The clinical consequences of an ageing world and preventive strategies

Impact of extreme weather events on food security among older people: a systematic review

BACKGROUND

Climate change has intensified the frequency and severity of extreme weather events, disproportionately affecting vulnerable populations, including older people for which the literature is still limited. This systematic review investigated the impact of extreme weather events on malnutrition and food security among individuals aged 60 and older.

METHODS

A systematic search of PubMed/MEDLINE, Scopus, and Web of Science was conducted without restrictions (October 2024), and following PRISMA guidelines. Observational studies examining older adults exposed to extreme weather events (e.g., droughts, floods, heatwaves, hurricanes) and their effects on malnutrition or food security were included. The Newcastle-Ottawa Scale assessed study quality. Protocol was registered in PROSPERO (ID: CRD42024596910).

RESULTS

From 1,709 articles, six observational studies involving 265,000 participants (aged 60 years and over) were included. These studies spanned multiple geographies, with a concentration in the United States. Findings revealed a dual impact: while some studies reported protective factors, such as social support and economic stability, others highlighted increased malnutrition risk due to disrupted food supply, economic hardship, and inadequate adaptive responses. Heterogeneity in study designs, exposure definitions, and outcome measures limited comparability.

CONCLUSION

Extreme weather events significantly impact malnutrition and food security among older adults, with outcomes influenced by socio-economic and geographical factors. Further longitudinal studies are needed to clarify causal pathways and inform targeted public health interventions to enhance resilience in aging populations.

The Quality of Life and Associated Factors Among Older Adults in Central Nepal: A Cross-Sectional Study Using the WHOQOL-OLD Tool

Ensuring people's quality of life (QOL) has become increasingly challenging due to population aging. This study aimed to investigate the QOL among older people and factors associated with it in an urban setting of Central Nepal using the World Health Organization Quality of Life (WHOQOL-OLD) tool. A cross-sectional study was conducted in Central Nepal. The association between QOL and independent variables was first examined using a univariate analysis of variance followed by multiple linear regressions. The mean age of the 366 participants was 70 years (standard deviation [SD]: 8.2 years). The mean of the overall QOL scores was 74.37 (SD: 7.82). Older people who were literate (regression coefficient (β): 1.909; 95% confidence interval (CI): 3.771 (1.986, 5.556)), who had an annual household income of NPR 40,000 (Nepalese Rupees) or more (β: 1.909: 95% CI: 0.337, 3.480), who reported health services as accessible (β: 4.019; 95% CI: 0.666, 7.371) and affordable (β: 3.176; 95% CI: 1.327, 5.025), and who reported partaking in physical activity (β: 2.107; 95% CI: 0.607, 3.606) had higher QOL scores compared to their respective counterparts. A holistic model of service using the social determinants of health framework is essential to improve the well-being of older people in Nepal.

Optimising prehospital trauma triage for older adults: challenges, limitations, and future directions

The ageing population presents significant challenges for prehospital trauma care, with older adults experiencing higher rates of undertriage and overtriage due to age-related physiological changes, frailty, and polypharmacy. Standard trauma triage tools, primarily designed for younger populations, often fail to accurately assess injury severity in older adults, leading to delays in definitive care or unnecessary resource use. This narrative review synthesises current evidence on the limitations of existing trauma triage tools for older adults, highlighting challenges such as inconsistent implementation, paramedic training gaps, and age-related biases. The review explores the role of adjusted systolic blood pressure thresholds, frailty assessments, and geriatric-specific triage protocols in improving triage accuracy. While these modifications show promise, their integration into prehospital care remains limited due to logistical and clinical barriers. Key findings suggest that incorporating frailty assessments, refining age-specific triage criteria, and enhancing paramedic education can improve the precision of prehospital trauma triage for older adults. However, significant research gaps remain, including the need for large-scale prospective studies on geriatric-specific triage tools and investigations into the impact of triage modifications on long-term patient outcomes. Standardising geriatric triage protocols, leveraging digital decision-support tools, and addressing disparities in trauma centre access are critical to optimising prehospital care for older trauma patients. Future research should focus on refining triage strategies to enhance decision-making and ensure that older adults receive timely, appropriate trauma care, ultimately reducing preventable morbidity and improving patient outcomes.

Aging, longevity, and healthy aging: the public health approach

BACKGROUND

Population aging is one of the most significant global demographic changes of the 21st century, driven by increased life expectancy and declining fertility rates. This phenomenon presents both achievements and challenges for public health systems worldwide.

AIMS

On the one hand, advances in healthcare and socio-economic conditions have contributed to longer lives and improved quality of life for older adults. On the other hand, aging populations are increasingly affected by chronic diseases, greriatric syndromes, and multimorbidity, leading to greater healthcare demands and higher associated costs.

METHODS

This manuscript explores evidence on regards of the impact of aging on healthcare and economic systems, emphasizing the need for a paradigm shift toward healthy aging.

RESULTS

Healthy aging, as defined by the World Health Organization, focuses on the maintenance of intrinsic capacity, physical, mental, and social well-being throughout life. It highlights the importance of preventive healthcare, proper nutrition, and regular physical activity in delaying the onset of chronic conditions and maintaining functional independence. Furthermore, the manuscript addresses the challenges faced by healthcare infrastructures and pension systems as they adapt to aging populations, with particular attention to the strain caused by workforce shortages and the rising need for long-term care.

DISCUSSION

A coordinated public health approach is essential to promote healthy aging and mitigate the economic and societal impacts of population aging.

CONCLUSIONS

This paper underscores the need for integrated health policies and multidisciplinary care models to ensure that longer life expectancy is accompanied by better quality of life for older individuals.

Handgrip strength and gait speed relationships with cognitive impairment in Iranian older adults: Birjand longitudinal aging study

BACKGROUND

Cognitive impairment prevalence is rising with population aging. This study examined the relationship between handgrip strength and gait speed with cognitive impairment and performance in older adults.

METHODS

This cross-sectional study used baseline data from Birjand Longitudinal Aging Study (BLAS), including 1347 older adults. Cognitive function was evaluated using the six-item Cognitive Impairment Test (6-CIT). Gait speed was measured over six meters, and grip strength was assessed with hand dynamometers.

RESULTS

After adjusting for potential confounders, the association between low handgrip strength and cognitive impairment lost its significance (relative risk ratio (RRR) = 1.07, 95% CI: 0.70, 1.63). However, low gait speed remained significantly associated with dementia (RRR = 1.92, 95% CI: 1.23, 3.01) after adjusting for age, sex, education, body mass index (BMI), hypertension, and depressive symptoms.

CONCLUSION

Low gait speed is significantly associated with dementia, highlighting the importance of incorporating physical function measures into dementia risk assessments.

Safety and Efficacy of Direct Oral Anticoagulants Apixaban and Rivaroxaban Versus Standard Therapy for VTE Prophylaxis Post Cancer Surgery-A Network Meta-Analysis of Randomized Clinical Trials

Background/Objectives: Venous thromboembolism (VTE) is a major risk for cancer patients undergoing surgery due to hypercoagulability and surgical stress. Traditional low-molecular-weight heparins (LMWHs) are used as the standard of care for VTE prophylaxis, but subcutaneous administration often leads to suboptimal patient adherence. Direct oral anticoagulants (DOACs) are being explored as more convenient and effective alternatives. This study employed a network meta-analysis approach to comparatively assess the safety and efficacy of DOACS and LMWH in preventing VTE among cancer patients undergoing oncologic surgery. Methods: A systematic review and network meta-analysis were conducted. The search strategy included randomized controlled trials (RCTs) retrieved from databases such as CLINICALTRIAL.GOV, MEDLINE, and EMBASE. The search encompassed studies published up to October 2023 and compared the efficacy and safety of DOACs with LMWHs in patients undergoing cancer surgery. The primary outcome was the incidence of VTE, and the secondary outcomes included the incidences of major bleeding events (MB) and clinically relevant non-major bleeding (CRNMB). Results: A network meta-analysis of four randomized controlled trials (RCTs) involving 1600 cancer surgery patients was conducted. No statistically significant differences in VTE rates were observed between DOACs and LMWHs. While rivaroxaban 10 mg once daily for 30 days significantly reduced VTE risk compared to placebo (RR: 0.27, 95% CI: 0.08-0.95), no significant differences were found in major or clinically relevant non-major bleeding risks between DOACs and LMWH or placebo. Conclusions: This network meta-analysis provides evidence supporting the use of DOACs, specifically apixaban and rivaroxaban, as safe and efficacious alternatives to LMWHs for VTE prophylaxis in cancer patients undergoing surgery. The oral administration and reduced monitoring requirements associated with DOACs address the limitations inherent to LMWHs, potentially improving patient adherence. These findings emphasize the need for additional head-to-head trials and long-term studies further to solidify their role in this high-risk patient population.

Food, nutrition and dining information on residential aged care facility websites: A website analysis

OBJECTIVE

High-quality food, nutrition and dining are essential tenets of residential aged care facilities (RACF). Residential aged care facilities provide website information on their services for prospective residents, which may offer insight into food, nutrition and dining practices. This study aimed to describe the food, nutrition and dining information on RACF websites.

METHODS

A cross-sectional website analysis was conducted on Southeast Queensland (SEQ) RACF websites. Food, nutrition and dining data were extracted verbatim under domains of nutrition care processes, food and menu planning, eating assistance and mealtime experiences, with further subdomains under each. Quantitative content analysis was conducted to describe the information reported on websites, descriptive statistics were used to describe RACF characteristics, and Pearsons χ2 analyses were performed to detect associations between different food, nutrition and dining practices and RACF characteristics.

RESULTS

A total of 268 websites were reviewed. Food, nutrition and dining information were limited, with no subdomains mentioned by all websites. The most frequently mentioned subdomains were the foodservice model (64%, n = 171), allied health services (72%, n = 173) and communal dining (73%, n = 193). Assistive/adaptive equipment to support independence (0%, n = 0), personalised nutrition care plan (0%, n = 1) and reference to food, nutrition or food safety standards (2%, n = 5) were the least mentioned subdomains. Facility characteristics had minimal associations with subdomains.

CONCLUSIONS

There are opportunities for RACF to improve the information on food, nutrition and dining information on websites to increase transparency to future residents. The subdomains developed in this study could provide guidance to RACF to enhance online information.

Digital X-ray Tomography in the Clinical Diagnosis of Suspected Neck of Femur Fractures

Background Occult fracture of the neck of femur (NOF) is a challenging acute presentation for orthopaedic surgeons. This study aimed to evaluate the use of digital tomography in the diagnosis of occult NOF fractures not visible on plain radiographs. Materials and methods A total of 100 patients admitted with suspected NOF fractures but negative plain X-rays underwent digital tomography studies. In equivocal tomography studies, patients who are clinically moderate to high probability suspicious of a hip fracture underwent further MRI or CT scans. Result In this study, 100 patients with suspected NOF fractures underwent a digital tomography investigation. The tomography identified 43 patients with fractures, including 18 with NOF, and therefore, they were surgically treated. In addition, 14 additional patients had other pelvic fractures and were treated conservatively. Eleven patients with suspicious fractures identified on tomography underwent MRI/CT to delineate the fracture pattern. From this subgroup, two patients were found to have fracture extension to NOF. Moreover, eight patients underwent tomography but were inconclusive and underwent MRI/CT, which identified five NOF fractures. A total of 37 patients with a negative tomogram for fracture NOF and a low clinical probability of a fracture did not undergo additional MRI/CT scanning. At 12 months of follow-up, this group had no readmissions due to complications related to their initial injury. Conclusion Tomography is a novel imaging modality that can be used to diagnose NOF and other pelvic fractures. This is a promising imaging modality, especially in patients not suitable to undergo MRI/CT. It offers a cost-effective and accurate alternative, making it an effective tool for managing patients in economically disadvantaged regions, as it is relatively easier to interpret.

Determinants of cognitive health in the elderly: a comprehensive analysis of demographics, health status, and lifestyle factors from NHANES

This study analyzes data from the National Health and Nutrition Examination Survey (NHANES) to identify factors influencing cognitive performance among the elderly, as measured by the Digit Symbol Substitution Test (DSST). Employing multivariable linear regression, we evaluated the impact of demographic, lifestyle, and health-related factors on cognitive function in U.S. adults aged 60 and older. Our findings indicate that advanced age, particularly in those aged 70-79 and 80 + years, is associated with lower DSST scores. Male gender is linked with reduced cognitive performance, while higher educational attainment appears protective. Lifestyle factors, including current smoking and higher alcohol consumption, negatively impact cognitive outcomes, and excessive sleep duration (over 9 h) is also detrimental. Among health conditions, diabetes, chronic heart failure, and a history of stroke were associated with cognitive declines. Furthermore, increasing severity of depression correlates with lower cognitive function. These results underline the need for comprehensive public health strategies that integrate lifestyle modifications and chronic disease management to maintain cognitive health in older adults.

Association of frailty with physical activity behaviour and well-being in older employees: moderated mediation by functional difficulty

BACKGROUND

Many studies have highlighted the association between frailty, physical activity behaviour (PAB), and well-being, but no study has investigated a potential moderated mediating role of functional difficulty in this relationship. This association may not be the same between different income levels. This study, therefore, assessed the above moderated mediation between low- and higher-income samples.

METHODS

This research employed a cross-sectional design in accordance with established research-reporting guidelines. The study population comprised two distinct Ghanaian samples, with N = 942 individuals in the low-income group and N = 600 individuals in the higher income group. Data analysis was carried out using Hayes's Process model through structural equation modelling, with additional sensitivity analyses performed through hierarchical linear regression.

RESULTS

Frailty had a direct negative effect and an indirect negative effect (through functional difficulty) on well-being in both samples. A partial mediation of functional difficulty was found in the relationship between frailty and well-being in both samples. We also found evidence of a moderated mediation by functional difficulty in both samples; however, this effect was stronger in the higher-income sample.

CONCLUSION

Older employees with frailty are less likely to report lower functional difficulty and well-being at higher PAB. Our results suggest a need for workplace programmes aimed at encouraging PAB. It also reinforces the importance of individuals performing and maintaining PAB.

The Influence of Lifestyle Modifications on Cardiovascular Outcomes in Older Adults: Findings from a Cross-Sectional Study

Background: Cardiovascular disease (CVD) is a leading cause of morbidity and mortality among older adults. Lifestyle modifications, including diet, physical activity, and smoking cessation, are key to reducing cardiovascular risk. This study examines the combined effects of these behaviors on cardiovascular outcomes and their mediating mechanisms. Methods: A cross-sectional study was conducted among older adults (aged ≥ 60 years) in Riyadh, Saudi Arabia. Data on dietary quality, physical activity, and smoking status were collected using validated questionnaires. Cardiovascular outcomes, including low-density lipoprotein cholesterol (LDL), systolic blood pressure (SBP), and body mass index (BMI), were measured. A composite cardiovascular risk score was computed. Path analysis was employed to assess direct and indirect effects of lifestyle factors on cardiovascular outcomes. Results: Participants adhering to a healthy diet, engaging in regular physical activity, and avoiding smoking had significantly lower composite cardiovascular risk scores. Non-smoking status showed the strongest direct effect (β = -0.20, p = 0.006), while dietary quality and physical activity exhibited significant indirect effects mediated by LDL, SBP, and BMI. Combined adherence to multiple healthy behaviors resulted in the greatest reductions in cardiovascular risk. The path analysis highlighted dietary quality and physical activity as critical mediators of cardiovascular health improvements. Conclusions: Lifestyle modifications significantly reduce cardiovascular risk in older adults, with cumulative benefits observed for combined adherence to healthy behaviors. These findings emphasize the importance of comprehensive lifestyle interventions targeting diet, physical activity, and smoking cessation to promote cardiovascular health in aging populations.

Circadian Rhythms and Lung Cancer in the Context of Aging: A Review of Current Evidence

Circadian rhythm is the internal homeostatic physiological clock that regulates the 24-hour sleep/wake cycle. This biological clock helps to adapt to environmental changes such as light, dark, temperature, and behaviors. Aging, on the other hand, is a process of physiological changes that results in a progressive decline in cells, tissues, and other vital systems of the body. Both aging and the circadian clock are highly interlinked phenomena with a bidirectional relationship. The process of aging leads to circadian disruptions while dysfunctional circadian rhythms promote age-related complications. Both processes involve diverse physiological, molecular, and cellular changes such as modifications in the DNA repair mechanisms, mechanisms, ROS generation, apoptosis, and cell proliferation. This review aims to examine the role of aging and circadian rhythms in the context of lung cancer. This will also review the existing literature on the role of circadian disruptions in the process of aging and vice versa. Various molecular pathways and genes such as BMAL1, SIRT1, HLF, and PER1 and their implications in aging, circadian rhythms, and lung cancer will also be discussed.

Preoperative cognitive performance and its association with postoperative complications in vascular surgery patients: A prospective study

BACKGROUND

Cognitive impairment affects nearly half of vascular surgery patients, but its association with postoperative outcomes remains poorly understood. This study explores the link between preoperative cognitive performance and postoperative complications, including postoperative delirium, in vascular surgery patients.

METHODS

A prospective cohort study was conducted on vascular surgery patients aged ≥65. Preoperative cognitive performance was assessed using the Montreal Cognitive Assessment, and postoperative complications were evaluated using the Comprehensive Complication Index. The association was analyzed through multivariable logistic regression.

RESULTS

Among 110 patients (18.2 ​% female, mean age 73.8 ​± ​5.7 years), cognitive impairment was evident in 48.2 ​%. Of the participants, 29 (26.3 ​%) experienced postoperative complications, among which 11 (10 ​%) experienced postoperative delirium. The adjusted odds ratio for the association between cognitive performance and postoperative complications was 1.19 (95 ​% CI 1.02-1.38; p ​= ​0.02).

CONCLUSION

Worse preoperative cognitive performance correlated with increased odds of postoperative complications and postoperative delirium in vascular surgery patients.

Improvement of Presbyopia, Dry Eye, Intraocular Pressure, and Near Vision Through Cassiae Tea Consumption

Background and Objectives: This study aimed to illustrate a novel method for improving presbyopia by drinking cassiae tea. Materials and Methods: A total of 425 eyes from 425 participants (aged 52.5 ± 9.5 years) were recruited and divided into several experimental groups over a 6-month period. Participants consumed cassiae tea daily (10 g of cassiae semen brewed in 500 cc of water). Meanwhile, control group participants consumed 500 cc of plain water along with 1000 mg of vitamin C each day. Experiments 1 and 2: Participants with severe dry eye and intraocular pressure (IOP) > 30 mmHg were enrolled, and outcomes were assessed for these conditions, respectively. Experiments 3, 4, and 7: These experiments evaluated pupil size, near vision, and serum superoxide dismutase (SOD) levels in two groups of volunteers. Experiment 5: Different quantities of cassiae tea were prescribed to various groups, and near vision was measured. Experiment 6: Three questionnaires assessed presbyopic symptoms after cassiae tea consumption. Experiment 8: The antioxidant activity of cassiae tea compared with other bioactive compounds and Chinese herbs was evaluated using the DPPH test. Results: By the fourth month of the study, participants experienced increased tear volume and reduced IOP. Pupil size constricted, near vision improved, and serum SOD levels increased. Furthermore, greater consumption of cassiae tea was correlated with better near vision. The antioxidant activity of cassiae tea was found to surpass that of anthocyanins, wolfberry, and vitamin C. Conclusions: Drinking cassiae tea improves dry eye symptoms, reduces IOP, regulates pupil size, and enhances near vision due to its excellent antioxidant and pharmacological properties. These benefits may particularly aid individuals with presbyopia and those engaged in near-distance activities, such as smartphone use.

The current status of trauma care for older adults in Saudi Arabia

The aging population in Saudi Arabia presents unique challenges to the trauma care system, especially in prehospital settings. This narrative review aims to assess the current status of trauma care for older adults in Saudi Arabia, focusing on the implications of aging, gaps in the trauma system, and the role of emergency medical services. The global rise in life expectancy has increased the incidence of injuries among older adults, leading to a greater burden on healthcare systems. The review highlights the complexity of assessing and managing trauma cases in older adults, including the impact of physiological changes on injury outcomes, challenges faced by ambulance workers, and the lack of a robust trauma care infrastructure in Saudi Arabia. Moreover, it identifies gaps in geriatric-specific training and prehospital care pathways that limit effective management. To address these issues, recommendations include enhancing geriatric-specific education for ambulance workers, improving trauma system infrastructure, and conducting further research to explore the impacts of aging on trauma outcomes. These efforts are critical for reducing the healthcare burden and improving trauma care quality for older adults in Saudi Arabia.

Coffee consumption and cardiometabolic health: a comprehensive review of the evidence

This review provides a comprehensive synthesis of longitudinal observational and interventional studies on the cardiometabolic effects of coffee consumption. It explores biological mechanisms, and clinical and policy implications, and highlights gaps in the evidence while suggesting future research directions. It also reviews evidence on the causal relationships between coffee consumption and cardiometabolic outcomes from Mendelian randomization (MR) studies. Findings indicate that while coffee may cause short-term increases in blood pressure, it does not contribute to long-term hypertension risk. There is limited evidence indicating that coffee intake might reduce the risk of metabolic syndrome and non-alcoholic fatty liver disease. Furthermore, coffee consumption is consistently linked with reduced risks of type 2 diabetes (T2D) and chronic kidney disease (CKD), showing dose-response relationships. The relationship between coffee and cardiovascular disease is complex, showing potential stroke prevention benefits but ambiguous effects on coronary heart disease. Moderate coffee consumption, typically ranging from 1 to 5 cups per day, is linked to a reduced risk of heart failure, while its impact on atrial fibrillation remains inconclusive. Furthermore, coffee consumption is associated with a lower risk of all-cause mortality, following a U-shaped pattern, with the largest risk reduction observed at moderate consumption levels. Except for T2D and CKD, MR studies do not robustly support a causal link between coffee consumption and adverse cardiometabolic outcomes. The potential beneficial effects of coffee on cardiometabolic health are consistent across age, sex, geographical regions, and coffee subtypes and are multi-dimensional, involving antioxidative, anti-inflammatory, lipid-modulating, insulin-sensitizing, and thermogenic effects. Based on its beneficial effects on cardiometabolic health and fundamental biological processes involved in aging, moderate coffee consumption has the potential to contribute to extending the healthspan and increasing longevity. The findings underscore the need for future research to understand the underlying mechanisms and refine health recommendations regarding coffee consumption.

Oxidative Stress and Antioxidants in Aging

Global aging represents a challenge for social health [...].

Socioeconomic and Health Characteristics as Predictors of Social Support in Elderly People with Visual Impairment: Evidence from Serbia

Background

Social networks and support have an independent and strong influence on health and quality of life at all stages of the life cycle, especially in the elderly. We aimed to determine the level of social support among the elderly population of the Republic of Serbia.

Methods

The survey is part of the fourth Health survey of the population of Serbia, which was conducted in 2019 by the Republic Institute of Statistics with the Institute for Public Health of Serbia "Dr. Milan Jovanović Batut" and the Ministry of Health of the Republic of Serbia. The research instrument was standardized questionnaires constructed in accordance with the European Health Interview Survey (EHIS, wave3) and the social support score (Oslo-3 Social Support Scale). For the purposes of this research, data on the population aged 65 and over were used.

Results

In terms of social support, 85.8% of respondents had bad , 13.9% moderate and 0.3% strong. Univariate regression analysis determined that respondents from the territory of Vojvodina had a 1.6 times higher chance of poor social support compared to respondents from southern and eastern Serbia. The probability of bad social support was 1.5 times higher in persons who were never married/cohabiting, persons with secondary education were at 1.6 times higher risk of poor social support compared to persons with higher education. Inactive persons had poor social support 1.4 times more often than employed persons, as well as persons with comorbidities (OR=1.218).

Conclusion

These researches are of great importance for public health because it provides valuable data for the creation of interventions that will intensify activities related to providing adequate social support to the elderly.

'You're Just Thinking About Going Home': Exploring Person-Centred Medication Communication With Older Patients at Hospital Discharge

BACKGROUND

The hospital discharge process poses significant safety risks for older patients due to complexities in communication and coordination among stakeholders, leading to potential drug-related problems post-discharge. Adopting a person-centred care (PCC) approach in medication communication by healthcare professionals (HCPs) is crucial to ensure positive health outcomes. This study aimed to explore the practice of PCC in medication communication between older patients and HCPs during the hospital discharge process.

METHODS

We conducted a qualitative study using non-participatory direct observations of patient-HCP consultations during hospital discharge, followed by semi-structured interviews with observed patients and, when applicable, their informal caregivers. Data collection occurred from October 2020 to May 2021 at two Swedish hospitals. We gathered data using an observational form and audio-recorded all consultations and interviews. The data were analysed thematically using the systematic text condensation method.

RESULTS

Twenty patients were included (median age: 81 years [range: 65-94]; 9 female) in observations and 13 of them participated in interviews. Two patients were accompanied by an informal caregiver during the interviews. Three main themes were identified: (1) The impact of traditional authoritarian structures, depicts power dynamics between patients and their HCPs, showing how traditional structures influence the practice of PCC in medication communication during hospital discharge; (2) Consultation timing and mode not on patients' terms, describes suboptimal times and settings for consultations, along with the use of complex language that hinders effective communication; and (3) Discrepancy in expectations of self-care ability, illustrates a mismatch between the self-care guidance provided by HCPs during hospital discharge and the actual needs and preferences of patients and informal caregivers.

CONCLUSION

Medication communication between older patients and HCPs during hospital discharge is frequently inconsistent with the practice of PCC. Not only must HCPs improve their communication strategies, but patients and their informal caregivers should also be better prepared for discharge communication and encouraged to participate in their care. This involvement would give them relevant knowledge and tailor communication to their individual needs, preventing problems in managing their medications after discharge.

PATIENT OR PUBLIC CONTRIBUTION

An advisory group of six patients and/or informal caregiver contributors provided input on the study design, edited the consent forms, and helped develop the interview guide.

Anterior cruciate ligament reconstruction in the elderly: 5-Year follow-up study

BACKGROUND

Older adults remain active for longer and continue sports and activities that require rotation on one leg later in life. The rate of anterior cruciate ligament (ACL) tears is therefore increasing in those over 40 years old, with an associated increase in the rate of surgical reconstruction (ACLR), but there is limited literature on its effectiveness. Our aim was to compare the outcomes of elderly patients who have undergone ACLR with those of a younger group of patients.

MATERIALS AND METHODS

Patients who underwent ACLR with bone-patella tendon-bone grafting (BPTB) at a level I trauma center between 2015 and 2017 were included in the study with a 5-year follow-up. Patients were divided into 4 groups: below 40 years, 40-49 years, 50-59 years and over 60 years. The graft function was evaluated by the International Knee Documentation Committee (IKDC) Objective Score, the anteroposterior (AP) displacement was measured by arthrometer (KT-1000; MEDMetric) and the Lysholm scale was used for subjective evaluation.

RESULTS

195 patients were included in the final analysis. The IKDC score showed significantly poorer scores in the 50-59 years and over 60 years group than in the younger groups, however in 83 % and 66 % of cases reached normal or nearly normal grades, respectively. A significant difference was found in the knee AP displacement (measured in mm) between the below 40 years group and 50-59 years as well as over 60 years old groups; however, the number of graft failure (laxity >5 mm) and elongation (>3 mm) did not increased in these senior groups. The patient-reported Lysholm scores in the 40-49 years, 50-59 years and 60 years groups was lower than in the below 40 years group, but the average score was "good".

CONCLUSIONS

The long-term results of ACL reconstruction in older athletes are comparable to those of younger patients, both in terms of knee function and patient satisfaction. Furthermore, there is no difference in outcomes for older patients over the age of 40 compared to those in their 50 s or even 60 s. There is still insufficient published evidence to define an upper age limit for ACL reconstruction in older athletes.

Health Information Seeking on the Internet Among Patients With and Without Cancer in a Region Affected by the 2011 Fukushima Triple Disaster: Cross-Sectional Study

BACKGROUND

Health information seeking via the internet among patients with cancer in disaster-affected areas is underresearched.

OBJECTIVE

This study aims not only to assess the extent and means of web-based health information seeking among patients with cancer living in the disaster-affected area of the 2011 Fukushima triple disaster but also to compare these patterns with those without cancer, identifying distinct and shared factors influencing their web-based health information behaviors.

METHODS

We surveyed 404 patients (263 with and 141 without cancer) from the surgery department outpatient office at Minamisoma Municipal General Hospital, from October 2016 to January 2017. The survey included self-administered questions on internet and digital device use. Descriptive analyses were performed to examine the use patterns of digital devices and the internet and their impact on health information seeking across different age groups of patients with and without cancer. Multivariable logistic regression was used to examine factors associated with web-based health information seeking, stratifying by cancer diagnosis.

RESULTS

The proportion of participants who sought health information on the internet was comparable between patients with cancer and patients without cancer (19% vs 17.4%; P=.71). Digital device use varied significantly with age, with peak smartphone use occurring among the youngest cohorts for both groups. Multivariable logistic regression revealed that patients with cancer using smartphones or tablets daily were significantly more likely to gather web-based health information (odds ratio [OR] for smartphones 3.73, 95% CI 1.58-8.80; OR for tablets 5.08, 95% CI 1.27-20.35). Trust in institutional websites also significantly influenced web-based health information gathering among patients with cancer (OR 2.87, 95% CI 1.13-7.25). Conversely, among patients without cancer, unemployment was associated with a lower likelihood of seeking web-based health information (OR 0.26, 95% CI 0.08-0.85), whereas trust in both institutional and personal websites significantly increased this likelihood (OR for institutional websites 6.76, 95% CI 2.19-20.88; OR for personal websites 6.97, 95% CI 1.49-32.58).

CONCLUSIONS

This study reveals that a small proportion of both patients with cancer and patients without cancer engage in health information seeking via the internet, influenced by age, digital device use, and trust in institutional websites. Given the growing prevalence of digital literacy, strategies to enhance accessible and reliable web-based health information should be developed, particularly for patients with cancer in postdisaster settings. Future efforts should focus on tailored health communication strategies that address the unique needs of these populations.

Voices of Wisdom: Geriatric Interviews on Self-Management of Type 2 Diabetes in the United States-A Systematic Review and Metasynthesis

This review is aimed at unraveling the intricacies of diabetic self-management among geriatric people, drawing on current insights and understanding the complex paths geriatric people navigate. A wide search was conducted in health-oriented databases, including CINAHL, Embase, PsycINFO, MEDLINE, PubMed, Web of Science, and Cochrane Library, while gray literature was excluded. The search combined keywords and subject headings, focusing on the geriatric population, diabetes, self-management, and qualitative research. A three-tiered screening process was employed, with titles and then abstracts initially reviewed. Full-text analysis followed, with disagreements resolved among reviewers. In total, there were 248 participants included across these eight studies. Positive attitudes and perceptions were found to play a significant role in optimizing diabetes self-care outcomes. Support from family and friends was identified as crucial for self-care, while healthcare professionals often lacked adequate support and encouragement. Participants emphasized the importance of listening to their bodies and acknowledging hidden issues. These themes collectively highlight the multifaceted aspects of diabetes self-care and the impact of various factors on the self-management experiences of geriatric individuals with diabetes. The goal of this review is not to objectify self-management as a treatment strategy but to emphasize the importance of cultivating positive attitudes, respecting individual values, and addressing cultural and ethnic differences in healthcare practices to enhance self-management in this population. By embracing cultural diversity, understanding barriers, and respecting individual values, healthcare professionals and policymakers can improve the quality of life for the geriatric population living with diabetes.

Hypertension in an ageing population: Diagnosis, mechanisms, collateral health risks, treatments, and clinical challenges

Ageing population is considerably increasing worldwide, which is considered to reflect an improved quality of life. However, longevity in the human lifespan has increased the burden of late-life illnesses including cancer, neurodegeneration, and cardiovascular dysfunction. Of these, hypertension is the most common condition with huge health risks, with an increased prevalence among the elderly. In this review, we outline the current guidelines for defining hypertension and examine the detailed mechanisms underlying the relationship between hypertension and ageing-related outcomes, including sodium sensitivity, arterial stiffness, endothelial dysfunction, isolated systolic hypertension, white coat effect, and orthostatic hypertension. As hypertension-related collateral health risk increases among the elderly, the available management strategies are necessary to overcome the clinical treatment challenges faced among elderly population. To improve longevity and reduce adverse health effects, potential approaches producing crucial information into new era of medicine should be considered in the prevention and treatment of hypertension among elderly population. This review provides an overview of mechanisms underlying hypertension and its related collateral health risk in elderly population, along with multiple approaches and management strategies to improve the clinical challenges among elderly population.

Gerontology in Public Health: A Scoping Review of Current Perspectives and Interventions

The intersection of gerontology and public health is increasingly vital due to the global aging population and its implications for health systems. This scoping review aims to map existing literature on gerontology within public health, identify current perspectives, and evaluate interventions tailored to the needs of older adults. A systematic search was performed using predefined keywords across multiple databases, including PubMed, Google Scholar, Scopus, and Web of Science. The review included 42 studies that employed various designs, all focusing on public health interventions targeting the aging population.  Key findings indicate a pressing need to integrate gerontological principles into public health practice, recognizing the heterogeneous nature of older adults and the significance of social determinants of health. Interventions ranged from preventive health measures and chronic disease management programs to health promotion activities and caregiver support, including the application of technology to improve health outcomes. However, there was a notable lack of research on diverse populations and mental health interventions. The review also uncovered critical gaps in the literature, such as economic barriers to care access and the necessity for comprehensive policies addressing the aging population's diverse needs. In conclusion, this review emphasizes the importance of a multidimensional approach to effectively addressing older adults' health needs. While several effective interventions exist, there is an urgent need to tackle identified gaps, particularly concerning diverse populations and mental health, to enhance overall health strategies for the aging demographic.

Effects of elastic band resistance training on the physical and mental health of elderly individuals: A mixed methods systematic review

OBJECTIVES

Elastic band resistance training in elderly individuals can improve physical fitness and promote mental health in addition to other benefits. This systematic review aimed to review, summarize, and evaluate quantitative, qualitative, and mixed methodological studies on the use of elastic band resistance training in elderly individuals, and to investigate the influence of elastic band resistance training on the physical and mental health of elderly individuals, as well as their preferences and obstacles in training.

METHODS

A convergent separation approach was used to synthesize and integrate the results, specifically the mixed systematic review approach recommended by the Joanna Briggs Institute. The extensive search strategy included electronic database searches in the Cochrane Library, PubMed, Embase, Web of Science, Google Scholar, MEDLINE, and CINAHL. The researchers rigorously screened the literature, extracted and analyzed the data, and evaluated the quality of the included studies using the Mixed Methods Appraisal Tool (MMAT).

RESULTS

Twenty-eight studies were included, of which 25 were quantitative studies, 2 were qualitative studies, and 1 was a mixed-methods study. A total of 1,697 subjects were investigated across all studies. Quantitative evidence supports the notion that elastic band resistance training can improve upper and lower limb flexibility, endurance, upper strength, physical balance, and cardiopulmonary function and enhance the mental health of elderly individuals. Participants in the qualitative study reported some preferences and obstacles with band resistance training, but most participants reported physical benefits.

CONCLUSIONS

Despite the heterogeneity between studies, this review is the first systematic review to comprehensively evaluate the effectiveness of elastic band resistance training in older adults. It not only shows the influence of elastic band resistance training on the physical and mental health of the elderly, but also emphasizes the preference and obstacles of elderly individuals face.

A molecular index for biological age identified from the metabolome and senescence-associated secretome in humans

Unlike chronological age, biological age is a strong indicator of health of an individual. However, the molecular fingerprint associated with biological age is ill-defined. To define a high-resolution signature of biological age, we analyzed metabolome, circulating senescence-associated secretome (SASP)/inflammation markers and the interaction between them, from a cohort of healthy and rapid agers. The balance between two fatty acid oxidation mechanisms, β-oxidation and ω-oxidation, associated with the extent of functional aging. Furthermore, a panel of 25 metabolites, Healthy Aging Metabolic (HAM) index, predicted healthy agers regardless of gender and race. HAM index was also validated in an independent cohort. Causal inference with machine learning implied three metabolites, β-cryptoxanthin, prolylhydroxyproline, and eicosenoylcarnitine as putative drivers of biological aging. Multiple SASP markers were also elevated in rapid agers. Together, our findings reveal that a network of metabolic pathways underlie biological aging, and the HAM index could serve as a predictor of phenotypic aging in humans.

Exploring perceptions of frailty, resilience, and self-efficacy in older adults and caregivers in acute care context

This study aimed to explore the experience and perceptions of frailty in hospitalized older adults and caregivers caring for older adults, in relation to resilience and self-efficacy. A qualitative explorative descriptive study design was utilized. Face to face interviews were conducted from September 2020 to July 2021 with 24 older adults who were 65 years and above and hospitalized in the acute care hospital. Ten informal family caregivers were also recruited. Data were analysed using an inductive content analysis approach. Frailty encompassed physical elements as well as manifestations of psychological traits, fear of the unknown, and being in control. Resilience was determined by individual psychological traits and mindset, and the possession of a coping mechanism. Self-efficacy could influence both frailty and resilience through inner motivation and assistance received. Older adults and family caregivers reported that considerable decline in physical health with age and level of perseverance can determine the level of frailty. Resilience and self-efficacy play a pivotal role in the context of frailty. Understanding resilience in this context will assist nurses to facilitate the use of individual and sociocultural resources to improve the way resilience is experienced by older adults. Various coping strategies can enhance self-efficacy and build greater resilience in older adults, including maintaining their active involvement in health management and social life.

Diverse Response to Local Pharmacological Blockade of Sirt1 Cleavage in Age-Induced versus Trauma-Induced Osteoarthritis Female Mice

Objective: Previous studies have shown that the cleavage of Sirt1 contributes to the development of osteoarthritis (OA). In fact, OA was effectively abrogated by the intra-articular (IA) administration of two compounds, one blocking Sirt1 cleavage (CA074me) and the other activating Sirt1 (SRT1720), using a post-traumatically induced model (PTOA) in young female mice. In this study, we attempted to understand if this local treatment is effective in preventing age-associated OA (AOA) progression and symptoms. Design: A group of 17-month-old female C57BL/6J mice were IA administered with CA074me and/or SRT1720 or their combination. Joint histopathological analysis and bone histomorphometry were carried out, with an assessment of knee mechanical hyperalgesia. A serum analysis for NT/CT Sirt1 was carried out along with immunohistochemistry for articular cartilage to detect p16INK4A or γH2A.X. Similarly, meniscal cartilage was monitored for Lef1 and Col1a1 deposition. The data were compared for young female mice subjected to post-traumatic OA (PTOA). Results: Similar to PTOA, combination-treated AOA exhibited improved knee hyperalgesia, yet structural improvements were undetected, corresponding to unchanged NT/CT Sirt1 serum levels. Both AOA and PTOA exhibited unchanged staining for nuclear p16INK4A or γH2A.X and lacked a correlation with OA severity. Contrarily to PTOA, the combination treatment with AOA did not exhibit a local reduction in the Lef1 and Col1 targets. Conclusions: When targeting Sirt1 cleavage, the PTOA and AOA models exhibited a similar pain response to the combination treatment; however, they displayed diverse structural outcomes for joint-related damage, related to Lef1-dependent signaling. Interestingly, nuclear p16INK4A was unaffected in both models, regardless of the treatment's effectiveness. Finally, these findings highlight the variations in the responses between two highly researched OA preclinical models, reflecting OA pathophysiology heterogeneity and variations in gender-related drug-response mechanisms.

Treated unruptured cerebral aneurysm in elderly patients: a single center study

INTRODUCTION

The increase in life expectancy raises the question of the treatment of unruptured intracranial aneurysms in extremely old patients (>80 years). We present results in terms of occlusion and complications in both symptomatic and asymptomatic aneurysm.

METHODS

All patients aged >80 years admitted to the Foundation Adolphe de Rothschild between January 1, 2005 and March, 2023 were included. Aneurysms were grouped as compressive and non-compressive. Procedural complications were grouped as symptomatic (i.e., leading to any temporary or permanent neurological deficit) and severe (defined by modified Rankin Scale (mRS) ≥3 at follow-up).

RESULTS

Forty-two aneurysms were treated in the study period. Coiling (with or without remodeling) was the treatment of choice in 30 patients. Eighteen patients had compressive aneurysm. Six complications occurred (14.2%), all ischemic. The majority of complications occurred in symptomatic aneurysms, in 4 patients (66.6%). One of the patients treated by flow-diverter had severe complications (mRs ≥3) with hemiplegia.

CONCLUSION

In extremely specific cases, treatment of unruptured aneurysm in people older than 80 years may be considered. Compressive aneurysm is associated with a high risk of complications. Treatments can be endovascular. Further prospective studies are required to confirm this hypothesis.

An Update on Drug-Nutrient Interactions and Dental Decay in Older Adults

In recent decades, the global demographic landscape has undergone a discernible shift that has been characterised by a progressive increase in the proportion of elderly individuals, indicative of an enduring global inclination toward extended lifespans. The aging process, accompanied by physiological changes and dietary patterns, contributes to detrimental deviations in micronutrient consumption. This vulnerable aging population faces heightened risks, including dental caries, due to structural and functional modifications resulting from insufficient nutritional sustenance. Factors such as physiological changes, inadequate nutrition, and the prevalence of multiple chronic pathologies leading to polypharmacy contribute to the challenge of maintaining an optimal nutritional status. This scenario increases the likelihood of drug interactions, both between medications and with nutrients and the microbiome, triggering complications such as dental decay and other pathologies. Since the drug industry is evolving and new types of food, supplements, and nutrients are being designed, there is a need for further research on the mechanisms by which drugs interfere with certain nutrients that affect homeostasis, exemplified by the prevalence of caries in the mouths of older adults. Infectious diseases, among them dental caries, exert serious impacts on the health and overall quality of life of the elderly demographic. This comprehensive review endeavours to elucidate the intricate interplay among drugs, nutrients, the microbiome, and the oral cavity environment, with the overarching objective of mitigating the potential hazards posed to both the general health and dental well-being of older adults. By scrutinising and optimising these multifaceted interactions, this examination aims to proactively minimise the susceptibility of the elderly population to a spectrum of health-related issues and the consequences associated with dental decay.

Quality of life profiles and its association with predictors amongst Chinese older adults in nursing homes: a latent profile analysis

BACKGROUND

Recently developments in the field of positive psychology have provided new perspectives for understanding the connection between individual variation in Quality of life (QoL) and positive aspects of human potential, strengths, and resources, commanding increasing attention. This study aimed to examine self-reported quality of life (QoL) profiles and the association of QoL profiles with positive psychosocial characteristics in Chinese older adults.

METHODS

A convenient sample of 354 older adults in nursing homes was recruited from Guangdong Province, China, between November 2020 and January 2021. Latent Profile Analysis (LPA) was conducted to explore QoL profiles using the four WHOQOL-BREF domains as input variables. Multinomial logistic regression was performed to explore the association between latent profiles and predictors.

RESULTS

LPA identified three latent QoL profiles: "low QoL with poor psychological health" (18.1%), "moderate QoL" (46.0%) and "high QoL" (35.9%). Frequency of weekly activity, optimism, gratitude, and social support were associated with the increased likelihood of belonging to the moderate-to-high QoL classes. Furthermore, Class 2 (moderate QoL group, reference) was compared with Class3 (high QoL group), higher frequency of weekly physical activity and spending more time on physical activity exhibited higher odds of belonging to high QoL class.

CONCLUSION

Using the domains of the WHOQOL-BREF scale, the QoL profiles Chinese older adults can be identified. We found that psychosocial variables and demographic characteristic, including lower level of optimism and gratitude, lack of social support, low frequency of physical activity, and shorter activity duration time, heighten the risk for lower levels of QoL. Identifying classification may help focus on those at elevated risk for poor QoL and for developing tailored QoL improvement programs.

Fractured systems: a literature review of OR/MS methods applied to orthopaedic care settings and treatments

Orthopaedic systems are facing an impending wave of increased pressures as a result of global ageing populations. This is compounded by the current stresses these services face, as a result of the COVID-19 pandemic, and increasing burden of musculoskeletal conditions. It is vital that measures are taken to alleviate the pressures on these systems, to ensure timely and quality access to care for patients. This literature review presents a taxonomic classification of the applications of Operational Research and Management Science (OR/MS) methodologies to orthopaedic care settings and treatments, covering the general, medical, and methodological context of each paper. Our structured search identified 492 relevant publications that have been included in our analysis. The results found a literature largely dominated by cost analysis applications, typically utilising Markov models or decision trees. Key gaps identified in this review include the lack of holistic modelling of orthopaedic systems and pathways, and limited applications to resource and capacity planning. The implications of our review are that researchers, healthcare professionals and managers can develop a research agenda to address these gaps, and enhance decision support in orthopaedics.

Ageing, sport and physical activity participation in Scotland

Aim

As sport and physical activity are vital to support extended health spans, this study aimed to analyse the current trends in sports participation and physical activity rates among individuals aged 65 years and older in Scotland. Data were compared with the Chief Medical Officer (CMO) guidelines and analysed the influence of key factors on participation rates.

Methods

The study used data from the Scottish Health Survey and the Scottish Household Survey (2019) to investigate self-reported participation in physical activity and sports across different age groups. Descriptive statistics and cross-tabulations were used to analyse the relationships between participation rates and influencing factors. Participation data for Parkrun events in Scotland were also analysed for the years 2008-2018.

Results

The study found a clear decline in sports participation with age, with a steep decline after the age of 65, particularly in women. The majority of participation among individuals aged 65+ was in walking, with a sport participation rate of only 31.2% when walking was excluded. Physical activity and sport participation was lower in women across all age ranges but particularly so in the 75+ age group. The most popular sporting activities in the older age group were keep fit/aerobics, swimming and golf. Additionally, the study found that social deprivation had a major impact on sports participation rates, with the most deprived households exhibiting the lowest participation levels irrespective of age. The prevalence of loneliness was lower among individuals who participated in sports or adhered to the CMO guidelines for moderate/vigorous physical activity and strength-building exercises.

Discussion

The findings of this study have implications for promoting physical activity and sports participation among older adults, particularly in deprived communities. This study highlights the importance of balance exercises within sport and the need for more targeted efforts to increase participation rates among older adults. The study also emphasizes the positive impact of sports participation on reducing loneliness among older adults. Overall, the findings suggest the need for ongoing efforts to promote physical activity and sports participation among older adults to improve their overall health and well-being.

Trajectories and determinants of ageing in Portugal: insights from EpiDoC, a nationwide population-based cohort

INTRODUCTION

The population in Portugal is ageing due to increased life expectancy and reduced fertility rates. We aimed to estimate the health trajectories of Portuguese older adults (60 + years old) in a 10-year period and to assess associated sociodemographic, lifestyle factors and multimorbidity status.

METHODS

Using the population-based EpiDoC cohort, we estimated the trajectories of health-related quality of life and physical function of 4135 Portuguese older adults over 10 years using linear mixed models. Factors associated to health-related quality of life and physical function were assessed using linear mixed models and random intercept tobit regression, respectively.

RESULTS

The physical disability of participants increased by 0.263 (0.240, 0.286), and health-related quality of life declined by 0.074 (-0.084, -0.063), over 10 years. With advancing age, older adults reported a faster reduction in health-related quality of life and faster increase in physical disability. In general, women were in worse health than men at baseline, albeit with a similar rate of change throughout the follow-up. Higher education and regular exercise were associated with better health-related quality of life and physical function while multimorbidity and excess weight were associated with worse reporting of these outcomes.

CONCLUSIONS

These findings, based on longitudinal data with 10 years of follow-up, are essential to effectively plan resource allocation, plan better healthcare and design informed public health policies in Portugal. This study characterizes ageing in Portugal showing increased physical disability and decreased health-related quality of life with advancing age older adults, helping to develop public health policies.

What Do Older Canadians Think They Need to Walk Well?

Purpose

To identify older Canadians' perception of the importance of expert-generated elements of walking quality, and the contributors to and consequences of perceived walking quality.

Method

Cross-sectional survey of 649 adults was conducted through a commercial participant panel, Hosted in Canada Surveys.

Results

Of the 649 respondents, 75% were between 65 and 74 years old (25% ≥ 75) and 49% were women. The most important elements were foot, ankle, hip, and knee mobility with little difference in ranks across walking perception (Fr χ12 = 5.0, p > 0.05). People who were older by a decade were more likely to report poorer walking (POR: 1.4; 95% CI: 1.0, 1.7), as were women compared to men, and people who used a walking aid compared to none. Lung disease showed the highest association with a perception of not walking well (POR: 7.2; 95% CI: 3.7, 14.2). The odds of being willing to pay more for a technology to improve walking were always greater for those with a lower perception of their walking quality.

Conclusions

People who perceived their walking quality as poor were more likely to report poorer health and were willing to pay more for a technology to improve walking. This supports the opportunity of leveraging wearable technologies to improve walking.

[Plastic-surgical reconstruction of the lower extremity in senior patients]

The proportion of patients in the population beyond the 7th decade of life is increasing worldwide, especially in highly developed countries. Consequently, there is also an increasing need for complex lower extremity reconstructions after trauma, tumors, or infections in this age group. The reconstruction of soft tissue defects of the lower extremity should be performed according to the principle of the plastic-reconstructive ladder or elevator. The goal of reconstruction is to restore anatomy and function of the lower extremity to enable pain-free and stable standing and walking; however, for older patients in particular, a careful preoperative multidisciplinary planning, detailed preoperative assessment and optimization of comorbidities, such as diabetes, malnutrition or pathological vascular alterations, as well an age-adapted perioperative management are necessary. By implementing these principles, older and very old patients can maintain their mobility and autonomy, which are crucial for a high quality of life.

On-Site Therapeutic Drug Monitoring of Paracetamol Analgesic in Non-Invasively Collected Saliva for Personalized Medicine

Paracetamol or acetaminophen is the main non-opioid analgesic recommended for mild pain by the World Health Organization (WHO) analgesic ladder. However, the high levels used of paracetamol are associated with the hepatotoxicity and nephrotoxicity caused by accumulation of toxic metabolites. The sensor is produced on a polyester substrate containing a full electrochemical device with working, auxiliary, and reference electrodes in which, guiding personalized medicine solutions are not reported. Temporal paracetamol profiles in human saliva are performed with the subject taking different amounts of commercial analgesic pills. The variation of saliva paracetamol levels is demonstrated to be interference free from electroactive interfering species and human saliva constituents. In addition, the sensor displays to be useful as a disposable device for the fast detection of paracetamol in untreated raw saliva following pill intake. The maximum concentration (C_max ) and half-life time (t_1/2 ) for paracetamol are 143.27 µm and 110 min. The results demonstrate the potential of a simple strategy with electrochemical devices for noninvasive personalized therapy toward guiding drug interventions through tracking of active substance, detecting, and correcting insufficiency of absorption to meet individual needs avoiding overdoses, side effects, and intoxication.

Variations in the Second Derivative of a Photoplethysmogram with Age in Healthy Korean Adults

Second derivative of photoplethysmogram (SDPTG) indices correlate with aging and vascular health. The trend of SDPTG indices with age has not yet been studied in the Korean population. Various SDPTG indices were measured in 300 healthy Koreans (150 men and 150 women), aged 19−69 years, stratified into five age groups consisting of 60 people (30 men and 30 women) in each age group from their 20s to 60s. The values of the SDPTG indices clearly showed distinct variations with age in healthy Korean groups (p < 0.001 for all indices). b/a increased linearly with age (y = 0.0045x − 0.803), as did SDPTG aging index (SDPTG-AI) (y = 0.0162x − 1.1389). c/a decreased linearly with age (y = −0.0044x + 0.1017), as did d/a (y = −0.0062x + 0.034) and e/a (y = −0.001x + 0.2002). A significant sex difference was shown in b/a and e/a ratios and SDPTG-AI (p < 0.001 for all indices); women had a higher b/a ratio (−0.55 ± 0.14 versus −0.65 ± 0.13) and SDPTG-AI (−0.33 ± 0.3 versus −0.52 ± 0.33) and a lower e/a ratio (0.13 ± 0.06 versus 0.18 ± 0.07) than men. A linear regression model of diverse SDPTG indices was provided according to the age of healthy Koreans, which may be valuable in preventing diseases related to vascular conditions by estimating the degradation of arterial function.

What is the overlap between malnutrition, frailty and sarcopenia in the older population? Study protocol for cross-sectional study using UK Biobank

BACKGROUND

In an increasingly older adult population, understanding the inter-relationship between three age related conditions malnutrition, frailty and sarcopenia is important in order to improve their recognition, treatment and prevention. This study aims to determine the overlap between malnutrition, frailty and sarcopenia by measuring estimates of prevalence for each individual condition. In addition, we will compare two models of frailty which are the accumulation of deficits and phenotype models.

METHODS/DESIGN

This is a cross-sectional study that will use the UK Biobank database, which will include a subset of 381,000 participants: males and females aged 50 years and above who completed the baseline assessments. For the baseline assessments, details of the participants' characteristics will be included. All three conditions will be identified and mapped to variables collected at the baseline assessment. Variables for malnutrition will be mapped according to the Global Leadership Initiative on Malnutrition (GLIM) criteria. Frailty will be defined according to two models: the 36 deficits and the phenotype model. Finally, sarcopenia will be assessed according to the European Working Group on Sarcopenia in Older People (EWGSOP) standard.

DISCUSSION

This proposed study will help to understand the presence of malnutrition, frailty and sarcopenia in the older population and describe any overlap between the conditions. There is little published research on the overlap between these three conditions. Despite the similarity and shared criteria used for the identification of malnutrition, frailty and sarcopenia there is still a lack of cohesive thinking around the overlap of applied definitions and identification criteria.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04655456 approved on the 10th of December 2020.

What will the ambitions of primary healthcare be in the 21st century?

This article attempts to analyze the problem of the modernity of primary healthcare, as well as the reforms to be implemented in a new context characterized by COVID-19. This article offers another vision to follow, to build a modern primary healthcare system. It is a descriptive and analytical study, which addresses the failure of the health system in general, as it proposes the reforms necessary to provide equitable, efficient and modern primary healthcare. The results clearly show that we can no longer act unilaterally; multi-sector efforts at the national level should be encouraged: we must act, in a preventive way, on the causes of the disease; international agreements on the environment, prices of basic foods and medicines, etc. are much needed to improve the health status of middle and low income countries, the case of the majority of African countries. So, different solutions can be conveyed by primary healthcare, in order to improve the whole health system.

The state of health in Belgium, 1990-2019: a benchmarking analysis based on the Global Burden of Disease 2019 study

BACKGROUND

In a context of decreasing resources and growing health needs, evidence-based health and care policies are essential. This study aims to assess the health trends in Belgium between 1990 and 2019, to compare the Belgian health status to that of the EU-15 countries, and to identify the main drivers in trends over time and country differences within the EU-15.

METHODS

We extracted estimates from the GBD 2019 study via the GBD results tool and visualization tools. We compared the Belgian health status with 14 European Union comparator countries between 1990 and 2019, and decomposed the time trends and country differences into the unique contributions of the different underlying causes of death and disability.

RESULTS

Life expectancy (LE) in Belgium improved significantly between 1990 and 2019 for both men and women. Belgium age-standardised mortality rates dropped significantly for men (-40%) and women (-33%) between 1990 and 2019. Overall, Belgium age-standardised disability-adjusted life year (DALY) rates dropped by 23%. This decrease is mainly due to decreasing trends in age-standardised years of life lost (YLL) rates while age-standardised years lived with disability (YLD) rates remained stable. Compared to EU-15, Belgium's ranking in terms of age-standardised DALY rates worsened for both men and women in 2019. Self-harm and falls are major causes of disease burden, with DALY rates that are higher than in many other EU-15 countries, indicating a realistic potential for improvement. Lung cancer DALY rates remain worrisome for men, and even show an increasing trend for women. Increasing trends of headache disorders, drug use disorders, and diabetes, require further attention.

CONCLUSION

Non-communicable diseases remain the main contributors for health burden in Belgium, with disability accounting for an increasingly larger share of the disease burden. Despite considerable improvements, Belgium's ranking for DALYs decreased between 1990 and 2019 compared to the EU-15. This study identified priority causes of disease burden based on their contributions to current evolutions and EU-15 differences. Since many of these causes are considered to be avoidable, primary and secondary prevention are crucial elements for reducing the burden of disease on the healthcare system.

Psychometric Properties of the Turkish Health Enhancement Lifestyle Profile-Screener Questionnaire (T-Help-Screener)

Objective: Healthy ageing is associated with a healthy lifestyle. The aim of this study was to evaluate the validity, reliability, and cultural adaptation of the Turkish version of the Health Enhancement Lifestyle Profile Screener (T-HELP-Screener). Methods: This study included 150 participants aged 65 years and above. Internal consistency of the T-HELP-Screener was measured using Kuder–Richardson. Test-retest reliability was performed with 66 of the 150 participants using intraclass correlation coefficient (ICC). Construct validity of the T-HELP-Screener was analyzed with the Healthy Lifestyle Behavior Scale-II (HLBS-II). Results: This study showed a substantially reliable level (Kuder–Richardson=0.72). The ICC for each of the T-HELP-Screener items ranged from 0.750 (95% CI = 0.590–0.847) to 0.965 (95% CI = 0.942–0.978) indicating acceptable to good test-retest reliability. There was a significant moderate correlation between the T-HELP-Screener and the HLBS-II (rs = 0.488; p =0.001). Conclusion: This study supports the psychometric properties of the T-HELP-Screener. This tool can help quickly identify older adults who need a more comprehensive assessment of their health risk behaviours. Future studies should develop and validate a Turkish version of the comprehensive 56-item Health Enhancement Lifestyle Profile (HELP).

Impact of Frailty on Short-Term Outcomes After Laparoscopic and Open Hepatectomy

BACKGROUND

Although laparoscopic hepatectomy (LH) is associated with improved short-term outcomes compared to open hepatectomy (OH), it is unknown whether frail patients also benefit from LH. The aim of this study was to evaluate the impact of frailty on post-operative outcomes after LH and OH.

PATIENTS AND METHODS

Consecutive patients who underwent LH and OH between January 2011 and December 2018 were identified from a prospective database. Frailty was assessed using the modified Frailty Index (mFI), with patients scoring mFI ≥ 1 deemed to be frail.

RESULTS

Of 1826 patients, 34.7% (N = 634) were frail and 18.6% (N = 340) were elderly (≥ 75 years). Frail patients had significantly higher 90-day mortality (6.6% vs. 2.9%, p < 0.001) and post-operative complications (36.3% vs. 26.1%, p < 0.001) than those who were not frail, effects that were independent of patient age on multivariate analysis. For those undergoing minor resections, the benefits of LH vs. OH were similar for frail and non-frail patients. Length of hospital stay was 53% longer in OH (vs. LH) in frail patients, compared to 58% longer in the subgroup of non-frail patients.

CONCLUSIONS

Frailty is independently associated with inferior post-operative outcomes in patients undergoing hepatectomy. However, the benefits of laparoscopic (compared to open) hepatectomy are similar for frail and non-frail patients. Frailty should not be a contraindication to laparoscopic minor hepatectomy in carefully selected patients.

Re-evaluating methods reporting practices to improve reproducibility: an analysis of methodological rigor for the Langendorff whole-heart technique

In recent decades, the scientific community has seen an increased interest in rigor and reproducibility. In 2017, concerns of methodological thoroughness and reporting practices were implicated as significant barriers to reproducibility within the preclinical cardiovascular literature, particularly in studies employing animal research. The Langendorff, whole-heart technique has proven to be an invaluable research tool, being modified in a myriad of ways to probe questions across the spectrum of physio- and pathophysiologic function of the heart. As a result, significant variability in the application of the Langendorff technique exists. This literature review quantifies the different methods employed in the implementation of the Langendorff technique and provides brief examples of how individual parametric differences can impact the outcomes and interpretation of studies. From 2017-2020, significant variability of animal models, anesthesia, cannulation time, and perfusate composition, pH, and temperature demonstrate that the technique has diversified to meet new challenges and answer different scientific questions. The review also reveals which individual methods are most frequently reported, even if there is no explicit agreement upon which parameters should be reported. The analysis of methods related to the Langendorff technique suggests a framework for considering methodological approach when interpreting seemingly contradictory results, rather than concluding that results are irreproducible.

Prevalence of Undernutrition, Frailty and Sarcopenia in Community-Dwelling People Aged 50 Years and Above: Systematic Review and Meta-Analysis

The world’s population aged ≥65 is expected to rise from one in eleven in 2019 to one in six by 2050. People aged ≥65 are at a risk of undernutrition, frailty, and sarcopenia. The association between these conditions is investigated in a hospital setting. However, there is little understanding about the overlap and adverse health outcomes of these conditions in community-dwelling people. This systematic review aims to quantify the reported prevalence and incidence of undernutrition, frailty, and sarcopenia among older people aged ≥50 living in community dwellings. Searches were conducted using six databases (AMED, CENTRAL, EMBASE, Web of Science, MEDLINE, and CINAHL), and 37 studies were included. Meta-analyses produced weighted combined estimates of prevalence for each condition (Metaprop, Stata V16/MP). The combined undernutrition prevalence was 17% (95% CI 0.01, 0.46, studies n = 5; participants = 4214), frailty was 13% (95% CI 0.11, 0.17 studies n = 28; participants = 95,036), and sarcopenia was 14% (95% CI 0.09, 0.20, studies n = 9; participants = 7656). Four studies reported incidence rates, of which three included data on frailty. Nearly one in five of those aged ≥50 was considered either undernourished, frail, or sarcopenic, with a higher occurrence in women, which may reflect a longer life expectancy generally observed in females. Few studies measured incidence rates. Further work is required to understand population characteristics with these conditions and the overlap between them. PROSPERO registration No. CRD42019153806.

Psychological impacts and online interventions of social isolation amongst older adults during COVID-19 pandemic: A scoping review

AIM

To summarise the psychological impacts of social isolation amongst older adults during COVID-19 and review the benefits and limitations of online interventions used to combat social isolation.

DESIGN

A scoping review was performed.

DATA SOURCES

A systematic search was performed from October 2020 to January 2021 in seven electronic databases: China National Knowledge Infrastructure (CNKI), PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Cochrane Library and Web of Science. A hand search of the reference lists of included papers and WHO publications was performed. Grey literature search was carried out from Scopus, ProQuest Dissertation and Google Scholar.

REVIEW METHODS

Studies were screened, appraised and extracted independently by two reviewers. Thematic analysis was used to synthesise data, which were presented in a descriptive manner and organised into categories and themes.

RESULTS

Totally, 33 studies were included. Four themes and eight sub-themes emerged: (1) negative impacts and experiences of older adults during social isolation, (2) adopting coping behaviours in the midst of COVID-19, (3) online interventions to combat the consequences of social isolation, (4) barriers to online intervention.

CONCLUSION

The COVID-19 pandemic has taken an emotional toll on older adults' psychological wellbeing and has highlighted the untapped strengths of older adults facing isolation. Online interventions, which could be a new normal in the COVID era, were beneficial in combating social isolation. Strategies by various stakeholders were recommended to tackle the barriers of online interventions.

IMPACT

With the COVID-19 pandemic still in progress, this review provides insights on the psychological impacts of social isolation amongst older adults. Nurses in the community and long-term care facilities could adopt strategies and online intervention to better support the older adults, contribute to a stronger COVID-19 response and support system, and an overall better road to recovery from this crisis.