Status Of Older People Research Articles

Seasonality of vitamin D status in older people in Southern Germany: implications for assessment

from a clinical and public health perspective, it is important to understand the influence of seasonality on the serum vitamin D level to adequately assess and interpret an individual measurement. Therefore, the aim of this study was to analyse the effects of seasonal conditions on 25-hydroxyvitamin D (25(OH)D) serum levels in a population-based cohort of older people. between March 2009 and April 2010 the 25(OH)D serum level was assessed in 1,418 community-dwelling individuals living in Germany aged ≥65 years (56.7% men) with no subscribed vitamin D supplementation. Least-square means of monthly 25(OH)D serum levels with 95% confidence intervals (CI) were estimated, adjusted for gender, age and body mass index. Additionally, the proportion of vitamin deficiency (<20 ng/ml), insufficiency (20-<30 ng/ml) and sufficiency (30 ng/ml or higher) were estimated for each month. Finally, mean values of daily total global solar radiation and daylight were calculated for each month. the minimum 25(OH)D serum level was observed in March with 15.4 ng/ml (SD = 6.56 ng/ml) and the maximum in August with 25.6 ng/ml (SD = 6.59 ng/ml). Compared with daylight and global solar radiation the progression over the year was similar but delayed by ∼2 months. The proportion of vitamin D deficiency, insufficiency and sufficiency were 78.8, 19.2 and 1.9% in March and 16.1, 63.4 and 20.5% in August, respectively. vitamin D insufficiency was very common in this cohort and showed a strong seasonal effect with lowest values in March.

Pharmakotherapie der Altersdepression

Depression is a common condition in older people, affecting in its moderate or severe forms around 4 % of those living in the community. Depression has been shown to also increase the rate of mortality. However, far less is known about depression in old age than in younger or middle age. Depression in the old differs from younger patients in several aspects: comorbid medical conditions, polypharmacy, alterations in age-associated organ function and pharmacodynamic and pharmacokinetic changes and a higher level of drug interactions. These patients also have a higher risk of medication side effects. However, treatment is effective and maintenance therapy can successfully prevent recurrence of depressive episodes. Selective serotonin reuptake inhibitors (SSRI) and selective serotonin-noradrenaline reuptake inhibitors (SNRI) are recommended as first-line treatment for the acute phase and continuation therapy. At least 6weeks of treatment is necessary to assess the therapeutic effect. Lithium augmentation has been shown to be effective in treatment-refractory depression. Continuation therapy is recommended for at least 9months and duration of maintenance therapy should be at least 2years.

The acute abdomen in the older person

The acute abdomen is a common condition in older people. Half of all presentations to hospital require admission, with a third requiring immediate surgery. The Royal College of Surgeons of England have reported a worryingly high mortality rate in the over 80s undergoing emergency surgery, with a 3-fold difference in mortality throughout the England, Wales and Northern Ireland. The aim of this article is to highlight the issues that older people face in relation to acute abdominal pathology.

Health, wellbeing, and disability among older people infected or affected by HIV in Uganda and South Africa

Objective: To describe and compare the health status, emotional wellbeing, and functional status of older people in Uganda and South Africa who are HIV infected or affected by HIV in their families.Methods: Data came from the general population cohort and Entebbe cohort of the Medical Research Council/Uganda Virus Research Institute, and from the Africa Centre Demographic Information System through cross-sectional surveys in 2009/10 using instruments adapted from the World Health Organization (WHO) Study on Global Ageing and Adult Health (SAGE). Analysis was based on 932 people aged 50 years or older (510 Uganda, 422 South Africa).Results: Participants in South Africa were slightly younger (median age − 60 years in South Africa, 63 in Uganda), and more were currently married, had no formal education, were not working, and were residing in a rural area. Adjusting for socio-demographic factors, older people in South Africa were significantly less likely to have good functional ability [adjusted odds ratio (aOR) 0.72, 95% CI 0.53–0.98] than those in Uganda, but were more likely to be in good subjective wellbeing (aOR 2.15, 95% CI 1.60–2.90). South Africans were more likely to be obese (aOR 5.26, 95% CI 3.46–8.00) or to be diagnosed with hypertension (aOR 2.77, 95% CI 2.06–3.73).Discussion and conclusions: While older people's health problems are similar in the two countries, marked socio-demographic differences influence the extent to which older people are affected by poorer health. It is therefore imperative when designing policies to improve the health and wellbeing of older people in sub-Saharan Africa that the region is not treated as a homogenous entity.

Practical theologians’ calling to serve in the field of gerontology

The South African demographic statistics echo the global trend of an ageing population. This fact poses challenges to the country’s labour supply, to health care, retirement and intergenerational relations. The elderly are faced with specific challenges such as negative views regarding older people, discrimination and prejudice based on age, changing roles, the loss of a support system when children emigrate, financial problems, abuse and neglect, emotions of fear and depression, and the struggle to find meaning in life and suffering. The field of study that concerns ageing and older adulthood is called gerontology. Joan Erber defines it as ‘the study of the biological, behavioural, and social phenomena that occur from the point of maturity to old age.’ It is an interdisciplinary field where different disciplines seek to address the problems associated with ageing. Biologists focus on the biological processes of ageing, psychologists focus on aspects like mental abilities, personality and behaviour, whilst sociologists study the social roles, group behaviour and status of older people. The question may be asked what is being done regarding the spiritual and emotional needs of the elderly. This is the niche of practical theology, as indicated by one definition of practical theology that it is ‘a place where religious belief, tradition and practice meet contemporary experiences, questions and actions and conducts a dialogue that is mutually enriching, intellectually critical, and practically transforming’ according to Pattison and Woodward. The aims of this exploratory article are (1) to investigate to what extent research in practical theology has addressed the spiritual and emotional needs of the elderly and (2) to identify opportunities where practical theology may provide service in the field of gerontology.

Vitamin D supplementation in older people (VDOP): Study protocol for a randomised controlled intervention trial with monthly oral dosing with 12,000 IU, 24,000 IU or 48,000 IU of vitamin D3

The randomised, double blind intervention trial ‘Optimising Vitamin D Status in Older People’ (VDOP) will test the effect of three oral dosages of vitamin D given for one year on bone mineral density (BMD) and biochemical markers of vitamin D metabolism, bone turnover and safety in older people. VDOP is funded by Arthritis Research UK, supported through Newcastle University and MRC Human Nutrition Research and sponsored by the Newcastle upon Tyne Hospitals NHS Foundation Trust.aBackgroundVitamin D insufficiency is common in older people and may lead to secondary hyperparathyroidism, bone loss, impairment of muscle function and increased risk of falls and fractures. Vitamin D supplementation trials have yielded conflicting results with regard to decreasing rates of bone loss, falls and fractures and the optimal plasma concentration of 25 hydroxy vitamin D (25OHD) for skeletal health remains unclear.Method/designOlder (≥70 years) community dwelling men and women are recruited through General Practices in Northern England and 375 participants are randomised to take 12,000 international units (IU), 24,000 IU or 48,000 IU of vitamin D3 orally each month for one year starting in the winter or early spring. Hip BMD and anthropometry are measured at baseline and 12 months. Fasting blood samples are collected at baseline and three-month intervals for the measurement of plasma 25OHD, parathyroid hormone (PTH), biochemical markers of bone turnover and biochemistry to assess the dose–response and safety of supplementation. Questionnaire data include falls, fractures, quality of life, adverse events and outcomes, compliance, dietary calcium intake and sunshine exposure.DiscussionThis is the first integrated vitamin D supplementation trial in older men and women using a range of doses given at monthly intervals to assess BMD, plasma 25OHD, PTH and biochemical markers of bone turnover and safety, quality of life and physical performance. We aim to investigate the vitamin D supplementation and plasma 25OHD concentration required to maintain bone health and to develop a set of biochemical markers that reflects the effect of vitamin D on bone. This will aid future studies investigating the effect of vitamin D supplementation on fracture risk.#ISRCTN 35648481 (assigned 16 August 2012), EudraCT 2011-004890-10.

Tips for GP trainees working in stroke medicine

Stroke units make a big difference to the lives of your patients and their families, following what is generally an earth-shattering event. While working in a stroke unit, you will see a vast spectrum of patients, some who make a full recovery, some who subsequently deteriorate, and the majority who fall somewhere in between. You may work on a hyperacute stroke unit, a stroke rehabilitation unit, or an integrated unit, which combines both. Stroke medicine is a subspecialty of geriatric medicine, however stroke is not just a condition of older people. Practising stroke medicine relies on a good core working knowledge of general medicine and neurology. You may have heard of multidisciplinary teams (MDTs) before. In no other field of hospital medicine will you have the opportunity to work so closely as a member of an MDT and see what positive effect they can have. Expect to be working as part of an MDT comprising of nurses, occupational therapists, physiotherapists, speech and language therapists, and neuropsychologists. All are integral to an effective stroke unit. Together, you will participate in complex discharge management. Communication underpins stroke medicine; failure to communicate well with patients and within the MDT will result in poor outcomes for your patients. You will see people with life-changing conditions, be sensitive to this. No one expects a stroke to happen. Working in …

2．生活自立からみた生活習慣病の基準値 （5）低栄養・高栄養

2．生活自立からみた生活習慣病の基準値 （5）低栄養・高栄養

A theoretical model of efficacy beliefs, functional status and quality of life for older people during rehabilitation: testing causal relationships

Structural equation modelling tested hypothesized causal relationships between age, gender, pain, depression, self-efficacy, outcome expectations, functional status and quality of life in older Australians post-orthopaedics surgery across three stages of their rehabilitation. Self-efficacy is important in forming personal beliefs about capabilities to perform functional activities, which is believed to maintain individual's quality of life. Research examining how efficacy beliefs influence functional status in older people following orthopaedic events is limited. A descriptive, longitudinal method was used for this study. A convenience sample of 101 older people with orthopaedic surgery to lower extremities was recruited from private rehabilitation units in Brisbane, Australia. Data were collected from September 2008-November 2009. Standardized questionnaires were used to measure efficacy beliefs, functional status, and quality of life. Structural equation modelling revealed that depression, efficacy beliefs, age, and gender significantly influenced quality of life, as self-efficacy and gender have a direct relationship on functional status. Across three stages in the model, outcome expectation at stage 2 was the most significant predictor of functional recovery after discharge. Older men with higher quality of life at admission was positively related to self-efficacy and negatively associated with depression at stage 2: quality of life influenced outcome expectations and pain positively at stage 3. Rehabilitation programmes play a significant role in assisting older people in resuming functional activities and quality of life following orthopaedic surgery. Enhancing self-efficacy may facilitate older people's participation and adherence to rehabilitation programmes during hospitalization and following discharge.

The effect of a Functioning Improvement Tool home visit program on instrumental activities of daily living and depressive status in older people

The effect of a Functioning Improvement Tool home visit program on instrumental activities of daily living and depressive status in older people

Preventive Effect of Protein-Energy Supplementation on the Functional Decline of Frail Older Adults With Low Socioeconomic Status: A Community-Based Randomized Controlled Study

Chronic undernutrition is a common condition in older people with low socioeconomic status and is clearly an important component of frailty. However, it is uncertain whether protein-energy supplementation can prevent functional decline in this group. Eighty-seven frail older adults (usual gait speed, <0.6 m/second; Mini Nutritional Assessment, <24) were enrolled in this randomized controlled trial. Participants were randomly assigned to either an intervention group, which was provided two 200-mL cans of commercial liquid formula (additional 400 kcal of energy, 25g of protein, 9.4g of essential amino acids, 400mL of water) per day for 12 weeks, or the controls group, which did not receive this supplement. The primary outcomes were the change of the Physical Functioning and Short Physical Performance Battery. Usual gait speed, timed up-and-go test, hand grip strength, and one-legged stance were also measured as secondary outcome variables. Physical Functioning increased by 5.9% (1 point) in the intervention group, although no change was observed in the control group (p =.052). Short Physical Performance Battery remained stable in the intervention group, although it decreased by 12.5% (1 point) in controls (p = .039). Usual gait speed decreased by 1.0% in the intervention group versus 11.3% (0.04 m/second) in controls (p = .039). Timed up-and-go improved by 7.2% (1.1 seconds) in the intervention group and worsened by 3.4% (0.9 seconds) in controls (p = .038). There were no differences between groups in hand grip strength or one-legged stance performance. The results indicate that protein-energy supplementation administered to frail older adults with low socioeconomic status shows evidence of reducing the progression of functional decline.

Poor nutritional status is associated with urinary tract infection among older people living in residential care facilities.

To investigate factors associated with poor nutritional status in older people living in residential care facilities. 188 residents (136 women, 52 men) with physical and cognitive impairments participated. Mean age was 84.7 y (range 65-100). The Mini Nutritional Assessment (MNA), Barthel ADL Index, Mini Mental State Examination (MMSE), and Geriatric Depression Scale were used to evaluate nutritional status, activities of daily living, cognitive status and depressive symptoms. Medical conditions, clinical characteristics and prescribed drugs were recorded. Univariate and multivariate regressions were used to investigate associations with MNA scores. The mean MNA score was 20.5 ± 3.7 (range 5.5-27) and the median was 21 (interquartile range (IQR) 18.8-23.0). Fifteen per cent of participants were classified as malnourished and 66% at risk of malnutrition. Lower MNA scores were independently associated with urinary tract infection (UTI) during the preceding year (β = - 0.21, P = 0.006), lower MMSE scores (β = 0.16, P = 0.030), and dependent in feeding (β = - 0.14, P = 0.040). The majority of participants were at risk of or suffering from malnutrition. Urinary tract infection during the preceding year was independently associated with poor nutritional status. Dependence in feeding was also associated with poor nutritional status as were low MMSE scores for women. Prospective observations and randomized controlled trials are necessary to gain an understanding of a causal association between malnutrition and UTI.

Causes of recurrent or persistent anemia in older people from the results of the São Paulo Ageing &amp; Health Study

Anemia is a prevalent condition in older people, and associated with increased morbidity and mortality. Previous studies identified various causes of anemia in this population. We aimed to determine the frequency and main causes of persistent or recurrent anemia in participants 2 years after their inclusion in the São Paulo Ageing & Health Study (SPAH). The SPAH is a cohort study of 2072 individuals aged 65 years or older living in poor neighborhoods of São Paulo, Brazil. A total of 2 years after inclusion, participants were reassessed; those with anemia at baseline were eligible for this ancillary study. Individuals were invited to a medical re-evaluation, including taking blood samples to determine serum iron, ferritin, total iron-binding capacity, folic acid, vitamin B(12), creatinine and transferrin saturation levels, and blood cell and reticulocyte counts. Anemia diagnosis was based on WHO criteria. Information about cause of death before follow-up assessment was obtained from death certificates. Of the 203 participants with anemia at inclusion, 97 (47.8%) were reassessed, 48 (23.6%) died before follow-up assessment, 33 (16.3%) refused to participate and 25 (12.3%) were not traced. A total of 57 (58.8%) of the 97 re-evaluated participants had persistent or recurrent anemia. Lower baseline hemoglobin was a predictor of anemia during follow up. Major causes of persistent or recurrent anemia at follow up were renal disease (62%) and chronic inflammation (35%). Anemia was a prevalent and persistent disease in this low-income sample of older individuals. Micronutrient-related anemia, chronic blood loss and renal disease are important mechanisms for perpetuating low hemoglobin levels.

Advance care planning measures towards enhancing good nutritional and health status of elderly people in Nigeria

The study investigated the measures that can be used to improve the nutritional and health status of old people in Nigeria. The sample comprised three hundred and eighty nine people,...

Contemporary concepts in the pharmacotherapy of depression in older people.

Late-life depression is common in older people. Its incidence increases significantly after age 70 to 85, as well as among those living in long-term care facilities. Depression contributes to excess morbidity and complicates management of comorbid conditions in older people. Diagnosis and management of depression often present clinicians with a challenge. Indeed, symptoms of depression in older people may not always be the same as those associated with depression in younger people. Additionally, age-related changes in pharmacokinetics and pharmacodynamics also impact selection, dosing, and monitoring of psychopharmacologic regimens. Optimizing management of depression and providing sound advice to older patients with depression requires knowledge and understanding of many clinical factors. The purpose of this review is to highlight salient issues in late-life depression, with a focus on the pharmacotherapy of depression.

Low status of older people’s wards affects nursing quality

Low status of older people’s wards affects nursing quality

Efectividad de un programa de intervención socio-motriz en población mayor con riesgo social

IntroductionThe objective is to assess the effectiveness of a social-physical activity intervention program in the improvement of the health-related quality of life and functional physical condition of patients older than 65 years at social risk. Material and methodsQuasi-experimental intervention (pretest-posttest). SettingCommunity activity; primary care and public education centres. Participants: Twenty-nine patients older than 65 years, seen at the health centre, with a diagnosis of social risk.The program included monthly health education sessions and two weekly sessions of one hour of exercise for 6 months. Measurements were taken before and at the end of the study. Outcome variables were: quality of life valued using the SF36 questionnaire and functional fitness through Senior Fitness Battery Test. ResultsAfter intervention improved all tests for the physical qualities improved after the intervention; in the 6-minutes walk all subjects improved from baseline, with an average increase of 62±36 metres (95% CI: 48-76). The SF-36 questionnaire improved 8 scales and mental summary component with a further increase of 6 points (P<.05). ConclusionsSocial-physical activity intervention program improved the health-related quality of life related and functional physical condition in older people at social risk. This paper provides evidence in favour of the implementation of social-physical community activities, coordinated between health services and education centres, aimed at the elderly at risk.

A classification and regression tree analysis for the evaluation of the role of nutritional services on cardiovascular disease risk status of older people living in Greek islands and Cyprus

Introduction: The purpose of this study was to evaluate, with classification–regression tree analysis, the structure of the associations between nutritional and health care services and the cumulative prevalence of the classical cardiovascular disease (CVD) risk factors of older individuals living in Greek islands and Cyprus. Methods: During 2005–2009, 744 men and 742 women (>65 years) from nine Greek islands and Cyprus Republic were voluntarily enrolled in the Mediterranean Islands study; various socio-demographic, clinical and lifestyle characteristics were recorded. Moreover, information regarding practising dieticians (n = 88) and nutritional services provided in these islands was also recorded. Results: Both medical and nutrition services act more effectively to elders' cardiovascular health. For example, older individuals living in areas with nutritional services' support for at least five years, with collaboration between dieticians and physicians, reduced the CVD risk factors (CVD RF) burden by 42%. Whereas, in areas with dietetic support less than five years, but more than two, the presence of advanced health care system seemed to control the CVD RF burden to the population average. Conclusions: Despite the fact that the present work shares some limitations mainly because of its cross-sectional design, the classification and regression tree approach has clearly demonstrated the interrelation between nutritional services and the health care system towards achieving benefits among the elders' quality of life.

Skin care in the older person: identifying and managing eczema

Eczema is a common skin condition in older people. Eczema is a long-term condition and older people may have had atopic eczema for many years; it may also be an acute condition, caused by a drug reaction. Many older people experience eczema and dermatitis for the first time as a consequence of ageing skin or triggered by environmental factors. Community nurses need to be able to assess older people's skin and recognize any signs and symptoms of eczema to ensure prompt treatment and good ongoing skin care.

Nutritional status using multidimensional assessment in Iranian elderly

Background: Nutrition is an important determinant of health in elderly and nutritional assessment is necessary for development of treatment protocols. The study aimed to evaluate nutritional status using multidimensional assessment in elderly. Methods: One hundred fourteen subjects (76 men and 64 women) from elderly residence house in Kermanshah, Western Iran were studied. Data was collected using Mini-Nutritional Assessment (MNA), FFQ, anthropometry, bioelectric impedance, biochemistry tools. Hematologic and biochemistry markers were assessed in 5 ml fasting blood sample. Results: 46.4% showed normal nutritional status while 38.7% have been classified as mild to moderate malnutrition and 14.9% suffered from severe malnutrition based on MNA scores. Malnutrition using different cut-offs were; body mass index 16.4%, haemoglobin 19%, albumin (with normal CRP level) 9.8%, ferritin 9.4% (<20 µg/l). Lean body mass and percent of body fat was lower than normal in 23% and 21% respectively. There was significant correlation between lean body mass, total body water and MNA score (p<0.05). A strong positive correlation was found between; BMI, percent of body fat, Mid arm circumference and MNA total score (p<0.001). Conclusion: The study confirmed that MNA score was significantly associated with anthropometric, bioelectric and biochemical findings. It is concluded that an appropriate nutrition intervention program need to introduce to improve nutritional status in older people living in elderly homes.