Healthcare for older people in lower and middle income countries

Evaluation of two-time zones online training to transform older people's care

This paper reports the evaluation by trainees of the innovative online education initiative known as the e-TRIGGER (e-TRaining In Gerontology and Geriatrics) program, which targets healthcare professionals working with older adults in Africa, the Middle East, and Europe (AFMEE course) and in Asia-Oceania (ASIO). The e-TRIGGER programs are implemented under the auspices of the International Association of Gerontology and Geriatrics (IAGG). The first year of teaching of the AFMEE program (May 2023 to April 2024) and the third year of the ASIO program (January to December 2024) were evaluated by the students using a satisfaction survey implemented at the end of the year of teaching. Almost all trainees reported that the course met their personal objectives. A significant majority reported applying acquired knowledge directly (AFMEE, 75 %; ASIO, 78 %) and indirectly (AFMEE, 30 %; ASIO, 42 %) in their daily work. Over half reported improved skills in caring for older adults (AFMEE 65 %, ASIO 52 %). Around one-fifth reported a job or career promotion after course completion (AFMEE 21 %, ASIO 17 %). The evaluation highlights the significant impact and success of the e-TRIGGER program for most alumni. Key challenges of this innovative teaching program include ensuring financial sustainability and addressing specific training needs related to long-term care, dementia management, and technology integration. Future perspectives include expanding the program to Latin America (IAGG e-TRIGGER LATAM) and developing complementary, specialized short courses on specific areas of geriatric medicine and gerontology.

Unintentional Injuries Requiring Medical Attention in Low-Income and Middle-Income Countries: Evidence from Nationally Representative surveys in 12 Countries

BACKGROUND

Despite a high burden of injuries in low-income and middle-income countries (LMICs), a lack of empirical evidence on mechanism, location, and distribution of unintentional injuries requiring medical attention (hereafter injuries) hinders informed health system policy development.

METHODS

Using individual-level data from nationally representative surveys conducted in LMICs between 2014-2019, we describe the weighted annual prevalence of non-fatal injuries, their mechanisms, environments in which they occur, and characteristics of people injured, in individuals aged 15-64 years. Multivariable logistic regression models were estimated to evaluate associations of injuries with individual-level characteristics.

RESULTS

We included data on 47,747 participants from 12 LMICs in four WHO regions. The weighted prevalence of non-fatal injuries in the past year was 6.8% (95% CI: 6.3%-7.2%); men suffered a greater prevalence of injuries than women (8.3% [95% CI 7.6%-9.0%] vs. 5.4% [95% CI 5.0%-5.9%], respectively). In the multivariable logistic regression, the odds of having any injury were lower among females and married people and higher among individuals with some primary education. Prevalence of non-road traffic collision injuries was almost threefold that of road traffic collision (RTC) injuries: 5.6% (5.2%-6.0%) vs. 1.7% (1.5%-2.0%). When considering non-RTC injuries, falls were the most common mechanism (47.0%, 95% CI 44.0%-50.1%), and homes were the most common location (38.1%, 95% CI 34.9%-41.4%), followed by road (17.9%, 95% CI 15.7%-20.4%), and workplace (17.4%, 95% CI 15.2%-19.8%). The largest proportion (23.2%, [95% CI 20.6%-25.9%]) of non-RTC injuries happened to women at home.

CONCLUSION

Non-RTC injuries, in particular falls, predominate in this population. This highlights a neglected side of injuries, many of which happen at home to women, whereas global attention tends to focus on RTCs. Data on all mechanisms of injuries and care-seeking behaviour after injuries are required for health system planning.

E-CARE as core competencies for palliative social workers: a systematic review

PURPOSE

To identify the core competencies of social workers in palliative care.

METHOD

A systematic review of 19 high-quality studies published in English and Chinese up to February 2025 was conducted.

RESULTS

The study identified five core competencies-Ethics, Coordination, Assessment, Resource Allocation, and Education-establishing the core competencies of social workers. They serve as interdisciplinary coordinators, communication facilitators, and educators, addressing psychosocial, emotional, and environmental challenges while navigating systemic resource constraints. The framework emphasizes ongoing assessment, resource allocation, and educational interventions, positioning social workers as system navigators and existential educators essential to compassionate, patient- and family-centered care.

DISCUSSION

E-CARE framework equips social workers to navigate complex care ecosystems, foster team cohesion, mediate conflicts, advocate for patient autonomy, destigmatize end-of-life discussions, and promote resilience through ongoing training, particularly in resource-constrained settings.

Weight-bearing and mobilisation timing after hip fracture surgery in older adults: an international survey of clinicians' perspectives

PURPOSE

This exploratory study aimed to describe international variations in mobilisation timing and weight-bearing after hip fracture surgery, focusing on differences between high-income countries (HICs) and low- and middle-income countries (LMICs) and identify the possible reasons for these variations.

METHODS

This international cross-sectional study was administered through an online, English-language, self-reported questionnaire. Healthcare professionals from various multidisciplinary teams were invited to participate via professional organisations, including the Fragility Fracture Network, social media, and through snowballing from key individual stakeholders.

RESULTS

A total of 389 healthcare professionals from 71 countries participated in the survey. Among them, 72.5% prescribed mobilisation the day after surgery, higher in HICs (79.1%) than LMICs (56.3%). Of those who prescribed early mobilisation, 38.3% achieved it 76-100% of the time, more frequently in HICs (42.9%) than LMICs (21.9%). Additionally, 73.5% prescribed unrestricted weight-bearing, also more common in HICs (86.3%) than LMICs (41%). For those who prescribed unrestricted weight-bearing, 50.4% achieved it 76-100% of the time, with HICs at 54.0% and LMICs at 31.9%. Multiple patient-related, process-related, and structure-related barriers were reported, with structure-related barriers more common in LMICs than HICs, underscoring the global complexities in implementing these practices.

CONCLUSION

This study offers insights into global variations in the timing of mobilisation and weight-bearing after hip fracture surgery in older adults. It reveals disparities in postoperative services and resources between HICs and LMICs. Additionally, it establishes a foundation for future research and underscores the importance of international collaboration and knowledge sharing in enhancing postoperative care services.

Frequency of care mediates the effect of older adults' cognitive performance on the perceived strain of their informal caregivers in a middle-income country

Background and Objectives: As low and middle-income countries face a rapid increase in their older adult populations, the demand for informal caregiving is expected to rise. Understanding caregiving dynamics in these settings is crucial for developing effective support systems.Aims: To investigate whether the frequency and duration of care provided to older adults mediate the relationship between cognitive performance and caregiver strain.Methods: A cross-sectional study that evaluated informal caregivers of cognitively unimpaired (n = 78) older adults and people living with Alzheimer's dementia (n = 39). We controlled for variables including age, current medications, functional status, cognitive decline, and cognitive functioning. We analyzed whether caregiving frequency and duration mediated the effect of older adults' cognitive performance on caregiver strain.Results: Frequency of care, rather than its duration, significantly mediates the association between older adults' cognitive performance and caregiver strain. Specifically, more days of care are associated with increased caregiver strain, compared to the total number of caregiving hours.Conclusion: Addressing the frequency of caregiving days rather than just the duration in hours offers a more effective approach to reducing caregiver strain. Policies should aim to reduce the number of caregiving days, potentially through expanded respite care programs and full days off for caregivers.

Factors influencing the cognitive performance in cognitively unimpaired older adults and people living with Alzheimer's disease: Insights from a middle-income Latin American country

Low- and middle-income countries, such as Brazil, often face higher dementia risk due to factors like lower education levels, with up to 90% of dementia cases remaining undiagnosed. Understanding factors that contribute to the cognitive performance of older adults may support healthcare professionals from these countries in their decision-making process when screening for cognitive decline in their communities. This study investigates factors associated with cognitive performance in older adults from a Latin American country. This cross-sectional and analytical study involved 137 participants (84 cognitively unimpaired older adults and 53 people with Alzheimer's Disease) from Brazil. The assessment included a sociodemographic questionnaire, the Addenbrooke's Cognitive Examination-Revised (ACE-R), the Mini-Mental State Examination (MMSE), the Memory Complaint Scale (MCS), Clinical Dementia Rating (CDR), Geriatric Depression Scale (GDS-15), Geriatric Anxiety Inventory (GAI-5), Katz scale, Lawton and Brody scale, and Pfeffer Functional Activity Questionnaire (PFAQ). Data were analyzed using descriptive statistics, linear regression, and mediation analysis, with a significance level set at p<0.05. AD participants were older, had fewer years of formal education, showed poorer cognitive performance, and had lower functionality. Age, education, and functionality were significantly associated with cognitive performance. Mediation analysis showed that years of education mediated the relationship between functionality and cognitive performance. This study underscores the significance of age, education, and functionality as key factors in cognitive performance among older adults in Brazil, providing valuable knowledge for improving cognitive assessment practices in Latin American countries.

Trends and projections of Non-Hodgkin lymphoma burden (1990-2040): a global burden of disease 2021 analysis

BACKGROUND

Non-Hodgkin lymphoma (NHL) is a common type of lymphoma. These vary geographically and within specific areas. A comprehensive and precise assessment of the global burden of NHL is important for the forward-looking planning and implementation of health policies.

METHODS

This study used data from the 2021 Global Disease Burden (GBD) study. We examined trends in disease burden in non-Hodgkin lymphoma patients using indicators including the incidence, prevalence, deaths, and disability-adjusted years of life (DALY), as well as the age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), age-standardized mortality rate (ASMR), and age-standardized DALY rate (ASDR). Temporal trends in NHL risk factors from 1990 to 2021 were analyzed. Joinpoint regression was used to determine the average annual percentage change (AAPC) in the age-standardized rate. The Bayesian age-period-cohort (BAPC) model was used to predict the age-standardized mortality and DALY rates by 2040.

RESULTS

In 2021, the NHL's global age-standardized incidence rate (ASIR) was 7.1 per 100,000 people. From 1999 to 2021, there was a downward trend in ASMR and ASDR of NHL (AAPC = -0.6 and -0.8, respectively), but ASIR and ASPR of NHL showed an upward trend (AAPC = 0.3 and 1.2, respectively). According to the socio-demographic index (SDI), the ASIP and ASPR of NHL were higher in regions and countries with higher SDI. The study also found an increase in ASMR and ASDR associated with high body mass index (BMI) in NHL. In addition, it is predicted that the global ASIR and ASPR will continue to show a slow upward trend in the next 2040, whereas ASMR and ASDR will gradually decline.

CONCLUSION

Non-Hodgkin lymphoma (NHL) remains a formidable public health challenge; however, different regions and socioeconomic statuses have different trends. A more aggressive, individualized intervention strategy is needed based on dynamic changes. Simultaneously, close international collaboration is essential to advance improvements in NHL management, including strengthening diagnostic and treatment strategies, strengthening healthcare infrastructure, expanding access to high-quality healthcare services, and strengthening public health education.

Impact of Traditional Dance and Games on Cardiovascular Health: A Scoping Review of Outcomes Across Diverse Low- and Middle-Income Countries

In low- and middle-income countries (LMICs), where healthcare resources may be limited, the elderly are especially vulnerable to the adverse effects of cardiovascular diseases (CVDs). The aging population in these regions presents unique challenges, highlighting the urgent need for effective, accessible, and culturally appropriate interventions to address this cardiovascular health challenge in older adults. We aimed to evaluate the impact of traditional dance and games on cardiovascular health outcomes in LMICs through a scoping review of existing literature. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. PubMed, Scopus, ProQuest, EBSCO, SPORT Discuss, Web of Science, and the grey literature were searched from 2000 to 20 September 2024. Two reviewers independently screened the titles, abstracts, and full texts and conducted data extraction. All conflicts were resolved with a third reviewer. A total of 3465 records were identified, of which 12 full-text articles were included in the review. The studies, five randomised clinical trials and seven non-randomised clinical trials, included varied age groups and populations including healthy, sedentary and obese participants. The interventions were traditional dance and games interventions with some extension to nutrition education. All the interventions were short term, with less than 6 months follow-up. Any traditional dance styles and games that involve physical performance can induce positive health outcomes. Undertaking traditional dance and games (TDGs) is equally effective on cardiovascular, functional and metabolic adaptations, leading to comparable improvements in older adults as for other forms of structured exercise. Collaboration of health practitioners, legislators, non-governmental agencies and local communities in LMICs in using TDGs may reduce the burden of CVDs.

Regional insights into the relationship between metabolic associated steatotic liver disease and chronic kidney disease: a socioeconomic perspective on disease correlation

BACKGROUND

Studies exploring the correlation between Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) and the increased risk of chronic kidney disease (CKD) from a country-specific perspective have been limited. This study addresses regional variations and the role of the Socio-Demographic Index (SDI) in this relationship.

METHODS

This analysis integrates MASLD and country-level CKD data from the Global Burden of Disease study 2021. To evaluate the relationships between MASLD and CKD incidence, mixed-effects linear regression models that account for country-level random effects were employed. This analysis was adjusted for median age, percentage of males, SDI, and metabolic risk factors.

RESULTS

The incidence of MASLD and CKD demonstrated a similar regional distribution, with the highest of MASLD and CKD occurring in North Africa and the Middle East. After adjusting for age, gender, systolic blood pressure, fasting plasma glucose, body mass index, and SDI, a higher incidence of MASLD was associated with an increased incidence of CKD (p < 0.001), with MASLD incidence accounting for 53.0% of the explained variance in CKD incidence. Additionally, SDI, demographic variables (median age, population of male) and metabolic risks (High SBP, FPG and BMI), were responsible for 10.4%, 6.3%, and 30.3% of the explained variance in CKD incidence, respectively. Different patterns emerged in this association according to SDI status. In low SDI countries, significant associations were observed between increasing MASLD incidence rates and higher CKD incidence (p = 0.007), whereas in high SDI countries, no significant associations were found between MASLD and CKD incidence (p = 0.106).

CONCLUSIONS

Our findings reveal a geographical correlation between MASLD and CKD incidence, contingent upon socioeconomic factors. To effectively mitigate the global burden of MASLD and CKD, it is imperative to design and implement targeted public health strategies that consider the unique socioeconomic contexts of each region, thus fostering equitable health outcomes.

Factors affecting the active aging situation in Bangladesh

Background

The older population in Bangladesh is growing rapidly, from 8.0% in 2020 to 22.0% in 2050. However, the determinants of active aging are scarcely known.

Objective

The study aimed to assess the determinants influencing the active aging situation in Bangladesh.

Methods

A cross-sectional study was conducted among 518 older adults aged 60 and over. Following the WHO active aging model, the respondents' socio-demographic, personal, behavioral, and physical environment and health and social services characteristics were collected using a semi-structured questionnaire. Multiple linear regression was performed to assess the effect of the determinants on active aging, followed by the bivariate level of analysis.

Results

The determinants of active aging were deeply rooted in the respondents' socio-cultural, economic, and spatial conditions. Nine out of 23 determinants, like marital status, income, decision-making capacity, regular walking/physical exercise, smokeless tobacco consumption, newspaper reading as a leisure activity, use of medicine, and health service accessibility, significantly influence active aging. The active aging score was 10-15% higher among the respondents who regularly adhered to the above determinants.

Conclusion

Effective initiatives are needed to improve the socio-cultural, economic, and health system-related determinants of active aging to enhance the active aging situation. Concerned bodies of the country, ministries, departments, and development partners should take appropriate measures to increase awareness and the participation of people in lifestyle-related determinants to improve the active aging situation in the country.

Systematic review and meta-analysis of the prevalence of frailty and pre-frailty amongst older hospital inpatients in low- and middle-income countries

BACKGROUND

As populations age, low- and middle-income countries (LMICs) are rapidly adapting hospital services to meet the needs of older populations. This systematic review aimed to establish the prevalence of frailty and pre-frailty amongst older people admitted to hospital in LMICs, and to compare levels with existing estimates for high-income settings.

METHODS

Databases Medline, Embase, CINAHL and PsychInfo were searched, and results were manually screened by two researchers. Included studies were cross-sectional or cohort design and reported data from hospital inpatients, aged ≥60 years, in LMICs, using validated methods for identifying frailty. Risk of bias was assessed by two researchers using the Joanna Briggs Institute checklist. Where possible, results were synthesised using meta-analysis.

RESULTS

Twenty-nine studies were included, all reporting data from middle-income countries. Physical frailty tools were the most common, with Fried's phenotype and the FRAIL Scale being the most often used methods of assessment. The pooled estimate of the prevalence of frailty was 39.1% [95% confidence interval (CI) 31.9-46.6%] comprising data from 23 311 older inpatients. For pre-frailty, prevalence was 40.0% (95% CI 25.1-51.4%) from 6954 individuals.

DISCUSSION

Due to the paucity of eligible studies and their geographical distribution, these pooled estimates are only representative of the burden of frailty in select middle-income settings (particularly China). Future research should seek to establish the prevalence of frailty in hospitals in low-income countries, and to assess clinical outcomes by frailty status, in order to develop bespoke clinical tools and to aid the planning of future geriatric services.

Nutrition and oral health-related quality of life (OHRQoL) in older adults: a systematic review and meta-analysis

BACKGROUND

Understanding the interplay between nutrition and oral health-related quality of life (OHRQoL) in older adults is crucial amidst the global aging population. This systematic review and meta-analysis aimed to explore this association, recognizing the growing prevalence of older individuals and the imperative of addressing their health needs for enhanced well-being.

MATERIALS AND METHODOLOGY

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, relevant studies were identified through electronic database searches and manual screening. Included were studies investigating the relationship between nutritional status, assessed via the Geriatric Oral Health Assessment Index (GOHAI), and OHRQoL in individuals aged 60 years and older. Quality assessment adhered to Joanna Briggs Institute (JBI) criteria, and statistical analysis was conducted using Comprehensive Meta-Analysis Software Version 3.

RESULTS

Out of 566 initial records, 14 full-text articles were assessed, with 4 studies meeting the inclusion criteria for meta-analysis. A consistent association emerged between lower nutritional assessment scores and poor OHRQoL among the older adults. Significant relationships were identified between poor oral health indicators, as measured by GOHAI, and an elevated risk of malnutrition. Particularly noteworthy was the role of negative self-perception of oral health as a significant predictor of nutritional deficits, emphasizing the importance of OHRQoL instruments in complementing clinical measurements.

DISCUSSION

The findings underscore the predictive capacity of oral health indicators in assessing nutritional well-being in older individuals. Despite previous studies reporting mixed findings, this review contributes to a comprehensive understanding of the association between nutrition and OHRQoL, highlighting the significance of addressing oral health concerns to enhance overall nutritional outcomes in the older adult population.

CONCLUSION

This systematic review and meta-analysis emphasize the significant association between nutrition and OHRQoL among older adults. Highlighting the importance OHRQoL instruments that can complement objective clinical measurements and serve as predictors of malnutrition, particularly among this population. Offering vital insights for stakeholders, policymakers, and public health officials to promote the overall well-being and quality of life of older adults.

Effects of executive function on age-related emotion recognition decline varied by sex

This study delves into the criticality of Emotion recognition (ER) as a pivotal component of social functionality and psychological well-being, focusing on its susceptibility to aging and sex-related differences. Underpinned by the 'frontal aging hypothesis,' which posits a particular vulnerability of executive functions to the aging process, this study aims to unravel the intricate dynamics of how aging influences ER in both sexes, emphasizing the mediating role of executive functions. A cohort of 127 healthy adults underwent the Multi-Modality Emotion Recognition Test mobile application to assess facial ER and cross-modal matching abilities. Comprehensive neuropsychological assessments supplemented this to evaluate various facets of executive function. The analysis indicated a pronounced decline in ER performance among older adults, with no significant sex differences across age groups. However, gender-specific patterns emerged in the aging-ER relationship. For males, cognitive flexibility (β = 0.399, p < 0.001) and inhibition (β = 0.329, p = 0.020) were partial mediators. In females, working memory (β = -0.297, p = 0.023) and selective attention (β = 0.290, p = 0.042) moderated the aging-facial ER link, with inhibition (β = 0.284, p = 0.015) also playing a partial mediating role. Additionally, inhibition (β = 0.194, p = 0.043) moderated the relationship between aging and the female's cross-modal matching. The findings highlight a gender-differentiated impact of executive functions on age-related ER decline. This underscores the need for gender-tailored approaches in enhancing ER, particularly in an aging population.

Demographic, socioconomic, and health correlates of sleep quality and sleep duration among community-dwelling older adults in India

BACKGROUND

Recent research has revealed that today's older adults report more sleep problems than their predecessors, a trend compounded by expanding social stratification. As such, this study examined the demographic, socioeconomic, and health correlates of sleep quality and sleep duration among community-dwelling older adults in India.

METHODS

The current study sample draws on data from 7118 respondents aged 50 years and over participating in the World Health Organization's Study on global AGEing and adult health (WHO-SAGE) wave-2 dataset. Sleep quality (good, moderate, and poor) and sleep duration (in hours and minutes) were self-reported. Adjusted multivariable logistic regression models were employed to examine the associations between sleep quality and sleep duration and several demographic, socioeconomic, and health indicators.

RESULTS

A total of 12.84% and 36.1% of older adults reported long (> 8 h) and short (< 7 h) sleep, respectively. Older adults with primary education had lower odds of poor sleep [aOR: 0.85, CI: 0.73-0.99] than peers with no formal education. The odds of poor sleep were lower among those in higher wealth quintiles than those in the poorest quintile. Older adults with higher education had higher odds of short sleep [aOR: 1.36, CI: 1.06-1.74], and those with primary education had lower odds of long sleep [aOR: 0.70, CI: 0.54-0.91] than those without formal education (base category: age-appropriate sleep, i.e., 7-8 h). Older adults who were widowed had lower odds of both short [aOR: 0.82, CI: 0.68-0.98] and long sleep [aOR:0.74, CI: 0.58-0.95] compared to those who were currently married. Older individuals with adequate nutritional intake reported lower odds of short [aOR:0.59, CI: 0.49-0.72] and higher odds of long sleep [aOR:1.52, CI: 1.20-1.93] relative to their counterparts. Older adults who reported chronic conditions and body pain had higher odds of poor sleep and short sleep than their counterparts.

CONCLUSIONS

We identified significant associations between several unmodifiable factors, including age, education, and marital status, and modifiable factors such as dietary intake, body pain, and pre-existing chronic ailments, and sleep quality and sleep duration. Our findings can assist health care providers and practitioners in developing a more holistic and empathic approach to care. Moreover, that several demographic, socioeconomic, and health-related factors are consequential for older adults' sleep health suggests that early detection through screening programs and community-based interventions is vital to improving sleep among older Indians who are most susceptible to sleep problems.

A systematic review and meta-analysis of the prevalence of Parkinson's disease in lower to upper-middle-income countries

Parkinson's disease (PD) is a common neurodegenerative disease that is a growing public health challenge. Estimates of the burden of PD have focused on data from high-income countries, with lower-income countries poorly described. We reviewed and examined the prevalence of PD reported by studies in low- to upper-middle-income countries. A systematic literature search was performed in the Medline/PubMed, Embase, LILACS, and Web of Science databases. Age group, sex, and geographic region were considered when analyzing the data. Of the 4327 assessed articles, 57 met the inclusion criteria for qualitative review, and 36 were included in the meta-analysis. Heterogeneity measures were high both as a whole and in each geographic region. Data analysis by geographic region showed that reported prevalence differed across regions, ranging from 49 per 100,000 (Sub-Saharan Africa) to 1081 per 100,000 (Latin America and the Caribbean). There was an increasing prevalence of PD with advancing age (per 100,000): 7 in 40-49 years, 158 in 50-59 years, 603 in 60-69 years, 1251 in 70-79 years, and 2181 in over the age of 80. The prevalence of PD in men and women was similar. There was a greater PD prevalence in populations with a higher 5-year GDP per capita and a higher life expectancy. Our findings suggest a higher prevalence of PD in lower and upper-middle-income countries than previously reported. Comparisons between regions are difficult, as the sociocultural differences and lack of methodological standardization hinder understanding key epidemiological data in varied populations.

Designing an mHealth application for informal carers concerning the management of behavioural and psychological symptoms of dementia: a need analysis survey

BACKGROUND

Informal carers face difficulties and challenges when dealing with the behavioural and psychological symptoms of dementia (BPSD) of their family members or friends residing at home. Mobile health (mHealth) applications are promising for educating and supporting carers. However, needs analysis studies have not been conducted in Sri Lanka to develop mHealth applications for informal carers of people with dementia.

AIMS

To explore the needs to design an mHealth application for informal carers of people with dementia concerning the management of BPSD.

METHOD

An exploratory cross-sectional survey was conducted among a convenience sample (N = 203) of informal carers as a part of developing an mHealth application. Family members, relatives, or friends who lived with people with dementia and provided care on an unpaid basis for more than three months were included. The questionnaire included sociodemographic data, carer-rated prevalence and severity of BPSD, and informal carers' knowledge of dementia, carer burden, information-seeking sources, availability of smartphones, mHealth information seeking and perception of mHealth information seeking related to managing BPSD. Descriptive analysis and inferential tests were performed.

RESULTS

Informal carers of people with dementia were predominantly female (70.4%), and 64% showed low knowledge of dementia. Of the participants, 35% reported a high carer burden, 53.7% reported a low burden, and only 11.3% reported no carer burden. Most of their care recipients (97%) had at least one BPSD. The prevalence and severity of BPSD were significantly and positively correlated with the carer burden. The participants' main source of information was health professionals. Most of them owned smartphones (63.5%), but none used mHealth applications for dementia-related information seeking. Approximately half of the respondents were ready to spend time (52.7%) and money (46.8%) on mHealth information seeking. Perceived mHealth usefulness was significantly associated with dementia knowledge, smartphone ownership, and readiness to spend time and money on mHealth information seeking.

CONCLUSION

Informal carers of people with dementia were affected by BPSD in their care recipients. This study explored carers' educational needs concerning dementia, BPSD, and carer burden. Informal carers could adapt mHealth for dementia-related information seeking. Their unmet needs in managing BPSD should be explored.

"BrainHeart": Pilot Study on a Novel Application for Elderly Well-Being Based on Mindfulness Acceptance and Commitment Therapy

The rising prevalence of mental illness is straining global mental health systems, particularly affecting older adults who often face deteriorating physical health and decreased autonomy and quality of life. Early detection and targeted rehabilitation are crucial in mitigating these challenges. Mindfulness acceptance and commitment therapy (ACT) holds promise for enhancing motivation and well-being among the elderly, although delivering such psychological interventions is hindered by limited access to services, prompting exploration of remote delivery options like mobile applications. In this paper, we introduce the BrainHeart App (v.1.1.8), a mobile application tailored to improve physical and mental well-being in seniors. The app features a 10-day ACT program and other sections promoting healthy lifestyle. In a pilot study involving twenty participants, individuals engaged in daily mental exercises for 10 days using the app. Clinical evaluations, including assessments of psychological flexibility, overall cognitive profile, mindfulness disposition, cognitive fusion, and heart rate collected with Polar H10, were conducted at baseline (T0) and one month post-intervention (T1). Analysis revealed significant improvements in almost all neuropsychological scores, with high usability reported (system usability scale average score: 82.3 ± 9.31). Additionally, a negative correlation was found between usability and experiential avoidance (r = -0.51; p = 0.026), and a notable difference in heart rate was observed between baseline and post-intervention (F-value = 3.06; p-value = 0.09). These findings suggest that mindfulness-ACT exercises delivered via the BrainHeart App can enhance the well-being of elderly individuals, highlighting the potential of remote interventions in addressing mental health needs in this population.

Assessing frailty amongst older people admitted to hospital in a low-income setting: a multicentre study in northern Tanzania

BACKGROUND

Populations are ageing globally and Low- and Middle-Income Countries (LMICs) are experiencing the fastest rates of demographic change. Few studies have explored the burden of frailty amongst older people in hospital in LMICs, where healthcare services are having to rapidly adapt to align with the needs of older people. This study aimed to measure the prevalence of frailty amongst older people admitted to hospital in Tanzania and to explore their demographic and clinical characteristics.

METHODS

This study had a prospective observational design. Over a six-month period, all adults ≥ 60 years old admitted to medical wards in four hospitals in northern Tanzania were invited to participate. They were screened for frailty using the Clinical Frailty Scale (CFS) and the Frailty Phenotype (FP). Demographic and clinical characteristics of interest were recorded in a structured questionnaire. These included the Barthel Index, the Identification of Elderly Africans Instrumental Activities of Daily Living (IADEA-IADL) and Cognitive (IDEA-Cog) screens, the EURO-D depression scale and Confusion Assessment Method.

RESULTS

540 adults aged ≥ 60 were admitted, and 308 completed assessment. Frailty was present in 66.6% using the CFS and participants with frailty were significantly older, with lower levels of education and literacy, greater disability, greater comorbidity, poorer cognition and higher levels of delirium. Using the FP, 57.0% of participants were classed as frail though a majority of participants (n = 159, 51.6%) could not be classified due to a high proportion of missing data.

CONCLUSIONS

This study indicates that the prevalence of frailty on medical wards in northern Tanzania is high according to the CFS. However, the challenges in operationalising the FP in this setting highlight the need for future work to adapt frailty screening tools for an African context. Future investigations should also seek to correlate frailty status with long-term clinical outcomes after admission in this setting.

Looking back on life: An updated meta-analysis of the effect of life review therapy and reminiscence on late-life depression

BACKGROUND

Twenty years ago, we confirmed the effectiveness of life review therapy and reminiscence (LRT-REM) to treat late-life depression in a meta-analysis. In the current study, we aimed to examine the most updated evidence on the effects of LRT-REM in older adults with depression.

METHODS

We systematically searched records in English and Chinese databases up to December 2022 and included randomized controlled studies comparing LRT-REM with control conditions in older adults with depression. Outcomes included depression, anxiety, quality of life, and life satisfaction. Effect sizes (Hedges' g) at post-treatment were pooled with random effects meta-analyses.

RESULTS

42 studies with 3361 depressed older adults (≥60 years) met the selection criteria. We found a significant and large effect of LRT-REM (g = 1.41, p < 0.001) on late-life depression, corresponding to a number-needed-to-treat (NNT) of 1.98. Heterogeneity shrunk from high (I2 = 86.78) to moderate (I2 = 46.87) after excluding eight detected outliers. There were no significant differences between the examined subgroups except for the type of control condition. The effects of LRT-REM were not statistically significant at follow-up when corrected for publication bias. The quality of many included studies was not optimal.

LIMITATIONS

The quality of many included studies was not optimal, with a high risk of bias.

CONCLUSIONS

LRT-REM may be effective for treating late-life depression, but long-term effects are unclear. More research is needed on the effects of LRT-REM, especially when guided by (para)professional or lay therapists in low- and middle-income countries.

The occurence of cancer in ageing populations at global and regional levels, 1990 to 2019

BACKGROUND

population ageing contributes to increased cancer cases and deaths and has profound implications for global healthcare systems. We estimated the trends of cancer cases and deaths in ageing populations at global and regional levels.

METHODS

using data from the Global Burden of Disease Study 2019, we analysed the change in cancer cases and deaths associated with population ageing, population growth and epidemiological factors from 1990 to 2019 using decomposition analysis. Additionally, we estimated the proportions of people aged 65 years and over accounting for total cases and deaths, and investigated relationships between the proportions and the Sociodemographic Index (SDI) using the Pearson correlation coefficient.

RESULTS

from 1990 to 2019, there was an increase of 128.9% for total cases and 74.8% for total deaths in all cancers combined; the percentages of older people increased from 48.6% to 56.4% for cases and from 52.0% to 61.9% for deaths. Population ageing contributed to the largest increase in global cancer occurrence, with 56.5% for cases and 63.3% for deaths. However, the changes attributed to epidemiological factors was 5.2% for cancer cases and -33.4% for cancer deaths. The proportions of total cases and deaths of older adults were positively correlated with socioeconomic development of the country.

CONCLUSION

our findings revealed that the main contributor to increased cancer cases and deaths has changed from comprehensive epidemiological factors to demographic shifts. To respond to the rapidly growing occurrence of cancer in ageing populations, the global health priority should focus on meeting the rising demand for cancer diagnosis, treatment and care services for older people.

The prevalence and incidence of progressive supranuclear palsy and corticobasal syndrome: a systematic review and meta-analysis

INTRODUCTION

Progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS) are progressive neurodegenerative syndromes characterised by Parkinsonism with additional features including cognitive dysfunction, falls, and oculomotor abnormalities. Understanding the epidemiology of these conditions is critical to planning for future service provision.

METHODS

We conducted a systematic review of studies reporting incidence and prevalence of CBS and PSP. A search of the PubMed and EMBASE data bases was conducted from their date of inception to 13th July 2021. Meta-analysis of studies sharing similar methodologies was carried out to generate estimated pooled prevalence and incidence.

RESULTS

We found 32 studies meeting our criteria for inclusion. There were 20 studies with data on prevalence and 12 with incidence data of PSP. Prevalence of CBS was reported in eight studies while seven studies reported incidence. Reported estimates of prevalence for PSP ranged from 1.00 (0.9-1.1) to 18 (8-28) per 100,000 while prevalence rates for CBS ranged from 0.83 (0.1-3.0) to 25 (0-59). Incidence rates for PSP and CBS respectively ranged from 0.16 (0.07-0.39) to 2.6 per 100,000 person-years and 0.03 (0-0.18) to 0.8 (0.4-1.3) per 100,000 person-years. A random effects model meta-analysis of studies with similar methodologies yielded a pooled prevalence estimate for PSP of 6.92 (4.33-11.06, I2 = 89%, τ2 = 0.3907) and 3.91 (2.03-7.51, I2 = 72%, τ2 = 0.2573) per 100,000 for CBS.

CONCLUSION

Studies of the epidemiology of PSP and CBS report highly heterogeneous findings. There is a need for further studies using rigorous phenotyping and the most recent diagnostic criteria to understand the true burden of these conditions.

A novel online training programme for healthcare professionals caring for older adults

The proportion of older people in the world population is growing rapidly. Training and retaining healthcare professionals in sufficient numbers in the field of ageing represents a major challenge for the future, to deal with the healthcare needs of this ageing population. The COVID pandemic has unfortunately compounded shortages of healthcare workers worldwide. There is therefore a pressing need to scale-up the education of healthcare professionals in geriatrics and gerontology. Over the last 30 years, a group of motivated geriatrics physicians from Europe have been striving to educate healthcare professionals in geriatrics and gerontology through various initiatives, and using innovative pedagogic approaches to train physicians, nurses and other healthcare professionals around the world. The COVID-19 pandemic unfortunately put a stop to presence-based training programmes, but prompted the development of the online International Association of Gerontology and Geriatrics (IAGG) eTRIGGER (e-Training In Geriatrics and GERontology) course, a new training course in geriatrics and gerontology for healthcare professionals from a wide range of backgrounds. We outline here the history of the educational initiatives that have culminated in the roll-out of this new programme, and the perspectives for the future.

Healthcare seeking behaviour during illness among older adults in Ghana: does food security status matter?

BACKGROUND

Ghana's growing older adult population raises critical questions regarding healthcare for these older adults. At the same time, food insecurity is high among older adults in Ghana. This underscores the need to investigate the issues of food security and healthcare seeking behaviour among older adults. However, research on the association between food security status and healthcare seeking behaviour among older adults is scant in the Ghanaian context. In this study, we advance the social gerontology literature by examining the association between food security status and healthcare seeking behaviors among older adults.

METHODS

Using a multi-stage sampling framework, we collected data from a representative sample of older adults across three regions in Ghana. Data were analyzed using logistic regression technique. We determined the significance of the test at a probability value of 0.05 or less.

RESULTS

Over two-thirds (69%) of respondents did not seek care during their last illness. Additionally, 36% of respondents were severely food insecure, 21% were moderately food insecure, 7% were mildly food insecure, and 36% were food secure. After controlling for theoretically relevant variables, our multivariable analysis revealed a statistically significant association between food security status and healthcare seeking behaviors with older people who are food secure (OR = 1.80, p < 0.01) and mildly food insecure (OR = 1.89, p < 0.05) being more likely to seek healthcare compared with their counterparts who are food insecure.

CONCLUSION

Our findings highlight the need for sustainable intervention programs to improve food access and health service use among older adults in Ghana and similar contexts.

Research to inform health systems' responses to rapid population ageing: a collection of studies funded by the WHO Centre for Health Development in Kobe, Japan

Population ageing is a global phenomenon that has profound implications for all aspects of health systems development. Research is needed to understand and improve the health system response to this demographic shift, especially in low- and middle-income countries where the change is happening rapidly. This Supplement was organized by the WHO Centre for Health Development in Kobe, Japan (WHO Kobe Centre) whose mission is to promote innovation and research for equitable and sustainable universal health coverage considering the impacts of population ageing. The Supplement features 10 papers all based on studies that were funded by the WHO Kobe Centre in recent years. The studies involve a diverse set of 10 countries in the Asia Pacific (Cambodia, Japan, the Lao People's Democratic Republic, Malaysia, Mongolia, Myanmar, the Philippines, Singapore, Thailand and Viet Nam); address various aspects of the health system including service delivery, workforce development and financing; and utilize a wide range of research methods, including economic modelling, household surveys and intervention evaluations. This introductory article offers a brief description of each study's methods, key findings and implications. Collectively, the studies demonstrate the potential contribution that health systems research can make toward addressing the challenges of ensuring sustainable universal health coverage even while countries undergo rapid population ageing.