.04; p = 0.01), length of stay in the ED (HR = 1.003, 95% CI = 0.99, 1.04; p = 0.006), geriatric care trained residents model in Hospital A (protective factor) (HR = 0.66, 95% CI = 0.46, 0.96; p = 0.031), and the FRAIL scale (HR of 1.34 95% CI, 1.02–1.76; p = 0.033).ConclusionsRisk factors for mortality in patients treated at Mexican emergency departments are length of stay and variables related to frailty status.

0737 Obstructive Sleep Apnea: A Distinct Physiological Phenotypic Risk Factor in older adults with Cognitive decline and Alzheimer’s disease

0737 Obstructive Sleep Apnea: A Distinct Physiological Phenotypic Risk Factor in older adults with Cognitive decline and Alzheimer’s disease

Suicide in older adults: current perspectives.

Suicidal behavior in older adults (65 years old and over) is a major public health issue in many countries. Suicide rates increase during the life course and are as high as 48.7/100,000 among older white men in the USA. Specific health conditions and stress factors increase the complexity of the explanatory model for suicide in older adults. A PubMed literature search was performed to identify most recent and representative studies on suicide risk factors in older adults. The aim of our narrative review was to provide a critical evaluation of recent findings concerning specific risk factors for suicidal thoughts and behaviors among older people: psychiatric and neurocognitive disorders, social exclusion, bereavement, cognitive impairment, decision making and cognitive inhibition, physical illnesses, and physical and psychological pain. We also aimed to approach the problem of euthanasia or physician-assisted suicide in older adults. Our main findings emphasize the need to integrate specific stress factors, such as feelings of social disconnectedness, neurocognitive impairment or decision making, as well as chronic physical illnesses and disability in suicide models and in suicide prevention programs in older adults. Furthermore, the chronic care model should be adapted for the treatment of older people with long-term conditions in order to improve the treatment of depressive disorders and the prevention of suicidal thoughts and acts.

Comorbidities and cardiovascular risk factors in an aged cohort of HIV-infected patients on antiretroviral treatment in a Spanish hospital in 2016

ABSTRACTObjectives: The increased survival of HIV-infected individuals has resulted in a premature aging of this population, with the consequent development of premature age-related comorbidities and risk factors. We aimed to describe the prevalence of age-related comorbidities and cardiovascular risk factors in older adults with HIV infection on antiretroviral therapy (ART).Methods: A retrospective cross-sectional study was undertaken in a cohort of HIV patients aged ≥50 years on ART in September 2016 in Spain. The prevalence of comorbidities (liver cirrhosis, respiratory diseases, cancer, cardiovascular, diabetes, and kidney and bone disorders) and risk factors (smoking, dyslipidemia, and arterial hypertension) was captured.Results: Among the 339 patients included in the study, any comorbidity was present in 52%, the most common being cirrhosis (19%), chronic lung disease (13%), and diabetes mellitus (11%). Over three quarters (78%) had any risk factor: dyslipidemia (55%) and smoking (44%). A higher prevalence of cardiovascular disease was seen in patients ≥60 years in comparison to those aged 50–59 years (23% vs 8%, p = 0.001). Of all study patients, 44% took more than three drugs in addition to their ART, while 29% received no additional pharmacological interventions.Conclusions: Comorbidities and risk factors for chronic diseases are very common in HIV-infected patients aged ≥50 years and increase with age, so they should be early considered in the clinical management of these patients. It is important to encourage healthy lifestyles to prevent comorbidities and to control risk factors. Concomitant treatments with ART should be carefully monitored to prevent drug interactions, adverse effects, and patient adherence failures.

Using Social Media to Reduce Multiple Risk Factors for CRC in Rural Appalachians: #CRCFREE

Abstract Purpose: To examine the efficacy, acceptability, feasibility, and applicability of a Facebook (FB) intervention designed to reduce multiple colorectal cancer (CRC) risk factors in older adults residing in rural Appalachian Kentucky. Methods: We piloted a 12 week FB intervention culturally tailored for older adults residing in rural Eastern Kentucky to impact CRC risk factors, including: nutrition, physical activity, and screening. Participants were aged 50+, had internet access, and were at risk for CRC. During the 12 week study, the participants received three daily posts via secret FB group regarding CRC risk factors. Demographics, dietary measures, body mass index (BMI), and CRC screening were assessed at baseline and post intervention. FB engagement and physical activity were tracked throughout the intervention. Dietary measures included the Healthy Eating Index (HEI) and Dietary Inflammatory Index (DII). Physical activity was tracked using Fitbits. Post-intervention focus group interviews were conducted to assess feasibility and acceptability. Results: Participants (n = 57) were Caucasian, aged 58 ± 6 years, predominately female (67%), and the majority reported at least a high school education (77%). Post intervention, participants experienced significant increase in HEI scores (49.94 ± 9.84 vs. 58.60 ± 12.06, P = &amp;lt; 0.01). DII scores significantly decreased (2.44 ±1.12 vs. 1.60 ± 1.63, P = 0.003). There was no significant change in physical activity, BMI, or screening status. Participants, on average, viewed more than half of the posts. Focus group participants found FB posts to be useful and motivating. They reported that FB posts were educational and motivational. Conclusion: This pilot study shows promising preliminary data to support using a FB intervention in rural Appalachian older adults to decrease CRC risks. Participants were receptive to FB intervention, and FB provides a unique and accessible method for health promotion in hard to reach populations.

Associations of activated coagulation factor VII and factor VIIa‐antithrombin levels with genome‐wide polymorphisms and cardiovascular disease risk

Essentials A fraction of coagulation factor VII circulates in blood as an activated protease (FVIIa). We evaluated FVIIa and FVIIa-antithrombin (FVIIa-AT) levels in the Cardiovascular Health Study. Polymorphisms in the F7 and PROCR loci were associated with FVIIa and FVIIa-AT levels. FVIIa may be an ischemic stroke risk factor in older adults and FVIIa-AT may assess mortality risk. Background A fraction of coagulation factor (F) VII circulates as an active protease (FVIIa). FVIIa also circulates as an inactivated complex with antithrombin (FVIIa-AT). Objective Evaluate associations of FVIIa and FVIIa-AT with genome-wide single nucleotide polymorphisms (SNPs) and incident coronary heart disease, ischemic stroke and mortality. Patients/Methods We measured FVIIa and FVIIa-AT in 3486 Cardiovascular Health Study (CHS) participants. We performed a genome-wide association scan for FVIIa and FVIIa-AT in European-Americans (n=2410) and examined associations of FVII phenotypes with incident cardiovascular disease. Results In European-Americans, the most significant SNP for FVIIa and FVIIa-AT was rs1755685 in the F7 promoter region on chromosome 13 (FVIIa, β=-25.9mUmL-1 per minor allele; FVIIa-AT, β=-26.6pm per minor allele). Phenotypes were also associated with rs867186 located in PROCR on chromosome 20 (FVIIa, β=7.8mUmL-1 per minor allele; FVIIa-AT, β=9.9 per minor allele). Adjusted for risk factors, a one standard deviation higher FVIIa was associated with increased risk of ischemic stroke (hazard ratio [HR],1.12; 95% confidence interval [CI], 1.01, 1.23). Higher FVIIa-AT was associated with mortality from all causes (HR, 1.08; 95% CI, 1.03, 1.12). Among European-American CHS participants the rs1755685 minor allele was associated with lower ischemic stroke (HR, 0.69; 95% CI, 0.54, 0.88), but this association was not replicated in a larger multi-cohort analysis. Conclusions The results support the importance of the F7 and PROCR loci in variation in circulating FVIIa and FVIIa-AT. The findings suggest FVIIa is a risk factor for ischemic stroke in older adults, whereas higher FVIIa-AT may reflect mortality risk.

The epidemiology of nonviral microbial keratitis in a tertiary care center in Muscat, Oman.

OBJECTIVE:The objective of this study is to describe the epidemiology, risk factors, etiology, and outcome of microbial keratitis in a tertiary care center in Muscat, Oman.METHODS:The electronic records of all patients diagnosed with keratitis or corneal ulcer between January 2013 and January 2016 in Al-Nahdha Hospital were retrospectively reviewed. Patients who presented with a corneal ulcer requiring admission and who underwent culture and sensitivity studies were included in the study. Patients with viral keratitis or sterile corneal ulcers were excluded from the study.RESULTS:A total of 606 electronic medical records of all presumed microbial keratitis were reviewed. Out of these, 304 met the eligibility criteria. The mean age of patients was 52.2 years (standard deviation [SD]: ±23.2 years; range: 0.1–89 years). A total of 198 (65%) microbial cultures yielded positive results. Of these, 182 (92%) were bacterial, 13 (7%) were fungal, and 3 (1%) cases were due to a combined (bacterial and fungal) etiology. Gram-positive bacteria accounted for 102 (55.1%), of which the majority was due to Streptococcus pneumoniae. Gram-negative bacteria accounted for 77 (41.6%) cases; half were caused by Pseudomonas aeruginosa. Keratitis in patients aged 18 years and younger was more likely to be associated with trauma (48.3%, P < 0.001) in young adults with contact lens wear (64%, P < 0.001) and in adults over 40 years with blepharitis (55.6%), sequelae of previous trachoma infection (26.3%), and eyelid abnormalities (18.4%). Following recovery, corneal scarring was seen in 63.2% of patients.CONCLUSION:Microbial keratitis affects patients of all age groups but is more common in older adults. The vast majority of culture-proven cases are due to bacterial infections. Children and teenagers are more likely to develop keratitis following eye trauma whereas young adults mostly develop the condition in association with contact lens wear. Ocular surface disease is the most important risk factor in older adults. The majority of patients end up with corneal scarring.

Rate of Antimicrobial Resistant Urinary Pathogens and Associated Risk Factor in Older Adults Living in Long-Term Care Facilities in Seoul

Rate of Antimicrobial Resistant Urinary Pathogens and Associated Risk Factor in Older Adults Living in Long-Term Care Facilities in Seoul

Stepping reaction time and gait adaptability are significantly impaired in people with Parkinson's disease: Implications for fall risk

BackgroundDecline in the ability to take effective steps and to adapt gait, particularly under challenging conditions, may be important reasons why people with Parkinson's disease (PD) have an increased risk of falling. This study aimed to determine the extent of stepping and gait adaptability impairments in PD individuals as well as their associations with PD symptoms, cognitive function and previous falls. MethodsThirty-three older people with PD and 33 controls were assessed in choice stepping reaction time, Stroop stepping and gait adaptability tests; measurements identified as fall risk factors in older adults. ResultsPeople with PD had similar mean choice stepping reaction times to healthy controls, but had significantly greater intra-individual variability. In the Stroop stepping test, the PD participants were more likely to make an error (48 vs 18%), took 715 ms longer to react (2312 vs 1517 ms) and had significantly greater response variability (536 vs 329 ms) than the healthy controls. People with PD also had more difficulties adapting their gait in response to targets (poorer stepping accuracy) and obstacles (increased number of steps) appearing at short notice on a walkway. Within the PD group, higher disease severity, reduced cognition and previous falls were associated with poorer stepping and gait adaptability performances. ConclusionsPeople with PD have reduced ability to adapt gait to unexpected targets and obstacles and exhibit poorer stepping responses, particularly in a test condition involving conflict resolution. Such impaired stepping responses in Parkinson's disease are associated with disease severity, cognitive impairment and falls.

Preoperative Risk Factors for Subsyndromal Delirium in Older Adults Who Undergo Joint Replacement Surgery.

Older adults with subsyndromal delirium have similar risks for adverse outcomes following joint replacement surgery as those who suffer from delirium. This study examined relationships among subsyndromal delirium and select preoperative risk factors in older adults following major orthopaedic surgery. Delirium assessments of a sample of 62 adults 65 years of age or older were completed on postoperative Days 1, 2, and 3 following joint replacement surgery. Data were analyzed for relationships among delirium symptoms and the following preoperative risk factors: increased comorbidity burden, cognitive impairment, fall history, and preoperative fasting time. Postoperative subsyndromal delirium occurred in 68% of study participants. A recent fall history and a longer preoperative fasting time were associated with delirium symptoms (p ≤ .05). Older adults with a recent history of falls within the past 6 months or a longer duration of preoperative fasting time may be at higher risk for delirium symptoms following joint replacement surgery.

The design and implementation of a theory-based interdisciplinary falls prevention pilot program for community dwelling older adults

The purpose of this research was to describe the development of an interdisciplinary community-based falls prevention program that integrated self-efficacy theory and to evaluate its impact on awarenessof fall risk factors and self-efficacy to engage in behaviors that reduce fall risk. Twenty-three communitydwelling older adults participated in a five-week falls prevention program held at a community centerin a large metropolitan county in the Mid-Atlantic. Positive improvements were demonstrated across alloutcome measures. Our findings indicate that a theory-based interdisciplinary falls prevention programincreased self-efficacy and awareness of falls risk factors in older adults.