Hasil untuk "Geriatrics"

Ritam Ghosh, Nibraas Khan, Miroslava Migovich et al.

BackgroundApathy is common among older adults residing in long-term care (LTC) and impairs quality of life for both older adults and care providers. Few pharmacological remedies exist, and nonpharmacologic approaches that engage those with apathy require extensive personnel time. Thus, technological approaches have been encouraged, including virtual reality (VR) and socially assistive robots (SAR). Despite a growing interest in their use, input from older adults and staff is often absent in their design. Involving older adults in the development of interactive health technologies is necessary to enhance the functionality, usability, and likelihood of promoting the intended health outcomes. ObjectiveWe aimed to design and evaluate SAR and nonimmersive VR (SAR-VR) activities for pairs of older adults that would encourage human-to-human interaction, an essential activity to mitigate apathy. MethodsWe implemented a multistep, user-centered design. A humanoid and dog SAR were used in combination with nonimmersive VR activities for pairs of older adults. An interdisciplinary team of engineers, nurses, and physicians collaborated with older adults and staff to create 4 activity prototypes, 3 with the humanoid robot and 1 with the dog robot. A total of 14 older adults at 2 sites participated in the design and evaluation of the different components of the system throughout all stages. Site 1 participants were instrumental in the development, and Site 2 participants validated the prototype activities. Data were collected at each session via observations, interviews, and a 6-item questionnaire that rated their degree of comfort and confidence in (1) using the wands, (2) interacting with the robot, and (3) interacting with the nonimmersive VR environment using a 5-point Likert response. Additionally, 5 staff from Site 2 were recruited to evaluate the ease of setting up and running the system at 2 different sessions. After each session, the system setup and interface were refined based on their feedback. ResultsA total of 4 of 6 older adults (mean age 85, SD 9.3 years; 2 male) at Site 1 completed field testing development, and 8 residents (mean age 80, SD 4.7 years; 2 male) at Site 2 completed field testing validation. Participant comfort and confidence increased significantly over successive iterations of the system across most categories (Site 1: Wilcoxon signed rank test P=.03; Site 2: Wilcoxon signed rank test P<.001). Additionally, 5 LTC staff members successfully set up the system with minimal cueing from the researchers, demonstrating the usability of the system for caregivers. Iterative design changes incorporated hardware, software, and activity domains. ConclusionsThese initial results demonstrate that LTC older adults and staff are capable and critical to the development and implementation of SAR-VR activities. Future studies are needed to evaluate the feasibility of implementation and effectiveness in reducing apathy. Trial RegistrationClinicalTrials.gov NCT05178992; https://clinicaltrials.gov/study/NCT05178992

Abdul Majid, Farhana Rafiq, Tufail Shafi et al.

Tereza Vágnerová, Olga Dvořáčková, Eva Topinková

Summary: Background &amp; Aims: The transition from middle age to old age (from adults aged 50–55 years to older seniors aged 75–80 years) represents a critical period in terms of changes in body composition, i.e., increase in body fat percentage and decrease in fat-free body mass, which occur even at long-term stable weight. These changes are caused, among other things, by a gradual reduction in physical activity and deterioration in dietary habits. For many health conditions, like weight status, nutritional assessment and nutritional literacy can provide valuable information that can guide treatment efforts and maintenance of healthy eating habits. We therefore attempted to map this issue using data from the Survey of Health, Ageing and Retirement in Europe (SHARE) project. Methods: The basis for this study was data from the 8th wave of the SHARE project. The analysis included the results of the primary questionnaires CAPI (Computer Assisted Personal Interviewing) and the National Dropoff Questionnaire developed exclusively for the Czech Republic with a special module D “Nutrition” summarizing questions on eating habits, nutrition care and nutritional literacy. Results: A total of 2316 respondents were included in the study, 37.9% of whom were female and 62.1% male, with a mean age of 71.7±7.6 years. The prevalence of undernutrition, overweight and obesity in the study population was 9.2%, 42.8% and 32.2%, respectively. The presence of depression, anxiety, polypharmacy, multimorbidity and pain were associated with poor nutritional status (Pearson correlation coefficient, P < 0.001 for all five factors). The lifestyle factors of dietary habits and regular physical activity of the subjects did not meet current recommendations. Awareness of the existence and availability of dietitians and the possibilities of nutritional therapy and its reimbursement from public health insurance proved to be low. Conclusion: The results show a high prevalence of overweight, obesity and malnutrition in the Czech population over 50 years of age, low nutritional literacy, and inadequate coverage of nutritional care.

Eri Otaka, Aiko Osawa, Kenji Kato et al.

Abstract BackgroundInterventions and care that can evoke positive emotions and reduce apathy or agitation are important for people with dementia. In recent years, socially assistive robots used for better dementia care have been found to be feasible. However, the immediate responses of people with dementia when they are given multiple sensory modalities from socially assistive robots have not yet been sufficiently elucidated. ObjectiveThis study aimed to quantitatively examine the immediate emotional responses of people with dementia to stimuli presented by socially assistive robots using facial expression analysis in order to determine whether they elicited positive emotions. MethodsThis pilot study adopted a single-arm interventional design. Socially assistive robots were presented to nursing home residents in a three-step procedure: (1) the robot was placed in front of participants (visual stimulus), (2) the robot was manipulated to produce sound (visual and auditory stimuli), and (3) participants held the robot in their hands (visual, auditory, and tactile stimuli). Expression intensity values for “happy,” “sad,” “angry,” “surprised,” “scared,” and “disgusted” were calculated continuously using facial expression analysis with FaceReader ResultsA total of 29 participants (mean age 88.7, SD 6.2 years; n=27 female; Japanese version of Mini-Mental State Examination mean score 18.2, SD 5.1) were recruited. The expression intensity value for “happy” was the largest in both the subjective and objective assessments and increased significantly when all sensory modalities (visual, auditory, and tactile) were presented (median expression intensity 0.21, IQR 0.09-0.35) compared to the other 2 patterns (visual alone: median expression intensity 0.10, IQR 0.03-0.22; PP ConclusionsBy quantifying the emotional responses of people with dementia, this study highlighted that socially assistive robots may be more effective in eliciting positive emotions when multiple sensory stimuli, including tactile stimuli, are involved. More studies, including randomized controlled trials, are required to further explore the effectiveness of using socially assistive robots in dementia care.

Samuel Gibbon, Audrey Low, Charlene Hamid et al.

Abstract INTRODUCTION We tested associations between two retinal measures (optic disc pallor, peripapillary retinal nerve fiber layer [pRNFL] thickness) and four magnetic resonance imaging markers of cerebral small vessel disease (SVD; lacunes, microbleeds, white matter hyperintensities, and enlarged perivascular spaces [ePVSs]). METHODS We used PallorMetrics to quantify optic disc pallor from fundus photographs, and pRNFL thickness from optical coherence tomography scans. Linear and logistic regression assessed relationships between retinal measures and SVD markers. Participants (N = 108, mean age 51.6) were from the PREVENT Dementia study. RESULTS Global optic disc pallor was linked to ePVSs in the basal ganglia in both left (β = 0.12, standard error [SE] = 0.05, P < 0.05) and right eyes (β = 0.13, SE = 0.05, P < 0.05). Associations were also noted in different disc sectors. No pRNFL associations with SVD markers were found. DISCUSSION Optic disc pallor correlated with ePVSs in the basal ganglia, suggesting retinal examination may be a useful method to study brain health changes related to SVD. Highlights Optic disc pallor is linked to enlarged perivascular spaces in basal ganglia. There is no association between peripapillary retinal nerve fiber layer thickness and cerebral small vessel disease markers. Optic disc examination could provide insights into brain health. The sample included 108 midlife adults from the PREVENT Dementia study.

Jadhav Abhijeet Vasant, H Bhakare Shilpa

Introduction: Multiple layers of vulnerability pose challenges for rural elderly to access health. Enrollment in government schemes is also limited by this section of society. This study focused on access to medicines and status welfare schemes for rural elderly. Subjects and Methods: It was a cross-sectional survey done in 84 villages in six districts of Rajasthan with 1266 elderly participants. The data were captured through a pretested questionnaire which was filled by trained data collectors. Results: The knowledge, as well as the actual enrollment of the elderly in various health care and welfare schemes, was very poor. Gender and caste analysis showed that women and lower castes were at the worst end in the enrollment and availing entitlements. Knowledge of health schemes was also less among them. The monthly average expenditure for participants on regular medication was Rs. 1570.35 and the time to procure the same was 6.10 h. Discussion: The elderly are vulnerable to the worst health outcomes and gender and cast categories add to it. Access to medicines is an essential component of health accessibility. However, it is largely neglected. Money and time in accessing required medicines seem to be too high to afford for these elderly people. Limited availability of public health facilities, poverty in old age, and the absence of private pharmacies in villages have contributed to the problem significantly. Welfare schemes have the potential to address these issues; however, enrollment and actual reach of benefits still need to be improved in rural areas.

Lino, Matheus Henrique dos Santos

Objetivos: analisar as dificuldades enfrentadas pelas pessoas idosas em relação à condução veicular, bem como avaliar a importância que atribuem a essa atividade. Métodos: estudo transversal quantitativo avaliou 61 pessoas idosas motoristas utilizando dois questionários desenvolvidos pelos pesquisadores: 1) dados sociodemográficos, 2) questões relacionadas às dificuldades e à importância da condução para pessoas idosas. Resultados: a maioria dos participantes relatou apenas acidentes leves e não teve problemas significativos com condições climáticas, horários de direção ou estado das estradas. Os participantes usavam o carro para atividades diárias e lazer, dirigindo em média cerca de duas horas por dia. A prática de dirigir é vista como crucial para manter a autonomia e a conexão com a família, e a ideia de parar de dirigir é considerada um grande desafio. Conclusão: a capacidade de dirigir é vital para o bem-estar emocional e a qualidade de vida das pessoas idosas, mas o estudo também destaca os riscos associados à condução nessa idade, como a presença em acidentes leves durante a condução veicular. Portanto, é fundamental encontrar um equilíbrio entre manter a independência das pessoas idosas e garantir a segurança no trânsito

Rui Chen, Tingting Yang, Bing Jin et al.

Abstract Skeletal muscle atrophy is a common clinical feature of many acute and chronic conditions. Circular RNAs (circRNAs) are covalently closed RNA transcripts that are involved in various physiological and pathological processes, but their role in muscle atrophy remains unknown. Global circRNA expression profiling indicated that circRNAs are involved in the pathophysiological processes of muscle atrophy. circTmeff1 is identified as a potential circRNA candidate that influences muscle atrophy. It is further identified that circTmeff1 is highly expressed in multiple types of muscle atrophy in vivo and in vitro. Moreover, the overexpression of circTmeff1 triggers muscle atrophy in vitro and in vivo, while the knockdown of circTmeff1 expression rescues muscle atrophy in vitro and in vivo. In particular, the knockdown of circTmeff1 expression partially rescues muscle mass in mice during established atrophic settings. Mechanistically, circTmeff1 directly interacts with TAR DNA‐binding protein 43 (TDP‐43) and promotes aggregation of TDP‐43 in mitochondria, which triggers the release of mitochondrial DNA (mtDNA) into cytosol and activation of the cyclic GMP‐AMP synthase (cGAS)/ stimulator of interferon genes (STING) pathway. Unexpectedly, TMEFF1‐339aa is identified as a novel protein encoded by circTmeff1 that mediates its pro‐atrophic effects. Collectively, the inhibition of circTmeff1 represents a novel therapeutic approach for multiple types of skeletal muscle atrophy.

Katarzyna Stawarz, Ian Ju Liang, Lyndsay Alexander et al.

BackgroundOlder adults are at increased risk of falls, injury, and hospitalization. Maintaining or increasing participation in physical activity during older age can prevent some of the age-related declines in physical functioning that contribute to loss of independence and low reported quality of life. Exercise snacking may overcome some commonly cited barriers to exercise and encourage older adults to engage in muscle strength and balance activity, but the best way to deliver and support this novel format remains unknown. ObjectiveOur aim was to explore how the novel exercise snacking approach, that is, incorporating short bouts of strength and balance activities into everyday routines, could be supported by technology within a home setting and what types of technologies would be acceptable for older adults who are prefrail. MethodsFollowing a user-centered design process, 2 design workshops (study 1) were conducted first to understand older adults’ (n=11; aged 69-89 years) attitudes toward technology aimed at supporting exercise snacking at home and to inform the design of 2 prototypes. Next, based on the findings of study 1, an exploratory pilot study (study 2) was conducted over 1 day with 2 prototypes (n=5; aged 69-80 years) at the participants’ homes. Participants were interviewed over the telephone afterward about their experience. Transcripts were analyzed using framework analysis. ResultsThe results showed that the participants were positive toward using technology at home to support exercise snacking, but both exercises and technology would need to be simple and match the participants’ everyday routines. Workshop discussions (study 1) led to the design of 2 prototypes using a pressure mat to support resistance and balance exercises. The exploratory pilot study (study 2) participants reported the potential in using smart devices to support exercise snacking, but the design of the initial prototypes influenced the participants’ attitudes toward them. It also hampered the acceptability of these initial versions and highlighted the challenges in fitting exercise snacking into everyday life. ConclusionsOlder adults were positive about using technology in their homes to support strength and balance exercise snacking. However, although promising, the initial prototypes require further refinement and optimization before feasibility, acceptability, and efficacy testing. Technologies to support exercise snacking need to be adaptable and personalized to individuals, to ensure that users are snacking on balance and strengthening exercises that are appropriate for them.

Zheng Qin, Zheng Qin, Kaixi Chang et al.

Aims: We aimed to assess the association between dietary inflammation index (DII) and abdominal aortic calcification (AAC) in US adults aged ≥40 years.Methods: Data were obtained from the 2013–2014 National Health and Nutrition Examination Survey (NHANES). Participants who were &lt;40 years old and missing the data of DII and AAC were excluded. DII was calculated based on a 24-h dietary recall interview for each participant. AAC score was quantified by assessing lateral spine images and severe AAC was defined as AAC score &gt;6. Weighted multivariable regression analysis and subgroup analysis were preformed to estimate the independent relationship between DII with AAC score and severe AAC.Results: A total of 2,897 participants were included with the mean DII of −0.17 ± 2.80 and the mean AAC score of 1.462 ± 3.290. The prevalence of severe AAC was 7.68% overall, and participants in higher DII quartile tended to have higher rates of severe AAC (Quartile 1: 5.03%, Quartile 2: 7.44%, Quartile 3: 8.38%, Quartile 4: 10.46%, p = 0.0016). A positive association between DII and AAC score was observed (β = 0.055, 95% CI: 0.010, 0.101, p = 0.01649), and higher DII was associated with an increased risk of severe AAC (OR = 1.067, 95% CI: 1.004, 1.134, p = 0.03746). Subgroup analysis indicated that this positive association between DII and AAC was similar in population with differences in gender, age, BMI, hypertension status, and diabetes status and could be appropriate for different population settings.Conclusion: Higher pro-inflammatory diet was associated with higher AAC score and increased risk of severe AAC. Anti-inflammatory dietary management maybe beneficial to reduce the risk of AAC.

Nichtima Chayaopas, Pornthep Kasemsiri, Panida Thanawirattananit et al.

Abstract Background Globally increasing number of elders is concerned. Hearing loss process in older adults cannot be avoided. An effective screening tool for hearing loss is essential for proper diagnosis and rehabilitation, which can improve QOL in older adults. Methods This prospective-diagnostic test study evaluates the diagnostic value of Thai version of the Hearing Handicap Inventory for Elderly Screening (HHIE-ST) and the Thai Single Question (TSQ) surveys in screening hearing disability in 1109 Thai participants aged 60 years and older in communities in four provinces in Thailand. The HHIE-ST consisted of 10 selected questions from the validated HHIE-Thai version. A TSQ survey was developed to have the same meaning as an English Single Question survey. The participants answered both questionnaires, and a standard audiometry test assessed with air conduction from 250 to 8000 Hz was included as a gold standard. Results The prevalence of hearing disability was 38.34%. The HHIE-ST achieved a sensitivity of 88.96% (95% CI 85.77–91.64) and specificity of 52.19% (95% CI 48.24–56.13) for diagnosis hearing disability in Thai older adults, whereas the TSQ yielded a sensitivity of 88.73% and a specificity of 55.93%. A combined test including the HHIE-ST and TSQ achieved better performance with sensitivity of 85.29% and specificity of 60.13%. Conclusions Either the HHIE-ST or the TSQ is a sensitive and useful tool for screening hearing disability in Thai older adults. Using the HHIE-ST together with the TSQ resulted in a better screening tool for detecting moderate hearing loss older adults who will benefit and recommended for hearing rehabilitation. Trial registration The study is registered with the following number in the Thai Clinical Trials Registry: TCTR20151015003 . Date of registration October 14, 2015.

Kelly Cummings, Shivani Chopra, Suzanne Goldhirsch et al.

As the magnitude of the coronavirus disease 2019 (COVID-19) pandemic became clear and with it came unprecedented stressors for clinicians, specifically trainees, the program leadership for the Geriatrics and Palliative Medicine Fellowship at Mount Sinai Hospital quickly recognized the urgent need to focus on trainee well-being. From March to June 2020, program leadership focused on implementation of five core strategies to assess and meet trainees’ real-time physical and psychological support needs. To assess fellows’ opinions of these strategies, a formal survey was administered six months after the initial COVID-19 surge. Results found that more than 75% of fellows agreed on the high value of four specific interventions: (1) flexible scheduling with (2) a built-in backup system and (3) a safe environment with (4) adequate personal protective equipment. These well-being strategies are feasible and broadly applicable to other training programs across the country. They may also be useful outside the scope of the pandemic crisis.

Francesco Valeri, Malena dos Santos Guilherme, Fuqian He et al.

Alzheimer’s disease is a progressive neurodegenerative disorder affecting around 30 million patients worldwide. The predominant sporadic variant remains enigmatic as the underlying cause has still not been identified. Since efficient therapeutic treatments are still lacking, the microbiome and its manipulation have been considered as a new, innovative approach. 5xFAD Alzheimer’s disease model mice were subjected to one-time fecal material transfer after antibiotics-treatment using two types of inoculation: material derived from the caecum of age-matched (young) wild type mice or from middle aged, 1 year old (old) wild type mice. Mice were profiled after transfer for physiological parameters, microbiome, behavioral tasks, and amyloid deposition. A single time transfer of cecal material from the older donor group established an aged phenotype in the recipient animals as indicated by elevated cultivatable fecal Enterobacteriaceae and Lactobacillaceae representative bacteria, a decreased Firmicutes amount as assessed by qPCR, and by increased levels of serum LPS binding protein. While behavioral deficits were not accelerated, single brain regions (prefrontal cortex and dentate gyrus) showed higher plaque load after transfer of material from older animals. We could demonstrate that the age of the donor of cecal material might affect early pathological hallmarks of Alzheimer’s disease. This could be relevant when considering new microbiome-based therapies for this devastating disorder.

Michael A. Chen

An octogenarian presented to our hospital in shock after being “found down” at home. She was dehydrated, hypernatremic, and suffering from a urinary tract infection. Findings of a murmur and those on electrocardiography led to the performance of echocardiography, with all findings consistent with a diagnosis of hypertrophic obstructive cardiomyopathy. The patient was volume resuscitated and administered antibiotics; after stabilization, she was started on a low-dose beta-blocker. Hypertrophic cardiomyopathy is a common genetic disorder that is usually diagnosed in the second to fifth decades of life, rarely being diagnosed at an advanced age. It is also an uncommon cause or contributor to shock. We briefly review the diagnosis and management of hypertrophic cardiomyopathy in older adults, particularly in the setting of shock.

Chapal Khasnabis, Catherine Holloway, Malcolm MacLachlan

Jennifer Cunningham-Erves, Victoria Villalta-Gil, Kenneth A. Wallston et al.

AbstractObjective:Lack of trust toward medical research is a major barrier to research participation, particularly among some population groups. Valid measures of trust are needed to develop appropriate interventions. The study purpose was to compare two previously validated scales that measure trust in biomedical research – one developed by Hall et al. (H-TBR; 2006) and the other by Mainous et al. (M-TBR; 2006) – in relation to socio-demographic variables and attitudes toward research. Differences between Black and White respondents were explored.Methods:Two nearly identical surveys – one with H-TBR and the other with M-TBR – were systematically administered to a convenience sample. Internal consistency reliability of each scale was assessed. Associations were computed between scores on each scale with attitudes toward biomedical research and demographic variables (i.e., gender, age, race, and socioeconomic status). The difference between White and Black respondents on each TBR score while controlling for age, education, and race was also investigated.Results:A total of 2020 participants completed the H-TBR survey; 1957 completed the M-TBR survey. Mean item scores for M-TBR were higher (F = 56.05, p < 0.001) among Whites than Blacks. Whites also had higher mean item scores than Blacks on H-TBR (F = 7.09, p < 0.001). Both scales showed a strong association with participants’ perceived barriers to research (ps < 0.001) and significant, positive correlations with interest in research participation (ps < 0.001). Age and household income were positive predictors of TBR scores, but the effects of education differed.Conclusions:Both scales are internally consistent and show associations with attitudes toward research. Whites score higher than Blacks on both TBR scales, even while controlling for age and socioeconomic status.

Yafit Gilboa, Talia Maeir, Sharon Karni et al.

Abstract Background Most surviving hip-fracture patients experience reduced mobility and lose some of their functional ability, which increases the risk of complications and rehospitalization. Post-discharge transitional programs to reduce readmissions and disabilities have shown some success. Telerehabilitation refers to the use of technologies to provide rehabilitation services to people in their homes. Considering the need for long-term follow-up care for people with hip fracture, in-home telerehabilitation could increase independence, decrease hospital stays and reduce the burden for caregivers. The objective of this study is to investigate the effectiveness of an intervention program based on telerehabilitation on activities of daily living (ADL), quality of life (QOL), depression and burden on caregivers compared to face-to-face home visits and usual care of community-dwelling older adults after hip fracture. Methods/design This will be a three-armed randomized control trial (RCT) including pre/post intervention and follow-up. The trial will include 90 older people with hip fractures who will be randomly assigned to a telerehabilitation group (N = 30), face-to-face visits (N = 30) and a control group. The aim of the intervention is to improve the transition from rehabilitation units to community dwelling. It will include 10 videoconferencing/ face-to-face sessions from an occupational therapist in the presence of the primary caregiver. Each session will be utilized to guide the participants to achieve their self-identified goals, focusing on problem-solving for daily life situations and on the ability to implement the discussed strategies for a variety of activities. Outcome measures include Functional Independence Measure (FIM) for evaluation of ADL, SF-12 for evaluation of Health-related QOL, The Geriatric Depression Scale (GDS) and The Zarit Caregiver Burden Scale. Data will be analyzed using Repeated measures MANOVA. Discussion The current study will enable the cost-effectiveness examination of a suggested rehabilitation service based on available technology. The proposed intervention will increase accessibility of in-home rehabilitation services, improve function and health, and reduce economic burden. Trial registration NCT03376750 (12/15/2017).

Jitendra Rohilla, Pinki Tak