Elderly Research Articles

A Review of the Consequences of Gut Microbiota in Neurodegenerative Disorders and Aging

Age-associated alterations in the brain lead to cognitive deterioration and neurodegenerative disorders (NDDs). This review with a particular focus on Alzheimer’s disease (AD), emphasizes the burgeoning significance of the gut microbiota (GMB) in neuroinflammation and its impact on the gut–brain axis (GBA), a communication conduit between the gut and the central nervous system (CNS). Changes in the gut microbiome, including diminished microbial diversity and the prevalence of pro-inflammatory bacteria, are associated with AD pathogenesis. Promising therapies, such as fecal microbiota transplantation (FMT), probiotics, and prebiotics, may restore gut health and enhance cognitive performance. Clinical data remain insufficient, necessitating further research to elucidate causes, enhance therapy, and consider individual variances. This integrative approach may yield innovative therapies aimed at the GMB to improve cognitive function and brain health in older people.

Cognitive interviewing for assessing the content validity of older-person specific outcome measures for quality assessment and economic evaluation: a scoping review.

Older people (aged ≥ 65years) are significant users of health and social care systems. However, many outcome measures for quality assessment and economic evaluation lack content validation for this population. Cognitive interviews are a key approach for generating content validity evidence. This systematic scoping review aimed to synthesise evidence on cognitive interviewing practices with older adults, including those with cognitive impairment and dementia, to determine the content validity of outcome measures used with these populations in health and social care settings. A search was conducted across five databases, and results were uploaded to Covidence review management software. Two researchers performed screening and data extraction using a custom template. The initial search identified 8814 articles. After removing duplicates and conducting title and abstract screening, 105 articles remained. Full-text screening excluded 86 references, resulting in 19 included articles. Studies utilised various cognitive interviewing approaches, predominantly concurrent think-aloud combined with verbal probing. Inductive analysis based on Tourangeau's four-stage response model was commonly used for analysing verbal protocol data. Only one in four included studies indicated any allowances to alleviate cognitive burden for older participants. There was limited involvement of older people with cognitive impairment and dementia, but studies including these populations reported several modifications enhancing meaningful inclusion.

Respiratory syncytial virus vaccination among US adults aged ≥60 years.

Respiratory syncytial virus (RSV) vaccines have been recommended for US adults aged ≥60 years for nearly one year. However, the extent of vaccination coverage and the factors influencing uptake remain underexplored. This study aimed to evaluate national and state-specific RSV vaccination coverage among US adults aged ≥60 years and to identify demographic and socioeconomic factors that influence vaccination uptake. This cross-sectional study analyzed data from the US Census Household Pulse Survey, from January 9 to March 4, 2024, which included 49,322 adults aged ≥60 years. Participants self-reported their RSV vaccination status along with demographic and socioeconomic information. Multivariable Poisson regression was used to identify factors associated with vaccination uptake. As of March 4, 2024, RSV vaccination coverage among US adults aged ≥60 years was estimated at 22.2% (95% CI, 21.6%-22.7%). State-specific vaccination coverage ranged from 12.4% in Mississippi to 33.1% in Colorado. Coverage was higher in older age groups, with 21.2% among those aged 65-69 years, 28.1% among 70-74 years, 31.9% among 75-79 years, and 30.2% among those aged ≥80 years, compared to 10.8% among those aged 60-64 years. Racial/ethnicity disparities were evident, with lower coverage among Hispanics (18.3%) and non-Hispanic Blacks (17.6%) compared to non-Hispanic Whites (23.3%). Coverage was similar between males (22.6%) and females (21.8%). Factors positively associated with vaccination included older age, higher education level, higher household income, unemployment, and residing in the Midwest or West. Conversely, being non-Hispanic Black, uninsured, experiencing financial difficulties, and lack of COVID-19 vaccination were associated with reduced likelihood of receiving the RSV vaccine. During the first RSV season after the recommendations for RSV vaccination in US adults aged ≥60 years, uptake shows promise but is marked by significant disparities related to race/ethnicity, socioeconomic status, and geographic location. Efforts to address these disparities are crucial to enhance vaccination coverage and reduce the impact of RSV on this vulnerable population.

Factors influencing engagement with adherence-enhancing mobile health app in sickle cell disease

BackgroundMobile health (mHealth) applications have been utilized in chronic diseases to improve medication adherence, though factors driving engagement remain understudied. We previously demonstrated the benefits of mHealth app utilization in increasing adherence to hydroxyurea. In the “Integration of mHealth into Sickle Cell Disease (SCD) Care to Increase Hydroxyurea Utilization” (meSH) study, greater engagement with the InCharge Health app increased the percentage of days covered (PDC) for hydroxyurea. However, factors influencing app engagement were not investigated. This study aimed to identify patient-level factors associated with mHealth engagement during and post-study among adolescents and adults with SCD.MethodsAll meSH participants were included. The InCharge Health app use was measured for 24 weeks (study period) and 12 weeks (post-study period). Baseline demographics and validated measures of self-efficacy, financial hardship, and pain severity, impact, and frequency were evaluated as predictors of app engagement during the study period and post-study using linear models.ResultsComplete app use data were obtained from 284 of 293 participants, including 150 (52.8%) females and 240 (84.8%) who were HbSS/HbSβ0-thalassemia with a median age of 27 years. During the study period, 232 (81.7%) used InCharge Health at least once (median use excluding zeros: 26 days; IQR: 7–72 days). During the post-study period, 132 (46.5%) participants used the app at least once (median use excluding zeros: 16 days; IQR: 3–44 days). During the study period, the HbSS genotype, age > 25 years, higher education, higher self-efficacy score, and lower pain severity were associated with greater app engagement. Only age (p = 0.0032) and financial hardship (p = 0.0125) were significant in a multivariable model after backward elimination. During the post-study period, older age (p = 0.035), lower pain severity (p = 0.021) and lower frequency of pain (p = 0.033) predicted mHealth engagement. All three remained significant in a multivariable model after backward elimination.ConclusionsOlder age, lower financial hardship, lower pain severity, and greater self-efficacy were associated with increased engagement with a mHealth intervention for improving medication adherence among people living with SCD. This research can shift future app development from focusing on factors that drive patient interaction with mHealth targeting modifiable factors influencing app engagement.Trial registrationThe trial was registered with ClinicalTrials.gov. Registration Identifier: NCT04080167. Registration date: November 11, 2019.

Predictors of frailty trajectories among people with HIV.

This study aimed to estimate the latent frailty trajectories and identify corresponding predictors (socio-demographic, HIV-related, comorbidities, and behavioral) among a cohort of PWH. Longitudinal observational study using latent class growth modeling. Nine hundred seventy-six PWH aged 40 years and older with frailty measured from at least two visits within the ACTG HAILO cohort were included. Frailty components included weakness, physical activity, weight loss, exhaustion, and slowness. Latent class growth models were estimated to capture change in frailty over time; multinomial logistic regression was used to estimate associations between predictors and frailty trajectory class. At baseline, participants were M = 51.5 years old (SD = 7.5), 81% male (n = 783), 48% White non-Hispanic (n = 461), and 20% Hispanic (n = 195). Latent class growth models identified three frailty trajectories: Sustained robustness (n = 811; 83%), Worsening frailty (n = 79; 8%), and Frailty improvement (n = 86; 9%). Older age, race, sex at birth, select comorbidities (cardiovascular disease, depression, type 2 diabetes), and behavioral characteristics (physical activity, smoking, and alcohol) were associated with fluctuations in frailty trajectories over time (p < 0.05). Modifiable factors such as managing comorbidities and promoting physical activity present ideal opportunities for future interventions to prevent or slow the progression of frailty.

Risk factors for poor outcomes in adult patients with lip through-and-through wounds

BackgroundRisk factors associated with infection and traumatic lacerations affecting the face are still not fully understood. This study investigated risk factors for poor outcomes in adult patients with through-and-through lip wounds who underwent debridement and suturing. MethodsPatients with through-and-through lip wounds who underwent debridement in our emergency department between January 1, 2017, and December 31, 2021, were included. The effects of gender, age, wound age (time from injury to wound closure), antibiotic application, injury mechanism, diabetes, wound length, wound cleanliness, peripheral tissue damage, and postoperative wound blood scab on the poor outcome rate were assessed for all patients. Poor outcome was analyzed based on atraumatic wound dehiscence before suture removal, pus in the wound, and unhealed oral wounds with a length >1 cm or deeper than the muscle layer 5–6 days after surgery. ResultsA total of 728 cases were included, with a poor outcome rate of 20.88 %. The univariable analysis showed that the proportion of poor outcomes was significantly associated with male gender, age (65–79 years old), bicycle/electric bicyble, antibiotic use, wound length of 4–8 cm, wound contamination, peripheral tissue damage, and scabs. Binary logistic analysis showed that the proportion of poor outcomes was significantly associated with older age (65–79 years old), wound length of 4–8 cm, peripheral tissue damage and wounds covered by scabs. In the binary logistic regression analysis, poor outcomes were not associated with gender, injury mechanism, wound contamination or the use of antibiotics. ConclusionOur findings provide valuable information on the risk factors for poor outcomes in adult patients with lip through-and-through wounds who underwent debridement and suturing.

Handgrip strength is independently associated with physical quality of life in patients undergoing maintenance hemodialysis: a cross-sectional study.

We aimed to identify the association between Health-related quality of life (HRQoL) and muscle strength in patients undergoing maintenance hemodialysis (MHD). In this cross-sectional study from March 2021 to December 2021, 110 MHD patients with a mean age of 63.9 ± 13.0 years and a median dialysis vintage of 25.5 (12.0-52.3) months, were enrolled at a hemodialysis center in Guangzhou city, China. HRQoL was assessed using the Short Form 36 Health Survey (SF-36) and converted into the Physical Component Summary (PCS) and the Mental Component Summary (MCS). The groups were assigned according to the mean score of PCS and MCS, and those with higher PCS/MCS scores (high-PCS/MCS) were compared with those with lower PCS/MCS scores (low-PCS/MCS). Independent factors were evaluated using multivariate analysis. Muscle strength was estimated by handgrip strength (HGS). The mean HGS was 23.7 ± 9.60 kg in men and 14.3 ± 5.30 kg in women. Compared to the high-PCS group, the low-PCS group had older age, higher levels of creatinine, total cholesterol, high-sensitivity C-reactive protein (hsCRP) and interleukin-6 (IL-6), and had lower HGS (all p < 0.05). After adjusting for confounding factors in different models, the five-model multivariate binary logistic regression analyses revealed that HGS was the only independent factor in PCS domain, but not in MCS. HGS may be an independent factor of poor HRQoL in MHD patients, particularly in relation to physical health. The management of muscle strength may improve the HRQoL in MHD patients. The study was registered at https://www.chictr.org.cn/ as ChiCTR2100053790.

Myocardial strain analysis by cardiac magnetic resonance associated with arrhythmias in repaired tetralogy of Fallot patients

BackgroundEvaluating myocardial function using cardiac magnetic resonance (CMR) feature tracking provides a comprehensive cardiac assessment, particularly a detailed evaluation for patients with repaired tetralogy of Fallot (rTOF). This study aimed to identify factors associated with arrhythmias in rTOF patients utilizing conventional CMR techniques, including myocardial strain measurements.MethodsThis single-center, retrospective study included 245 rTOF patients who underwent CMR between 2017 and 2023. Patients were stratified based on the presence or absence of arrhythmias during follow-up. The biventricular strain was assessed using CMR-derived feature tracking. Demographic, clinical, and imaging data were collected, and statistical analyses were performed to identify factors associated with arrhythmic events.ResultsThe median age at surgery was 5.6 years (range 1–44 years), with the median age at CMR was 27.5 years (range 15–69 years). Over the follow-up period, 25 patients (10.2%) experienced atrial or ventricular arrhythmias. Univariate analysis revealed significant associations between arrhythmic events and older age at surgery and CMR, lower functional class, larger heart size on chest radiograph, and prolonged QRS duration (QRSd). Additionally, arrhythmias were associated with increased right ventricular (RV) volume, reduced RV and left ventricular (LV) ejection fraction (EF), and impaired strain values. Multivariate binary logistic regression, adjusting for age at surgery, NYHA class, QRSd, and cardiothoracic ratio, identified that a lower RV EF (adjusted odds ratio [aOR] 6.97), RV global radial strain (GRS) (aOR 6.68), RV global circumferential strain (GCS) (aOR 6.36), RV global longitudinal strain (GLS) (aOR 3.14), and LV GRS (aOR 3.02) were all significantly associated with arrhythmias.ConclusionThis study highlights the significant contribution of CMR-derived myocardial strain measurements in predicting arrhythmic events in patients with rTOF. In addition to conventional RV EF, strain metrics—particularly those of the right ventricle- emerged as strong, independent predictors of arrhythmias, offering valuable prognostic information for clinical management in this patient population. These findings underscore the importance of myocardial strain analysis as a complementary tool to conventional imaging in evaluating arrhythmic risk in rTOF patients.Clinical trial numberNot applicable.

Outcomes of Salvage Surgery for Esophageal Carcinoma: A Nationwide Cohort Study from the Dutch Upper GI Cancer Audit.

Salvage esophagectomy is more complex and associated with higher postoperative morbidity and mortality than standard resection. This study aimed to investigate short-term outcomes and theinfluence of hospital volume on these outcomes of salvage surgery for esophageal cancer. The study enrolled all patients undergoing esophagectomy for esophageal cancer registered in the Dutch Upper Gastrointestinal Cancer Audit (DUCA) between 2012 and 2022. The patients were classified as salvage or non-salvage by registering surgeons. Salvage surgery is defined in the DUCA as surgery after definitive chemoradiotherapy. Postoperative mortality (30-day/in-hospital) and morbidity were compared between the salvage and non-salvage patients using multilevel logistic regression analyses. Hospital variation in the use of salvage esophagectomy was investigated using funnel plots. The influence of hospital volume (≤ 40 to > 40 cases) and salvage volume (< 6 to ≥ 6 cases) on outcomes for salvage patients were investigated. Using backward elimination, relevant baseline characteristics influencing salvage outcomes were identified. Between 2012 and 2022, 7749 patients underwent esophagectomy, 251 (3%) of whom underwent salvage resection, varying from 0 to 8% between centers. Severe complications (43% vs 28%; odds ratio [OR], 1.81; 95 % confidence interval [CI], 1.40-2.34) and 30-day/in-hospital mortality (11% vs 3%; OR, 3.65; 95% CI, 2.38-5.61) were higher after salvage surgery than after non-salvage surgery. Salvage patients treated in high-volume centers had a lower risk of 30-day/in-hospital mortality than those treated in low-volume centers (9% vs 19%; OR, 0.42; 95% CI, 0.18-0.99), with no relation between salvage volume and outcome. Male sex, older age (> 75 years), and squamous cell carcinoma were associated with worse short-term outcomes of salvage surgery. Salvage surgery is associated with worse short-term outcomes than non-salvage esophagectomy. Outcomes after salvage surgery were favorable in high-volume esophagectomy centers.

“If I lose my mind, she will take care of me.”

Personal autonomy is among the core values of modern Western liberalism, but what is the precise meaning of this term, and why is autonomy valued so highly? What if one is no longer fully capable of self-determination, as may be the case as we grow old? In this article, we clarify the meaning of personal autonomy, claim that its importance is connected to its contribution to human well-being, and introduce some legal instruments with which to support the autonomy of older people. We illustrate our theoretical and legal analysis by drawing on the actual experiences of older people in Finland. Our empirical material supports the theoretical claims about autonomy’s importance, its connection to well-being, and its relational nature. However, this article also reveals that people should be more aware of the importance of engaging in legal planning in advance to ensure an autonomous life until the end of their lifespans.

Relieving the burden on doctors' practices &amp; sustainable care

More than 16 million people over the age of 67 live in Germany. This figure is expected to rise to over 20 million by 2040. As the proportion of older people in the population increases, so too will the number of chronically ill, multi-morbid and care-dependent people. The care problem will become particularly acute in rural and structurally weak regions, as the demographic developments described above tend to be more pronounced here than in urban areas. As a result of this development, the already tense situation in many doctors' surgeries will become even more acute. At the same time, there are difficulties in attracting doctors and nurses to work in rural and structurally weak urban regions. In order to counter these undesirable developments, the ErwiN innovation fund project is utilising the advantages of the organised 'doctor network' setting to transfer medical activities to members of the geriatric and nursing professions for the independent practice of medicine in accordance with the G-BA directive pursuant to Section 63 (3c) SGB V. The transfer of activities that relieve physicians to specialised nursing professionals (SPFP) is intended to significantly relieve the burden on doctors' practices and make a genuine contribution to the future viability of care structures in Germany.

Management of glucocorticoid-induced diabetes

Glucocorticoid-induced diabetes (GID) is a frequent metabolic complication of glucocorticoid therapy. It results from both insulin resistance and impaired insulin secretion, exacerbated by glucocorticoid use. Despite its prevalence, consensus guidelines on screening and management remain limited. GID affects approximately one in five patients receiving long-term glucocorticoid therapy. Risk factors include older age, high BMI, prediabetes, ethnicity, and high-dose systemic glucocorticoids. All patients initiated on moderate to high doses of glucocorticoids should be assessed for GID risk factors and closely monitored for the development of hyperglycemia and diabetes. In addition, glucocorticoid therapy can significantly exacerbate hyperglycemia in individuals with pre-existing diabetes, and stringent glucose monitoring is crucial. Treatment should be tailored to individual patient. Oral anti-diabetics such as metformin and sulfonylureas might be used in selected patients with mild GID. However, insulin is the primary treatment for severe hyperglycemia. Early detection and individualized management strategies are critical to mitigate GID’s impact. Further research is needed to develop consensus guidelines and optimize treatment approaches.

Symptoms, causes, management and outcomes of hyponatraemia: a single centre study among hospitalised adult patients in Malaysia

Background Hyponatraemia is a common electrolyte abnormality seen in medical admissions. To date, there is no hospital-wide local study on hyponatraemia across the young, middle and older age groups. We evaluated the clinical features, aetiology, and outcomes of patients admitted in a tertiary hospital when hyponatraemia was noted as part of initial investigations. We also reviewed the documented management, aiming to promote local guideline development for hyponatraemia. Methods A retrospective study based in Hospital Sultan Ismail (HSI) Johor Bahru was undertaken between January 2020 to December 2022 on adults admitted with a serum sodium (Na) level of &lt;135mmol/L. Patients were identified through the electronic database. Results 165 patients (mean age 64.4 ± 12.9, 52.6% females, 42.4% males) were diagnosed with mostly moderate or severe hyponatraemia. Severe hyponatraemia was significantly more prevalent among elderly patients (p= 0.002). Loss of appetite, generalised weakness and vomiting were the common presentations. 27.9% of patients were identified based on laboratory results without symptoms of hyponatraemia. The main causes of hyponatraemia were poor oral intake (20.6%), multifactorial (18.8%) and diarrhoea and vomiting (14.5%). Majority received 0.9% sodium chloride (NaCl) infusion. 18 patients (10.9%) have ≥10 mmol/L Na increment over the first day without complication. The overall mortality rate was 4.85% over 3 years. Conclusions Hyponatraemia may present with non-specific symptoms in hospitalised patients. Early recognition and management are required to avoid complications. Larger prospective studies to further explore the clinical profile of hyponatraemia among local patients will aid in protocol development to optimise patient outcome.

Epidemic risks of measles and rubella in China: a systematic review and meta-analysis.

Seroprevalence studies across various countries can contribute to achieving the elimination target for measles and rubella. However, in the Mainland of China, the concept of herd immunity remains unclear due to the lack of a nationwide serosurvey. This systematic review and meta-analysis was conducted by retrieving literature reporting the seroprevalence of measles and rubella published between 2012 and 2023. The pooled positive rates and estimated geometric mean concentrations (GMCs) of measles and rubella immunoglobulin G antibodies were calculated. This study analysed 135 studies on measles and 77 on rubella, including data from 368,023 and 177,422 healthy individuals, respectively. Between 2010 and 2022, the overall pooled positive rates for measles and rubella antibodies were 88.8% and 79.91%, respectively. The age-specific susceptibility analysis showed that infants aged < 1year had the lowest pooled positive rates. Other age groups had a roughly U-shaped distribution, with relatively higher positive rates and GMC of measles and rubella antibodies in young children and older age groups. However, the positive rates for both measles and rubella antibodies fell below the elimination threshold in almost all age groups other than young children aged 1-4years, especially in recent years. In addition, antibody positivity rates varied by geographical region and decreased with economic level. Our findings provide preliminary insights into herd immunity for measles and rubella, highlighting the challenges to achieving their elimination in China.

Serum Neurofilament Light-Chain Levels in Essential Tremor: A Replication Study.

Essential tremor (ET) is a highly-prevalent neurological disease. At present, there are no clinical biomarkers. Neurofilament light (NfL) has been studied as a measure of neuronal damage in a considerable number of neurological disorders. There have been three studies of ET, and results are inconsistent. 40 ET cases were enrolled in a research study between February and November 2023 and compared to two control groups from Study 1 (n = 41) and Study 2 (n = 185). Total tremor score was a measure of the severity of action tremor. Blood samples were analyzed for serum NfL level on the Simoa® platform using an NF-Light™ kit as a marker of axonal injury. Serum log NfL levels were higher in ET cases than controls in Study 1 (p<0.001) and Study 2 (p<0.001). In a multivariate linear regression model, ET cases (p = 0.03) and individuals of older age (p<0.001) had higher serum log NfL levels than controls (combined in Studies 1 and 2). There was no association in ET cases between serum log NfL level and total tremor score (Pearson's r = 0.08, p = 0.63). This new study further validates the elevation in serum NfL levels in ET, now representing the third study to do so. In combination, the converging data suggest that there is an overall increase in serum NfL levels in ET. The demonstration of elevated serum levels of NfL in ET adds an additional piece of evidence that there is neuronal damage in ET.

The Role of Health in the Technology Acceptance Model Among Low-Income Asian American Older Adults: Cross-Sectional Survey Analysis

Background Self-rated health is associated with information and communications technology (ICT) use among older adults. Non–US born, older Asian American individuals are more inclined to rate their health as fair or poor compared to individuals from other racial and ethnic backgrounds. This population is also less likely to use ICTs as compared to White older Americans. Furthermore, cognitive decline may impact technology acceptance. In a previous adaptation of the technology acceptance model for low-income, Asian American older adults, perceived usefulness (PU), perceived ease of use (PEOU), age, educational attainment, ethnicity, and English proficiency were significant predictors of ICT use. However, the association between health and technology acceptance has not been explored among Asian American older adults. Objective This study examined the role of self-rated health and subjective cognitive decline in the acceptance and use of ICTs among low-income, Asian American older adults. Methods This cross-sectional survey included Asian American individuals aged ≥62 years living in affordable housing for older adults (N=392). Using hierarchical multiple regression, we explored the association between self-rated health and ICT use and technology acceptance model mediators (PU and PEOU) while adjusting for demographics, English proficiency, and subjective cognitive decline. Contrast statements were used to estimate contrasts of interest. To further examine the separate and joint association between age and subjective cognitive decline and the dependent variables, we examined scatterplots with locally estimated scatterplot smoothing lines, revealing that the relationship between subjective cognitive decline and ICT use varied in 3 age segments, which led to updating our analysis to estimate differences in ICT use among age categories with and without subjective cognitive decline. Results Self-rated health was not significantly associated with ICT use (β=.087; P=.13), PU (β=.106; P=.10), or PEOU (β=.062; P=.31). However, the interaction terms of subjective cognitive decline and age significantly improved the model fit for ICT use (ΔR2=0.011; P=.04). In reviewing scatterplots, we determined that, in the youngest age group (62-74 years), ICT use increased with subjective cognitive decline, whereas in the older age groups (75-84 and ≥85 years), ICT use decreased with subjective cognitive decline, more so in the oldest age category. Through regression analysis, among participants with subjective cognitive decline, ICT use significantly decreased in the middle and older age groups as compared to the youngest age group. However, among participants without subjective cognitive decline, the difference in use among age groups was not significant. Conclusions This study contributes to the understanding of the complex relationship between health and ICT acceptance among low-income, Asian American older adults and suggests the need for tailored interventions to promote digital engagement and quality of life for this population.

Community-dwelling older people's experiences of advance care planning with health care professionals: a qualitative systematic review.

The objective of this review is to examine community-dwelling older people's experiences of advance care planning with health care professionals. The importance of health care professionals initiating advance care planning for patients has been reported; however, because of the shift from institutionalized to community care, community-dwelling older people have fewer opportunities to discuss these plans with health care professionals compared with those living in other settings. The timely initiation of advance care planning and sustainable discussions among older people, their families, and community health care professionals is necessary and may improve palliative and end-of-life care. Studies with participants aged 60 years and older who have experience with advance care planning and live in their own homes in the community were included. We considered qualitative studies and the qualitative component of mixed methods studies published between January 1999 and April 2023 in English or Japanese. MEDLINE, CINAHL, Embase, PsycINFO, JSTORE, Scopus, Japan Medical Abstract Society, and CiNii were searched for published papers, and Google Scholar, ProQuest Dissertations and Theses Global, and MedNar were searched for unpublished papers and gray literature. Study selection, critical appraisal, data extraction, and data synthesis were conducted by 2 independent reviewers using the JBI approach and JBI standardized tools. Findings were pooled using a meta-aggregation approach. The synthesized findings were graded using the ConQual approach for establishing confidence in the output of qualitative research syntheses and presented in a Summary of Findings. Five studies published between 2017 and 2022 were included in the review. Each study's total score was between 6 and 8 out of 10 on the JBI critical appraisal checklist for qualitative research. We extracted 28 findings and aggregated them into 7 categories, generating 3 synthesized findings: i) A trusting relationship with health professionals is essential for older people's decision-making. Health professionals' attitudes, knowledge, and skills play a role in this, influencing the perceived quality of care; ii) Shared decision-making and patient-centered communication are essential. Older people feel ambiguity toward end-of-life decision and advance care planning and they want their wishes to be heard in any situation to maintain their autonomy and quality of life; iii) Older people need the appropriate forms and accessible and coordinated care to begin advance care planning. Qualitative studies on community-dwelling older people's experiences of advance care planning with health care professionals are scarce. The experiences have illustrated that trusting relationships influence people's perception of the quality of care they receive; there is uncertainty about their future; and they have varying feelings or attitudes toward their impending death, including denial and avoidance. This review highlighted the need for appropriate forms, and accessible and coordinated care to begin advance care planning; thus, an approach that meets the individual's health and psychosocial status should be selected carefully. Further research is recommended to include older populations from broader geographical and cultural backgrounds and to assess and evaluate the different advance care planning approaches and their implementation processes among groups of community-dwelling older people with different health and psychosocial statuses. PROSPERO CRD42020122803.

Unmet Health Care Needs Among Older People in Canada: Does Household Food Insecurity Matter?

Canada is undergoing a demographic shift, with projections indicating that over 25% of the country's population will be 65 years or older by 2063. While this has raised critical concerns about Canada's preparedness to meet the social and health-care needs of an aging population, the increasing incidence of food insecurity is particularly affecting vulnerable groups, such as older Canadians, with implications for their health-care service utilization. Despite this observation, there are nascent studies examining the role of household food insecurity status on unmet health-care needs among older people in Canada. The main objective of our study is to assess the association between household food insecurity and unmet health-care needs among older Canadians. We used data from a selected sample of 21,178 participants as part of the 2017-18 Canadian Community Health Survey and applied logistic regression analysis. Our findings indicate that older people experiencing any type of food insecurity, that is, either moderate (OR=3.07, p<.01) or severe (OR=4.09, p<.01) were more likely to have reported unmet health-care needs compared to their counterparts in food secure households, even after controlling for a range of demographic, socioeconomic, and health and health-care variables. Our finding is concerning, considering that older people in Canada who are in most need of health-care services due to their food insecurity status are instead reporting unmet health-care needs. This revelation calls for urgent policy attention to reduce the episodes of household food insecurity among older people in Canada. Specifically, to improve their access to health-care services, providing them with periodic grocery rebates as part of the social protection package for seniors in Canada would help mitigate the problem of food insecurity among them.

Cognitive Stimulation Therapy for older people with Dementia in Africa: A Scoping Review

Background Cognitive Stimulation Therapy (CST) is a non-pharmacological intervention developed for dementia that is useful in Africa but has not been studied widely. We reviewed the existing evidence regarding CST among older people living with dementia in Africa. Methods A systematic literature search on CST among older people with dementia in Africa from 2000–2021 was done in MEDLINE (PubMed), CINAHL (EBSCOhost), and PsycINFO. A narrative approach was taken to chart, synthesize and interpret the data using Microsoft Excel. Results After removing duplicates using Endnote, a total of 122 studies were retained and screened first by title, then abstract, and finally by full text. Six articles matched the inclusion/exclusion criteria. CST has been adapted and piloted in two African countries (Nigeria and Tanzania). CST studies in Africa indicate improvements in clinical outcomes including cognition and quality of life. Although there are some barriers to overcome, CST has significant facilitators in an African context. Conclusions CST is feasible, adaptable, and acceptable in the African countries it has been implemented in. Some cultural barriers, such as religious affiliation and respect for older people, should be overcome. Further research is needed to further evaluate the efficacy of CST in various African contexts.

Five-Year Incidence of Age-Related Macular Degeneration and Its Risk Factors in Adult Chinese Population: The Tongren Health Care Study.

To examine the 5-year incidence of age-related macular degeneration (AMD) and its associated factors in an adult Chinese population. The Tongren Health Care Study included individuals attending regular health care check-up examinations in the Beijing Tongren Hospital. Baseline examinations were performed from 2014 to 2015, with 5-year follow-up examinations conducted between 2019 and 2020. Fundus photographs were graded according to the Beckman Initiative guidelines. A total of 5658 participants with gradable photographs at both examinations were included in the study, comprising 58.0% women, with a mean age of 54.9 ± 11.0years. The 5-year incidence of any, early, intermediate, and late AMD were 6.1% (95% confidence interval [CI], 5.5%-6.8%), 5.0% (95% CI, 4.4%-5.6%), 3.4% (95% CI, 2.9%-3.9%), and 0.3% (95% CI, 0.2%-0.4%), respectively. In multivariate analysis, incident early AMD was associated with older age (P < 0.001; odds ratio [OR], 1.04; 95% CI, 1.02-1.06), female sex (P = 0.011; OR, 1.42; 95% CI, 1.08-1.86), and a higher estimated glomerular filtration rate (P = 0.020; OR, 1.15; 95% CI, 1.02-1.30), whereas having diabetes was a protective factor (P = 0.019; OR, 0.61; 95% CI, 0.41-0.92). Incident intermediate AMD was associated with older age (P < 0.001; OR, 1.05; 95% CI, 1.04-1.07), a higher high-density lipoprotein cholesterol level (P < 0.001; OR, 1.97; 95% CI, 1.38-2.83) and a lower triglyceride level (P = 0.008; OR, 0.77; 95% CI, 0.64-0.93). A higher estimated glomerular filtration rate level was a risk factor for incident early AMD. A higher high-density lipoprotein cholesterol level and lower triglyceride level were risk factors for incident intermediate AMD. This finding may point to the role of renal circulation and lipid metabolism in incident AMD. This community-based longitudinal study may provide a valuable understanding of AMD and its associated factors for targeted prevention and management strategies.