Disability incidence and functional decline among older adults with major chronic diseases

Experiences of older adult patients with cancer on nursing care: A qualitative study

This study described the experiences of hospitalized older adult patients with cancer in the care provided by nurses. This study utilized descriptive qualitative research from February to April 2024; the researchers conducted semi-structured interviews among 14 older adult patients with cancer aged 65 to 75. The interviews were audio-recorded, transcribed, translated, and then analyzed using a thematic analysis approach. The study has identified themes, namely "Nurturing Care of Nurses Received by the Patient," "Attributes and Qualities of Nursing Staff," "Challenges and Concerns of Patients During Hospitalization," and "Suggested Approaches of the Patients towards Enhancing Staffing and Support Systems." Our findings revealed that compassionate and attentive nursing practices ensure a better understanding of elderly health needs. Older adult patients with cancer experience physical and emotional challenges such as pain and depression. Moreover, nurses cannot provide emotional care due to insufficient nursing staff.

Sociodemographic Factors Associated with Physical Functioning in Elderly Males and Females from Serbia: Population-Based Modeling Study

Background and aim: During the past few decades, the aging population has increased. With aging, there is an increase in functional limitations. The aim of this study was to analyze sociodemographic factors associated with physical functioning impairment in elderly males and females. Methods: This population-based modeling study based on a data from a third national study of health of Serbian inhabitants from 2013 in Serbia included 3540 elderly participants 65 years of age and above from Serbia. Physical functioning for both genders was categorized as follows: PF1-walking half a kilometer on level ground without the assistance of any mobility aids and PF2-walking up or down 12 steps. Modeling of physical functioning for both genders was categorized as follows: Model 1: inability to perform PF1, Model 2: some/a lot of difficulty in performing PF1, Model 3: inability to perform PF2, and Model 4: some/a lot of difficulty in performing PF2. Further variables were evaluated: age, education level, marital status, body mass index (BMI), wealth index, and place of residence. Logistic regression was performed to identify the variables that are factors associated with PF1 and PF2 in elderly males and females. Results: Statistically significant factors were as follows: age (Model 1 (male OR: 2.591; female OR: 4.708); Model 2 (male OR: 1.791; female OR: 2.354); Model 3 (male OR: 2.386; female OR: 4.985); Model 4 (male OR: 1.883; female OR: 2.772)); BMI (Model 2 (female OR: 1.348); Model 4 (female OR: 1.329)), marital status (Model 2 (female OR: 0.713); Model 4 (male OR: 0.688)); education level (Model 1 (male OR: 0.626; female OR: 0.537); Model 2 (male OR: 0.811; female OR: 0.653); Model 3 (male OR: 0.697; female OR: 0.494); Model 4 (male OR: 0.784; female OR: 0.639)); wealth index (Model 2 (male OR: 0.823; female OR: 0.740); Model 3 (male OR: 0.724); Model 4 (male OR: 0.787; female OR: 0.731)); and place of residence (Model 1 (female OR: 1.704); Model 3 (female OR: 1.575)). Conclusions: Increased age, being single, a lower education level, and a lower wealth index were factors associated with functional disability in the elderly of both genders, while an increased BMI and living in another place than a city were factors associated with functional disability in elderly females. Specific social strategies bearing in mind possible gender differences should be created and implemented in order to optimize the physical functioning, mobility, and participation of the elderly.

Associations Between MASLD, Ultra-Processed Food and a Mediterranean Dietary Pattern in Older Adults

Background/Objectives: Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) is the most common liver disease worldwide, affecting 38% of the adult population globally. Methods: We examined the impact of the Mediterranean Diet and Ultra Processed Food (UPF) intake on the risk of prevalent MASLD in older adults. Results: Our major findings include that increased adherence to a Mediterranean Dietary pattern was associated with a decreased risk of MASLD. Additionally, we found that high UPF intake was associated with an increased risk of MASLD. Furthermore, our study found that even with a high UPF intake, the risk of MASLD decreased if the individual also had a higher Mediterranean Diet intake compared to a lower Mediterranean Diet intake. Conclusions: These results are of particular importance in older people, given the known links between MASLD, metabolic comorbidities and frailty. Public health messaging should focus on promoting Mediterranean dietary habits, and ways to help older people achieve this given the social and economic barriers they may face.

Factors influencing dignity impairment in elderly patients with incontinence-associated dermatitis: A lasso and logistic regression approach

OBJECTIVE

To understand the current status of dignity impairment in elderly patients with incontinence-associated dermatitis and to systematically analyze the factors influencing it.

METHODS

This study employed a cross-sectional survey design. From July 15th to 31st, 2024, a convenience sampling method was used to select elderly patients with incontinence-associated dermatitis (IAD) from 42 tertiary comprehensive medical institutions across 11 provinces and autonomous regions, including Sichuan, Zhejiang, and Guangdong. A general information questionnaire and a dignity assessment scale were used to gather data on participants' demographic characteristics, clinical conditions, and dignity impairment symptoms.

RESULTS

A total of 372 patients were effectively surveyed, of whom 131 exhibited symptoms of dignity impairment, resulting in an incidence rate of 35%. Multifactorial analysis revealed that Employment Status [OR = 4.183, 95% CI (2.233-7.837)], Primary Caregiver [OR = 1.451, 95% CI (1.005-2.095)], Respiratory System Disease [OR = 5.053, 95% CI (2.079-12.279)], and Nervous System Disease [OR = 2.452, 95% CI (1.206-4.985)] were risk factors for dignity impairment symptoms in elderly patients with incontinence-associated dermatitis. Conversely, Gender [OR = 0.488, 95% CI (0.295-0.807)] and Self-Reported Family Harmony [OR = 0.703, 95% CI (0.550-0.898)] were identified as protective factors against dignity impairment symptoms in this patient population.

CONCLUSION

Although the incidence of dignity impairment symptoms in elderly patients with incontinence-associated dermatitis is relatively low, the psychological trauma it causes cannot be overlooked. Healthcare professionals must actively establish and enhance prevention and management systems for this condition.

The trajectory of functional status among older adults with chronic diseases and the association with social relationships

Background

Functional status crucially affects healthy aging. Identifying trajectory of functional status and related determinants is important. We aimed to identify the trajectory of functional status over 6 years among older adults with chronic diseases and its association with social relationships.

Methods

A latent class growth model analysis was conducted to explore the trajectory of functional status using three time points over 6 years. After identifying the trajectories, a multi-nominal logistic regression analysis was performed to examine the association between social relationships and the trajectories.

Results

We included data from 458 participants aged ≥65 years with chronic diseases in Japan. Three distinct trajectories were identified, with 73.3% of participants being functionally stable, 16.6% moderate functional decline, and 10.1% rapid functional decline. Good social relationships were associated with a lower probability of having moderate or rapid functional decline trajectories (odds ratio [OR] 0.75, 95% confidence interval [CI] 0.65-0.87 and OR 0.63, 95% CI 0.51-0.78, respectively).

Conclusion

Differences were found in the functional trajectories of older adults with chronic disease over time. Older adults with more extensive social relationships appeared less likely to have a poorer functional trajectory. The findings suggest that fostering extensive social relationships could be an effective management strategy for functional decline deterioration.

Tailoring registered dietitian and occupational therapy services for home-delivered meal recipients: feasibility study protocol for a randomized controlled trial

BACKGROUND

Home-delivered meal recipients often present with complex nutritional and functional needs that place them at elevated risk for health decline and potential institutionalization. To address these complex needs, clinical services-namely registered dietitian and occupational therapy services-may be warranted to reduce the risk of health decline and maximize outcomes of this vulnerable older adult population. Accordingly, this study will explore the feasibility of testing four different clinical service models with home-delivered meal recipients. In particular, this study will determine the feasibility of recruiting and retaining participants from one home-delivered meal provider, determine challenges and opportunities to improve data collection procedures, assess resources needed to conduct study activities, and identify if service models can be implemented as intended.

METHODS

This is a feasibility RCT with 1:1:1:1 allocation to four service arms: (a) meals only, (b) meals + registered dietitian services, (c) meals + occupational therapy services, or (d) meals + registered dietitian services + occupational therapy services. Study activities will be conducted in collaboration with one, large community-based agency in the Midwest United States. We will recruit 60 participants who meet the following inclusion criteria: is eligible to receive home-delivered meals funded through Title 3 of the Older Americans Act, has a self-reported diagnosis of diabetes and/or heart disease, is at risk for falling, and can store and reheat up to 14 frozen meals per week. Data collection will occur at baseline and at 3 months after informed consent to assess malnutrition risk, self-management of health conditions, and fall risk.

DISCUSSION

While tailored dietitian and occupational therapy services may be warranted to address the nutritional and functional needs of home-delivered meal recipients, the effect of these services on recipient outcomes has yet to be rigorously examined. This feasibility study will identify the degree to which our service models can be tested with one community-based agency and identify opportunities to improve study procedures prior to conducting a definitive, stage III randomized controlled trial.

TRIAL REGISTRATION

NCT06059404.

Associations of sarcopenia status and its components with the risk of developing functional disability in older Chinese adults: evidence from the China health and retirement longitudinal study

OBJECTIVES

In the aging population, sarcopenia has become a major concern due to its association with increased risks of disability, including impairments in both activities of daily living (ADL) and instrumental activities of daily living (IADL). This relationship, however, has been rarely studied within the Chinese population. This study was conducted to assess the relationships of sarcopenia status and its components with the risk of developing ADL/IADL disability among Chinese community-dwelling elderly people.

METHODS

In this study, we used data from the China Health and Retirement Longitudinal Study. The ADL and IADL scales were used to assess an individual's functional disability. Logistic regression models were used to assess the association between sarcopenia status and its components and the risk of developing ADL/IADL disability in the overall population. Sex-specific receiver operating characteristic (ROC) curves was used to evaluate the value of sarcopenia component indicators for predicting ADL/IADL disability.

RESULTS

A total of 4,893 participants were included in the study, comprising 2,220 males and 2,673 females, with ages ranging from 60 to 102 years. There were greater IADL disability risks in the possible sarcopenia group (OR = 1.87, 95% CI: 1.48-2.37), sarcopenia group (OR = 1.85, 95% CI: 1.24-2.76) and severe sarcopenia group (OR = 2.54, 95% CI: 1.63-3.94). The results were similar (possible sarcopenia: OR = 2.16, 95% CI: 1.44-3.22; severe sarcopenia: OR = 4.99, 95% CI: 2.52-9.87)) for ADL disability, except for the sarcopenia group (OR = 2.00, 95% CI: 0.97-4.12). We found that handgrip strength (HS) (OR = 0.95, 95% CI: 0.92-0.97) and gait speed (GS) (OR = 0.33, 95% CI: 0.12-0.86) were negatively associated with the risk of developing ADL disability and that the repeated chair stand (RCS) test results (OR = 1.09, 95% CI: 1.05-1.12) were positively associated with the risk of developing ADL disability. Similar results were found for the associations between several sarcopenia component indicators and the risk of developing IADL disability. The area under the curve (AUC) of HS was 0.702, which could better recognize ADL disability and showed good discriminant validity in males.

CONCLUSION

The prevalence of sarcopenia is high among the elderly Chinese population. Additionally, HS showed good discriminant validity for discriminating ADL disability in males. Further prospective studies are needed to clarify the relationship between sarcopenia status and the risk of developing functional disability and to determine whether indicators of the separate sarcopenia components can be used for early warning, screening and identifying functional disability.

Associations of baseline and longitudinal changes in basic activity of daily living with risk of cardiovascular disease among older adults in China

BACKGROUND AND AIMS

The purpose of this study was to examine the associations of basic activities of daily living (BADL) and its longitudinal changes with cardiovascular disease (CVD) risk among older population.

METHODS AND RESULTS

We conducted a prospective analysis of the Chinese Longitudinal Healthy Longevity Survey between 2008 and 2018 in 7051 participants aged 65 years or over. Cox proportional hazards models were performed to evaluate the associations of baseline and longitudinal changes in BADL with the incidence of CVD. A total of 1510 incident CVD cases were identified. The participants with BADL limitation at baseline had a 67 % increased risk of CVD compared with those without BADL limitation (multivariable-adjusted hazards ratio (HR): 1.67, 95 % confidence interval (CI): 1.35-2.07). Moreover, participants with persistent BADL limitation (HR: 2.25, 95 % CI: 1.73-2.93), BADL from limitation to non-limitation (HR: 1.80, 95 % CI: 1.27-2.54), and BADL from non-limitation to limitation (HR: 1.86, 95 % CI: 1.62-2.14) were each experienced a higher risk of CVD compared with those with persistent BADL non-limitation. Of all the items of BADL, limitation of bathing or multiple BADL limitations (≥2) was positively associated with the risk of stroke.

CONCLUSION

Longitudinally persistent BADL limitation was associated with a more than twofold risk of CVD in later life among the Chinese older adults. Similar but slightly weak association was also observed for temporary BADL limitation. Older adults with BADL limitation, especially those with bathing limitation or with multiple functional limitations, should be the target population for CVD prevention.

Social functioning in bipolar disorder: investigating the role played by comorbid physical illnesses and cognition

Bipolar disorder (BD) is a psychiatric disorder associated with functioning and cognitive impairments, as well as a higher prevalence of physical disease comorbidities.

Objective

To determine the main predictors of functioning in patients with BD.

Methods

Thirty-five patients with BD type I in remission participated in this study. To better characterize the degree of impairment, 20 matched controls were also studied. Functioning was assessed through the Functioning Assessment Short Test (FAST) and the UCSD Performance-based Skills Assessment (UPSA), while cognition was assessed through the BAC-A. Current physical conditions were assessed and categorized according to the Cumulative Illness Rating Scale (CIRS). Regression analyses were performed to examine the relationship between functioning and clinical variables, global cognitive performance, and physical comorbidities in BD.

Results

UPSA correlated positively with the BAC-A total score (r=0.488; p=0.025), years of education (rho=0.41; p<0.01), and CIRS total score (rho=0.394; p<0.001). CIRS was the only predictor that remained negatively and significantly correlated with the UPSA total score (R2=0.446, F (1, 33)=8.198, p=0.007).

Conclusion

Patients with BD had poor functioning, with the primary determinant of poor functioning being the burden of physical illnesses. In addition, the low agreement between the FAST and UPSA scales suggests these tolls assess distinct constructs.

Latent profile analysis of depression in elderly patients with cardio- and cerebrovascular diseases in China- based on CLHLS data

Background

This study explored the depressive status of elderly patients with cardio- and cerebrovascular disease, using latent profile analysis to explore different profiles of depression. It also explored the factors influencing different profile of depression in patients with cardio- and cerebrovascular diseases to provide reference to healthcare workers to identify the high-risk group of anxiety and depression symptoms at an early stage.

Methods

Data came from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). In this study, we used latent profile analysis (LPA) to develop a latent profile model of elderly patients with cardio- and cerebrovascular disease combined with depression and to explore its influencing factors.

Results

The 1890 study participants were divided into a low-level group (11%), a medium-level group (52%), and a high-level group (37%). The results of the univariate analysis showed statistically significant differences in the distribution of gender, age, co-residence, self-reported health, main source of financial support, marital status, diabetes, smoke, drank, exercise, level of anxiety, and IADL in the three profiles. Multiple logistic regression showed that good or fair self-reported health and exercise were associated with the low-level of depression; no spouse, and anxiety level were associated with moderately severe depressive conditions; and retirement wages, and local government or community predicted the appearance of low-level of depression compared to medium-level of depression.

Effects of Exercise Program on Mental, Pulmonary, and Cardiovascular Health of Elderly Men with Acquired Severe Physical Disabilities: A Retrospective Study

Background/Objectives: Physical activity is recommended for people with physical disabilities and is beneficial not only for physical health but also for mental health. This study aimed to evaluate the quality of life (QoL), pulmonary health, and cardiovascular health among a group of older men with physical disabilities who participated in an exercise program. Methods: This study included 23 participants in the exercise group (EG) as an experimental group and 23 in the culture group (CG) as a control group. All participants were ≥65 years, with one or more physical disabilities, and used wheelchairs or crutches for mobility. The participants were each provided with the exercise program for 8 weeks. Assessments included a QoL, pulmonary function test, brachial-ankle pulse wave velocity (baPWV), and factors of metabolic syndrome. The exercise program consisted of aerobics, strength training using dumbbells and tubes, and mat exercises for three days a week for 8 weeks. The culture program included singing, drawing, and writing. Results: The interaction effects by time and group showed that EG had a superior change compared to CG in QoL (physical function, pain, fatigue, social), forced vital capacity, baPWV, triglycerides, and high-density lipoprotein cholesterol (p < 0.05). Conclusions: Participation in the exercise program positively influenced mental, pulmonary, and cardiovascular health in older men with physical disabilities. Our research results will provide useful information for rehabilitation and social security research to improve the health of elderly people with physical disabilities.

Determinants of limitations in activities of daily living among community-dwelling persons aged 80 years and older: Longitudinal national evidence from the Health, Aging and Retirement in Thailand study, 2015-2022

AIM

Few studies have longitudinally assessed the determinants of limitations in activities of daily living (LADL) among persons aged ≥80 years. The aim of this study was to estimate the determinants of LADL among persons aged ≥80 years based on 4-wave national longitudinal data from Thailand.

METHODS

Data from the Health, Aging and Retirement in Thailand study from 2015, 2017, 2020 and 2022 were utilized. The sample was restricted to community-dwelling persons aged ≥80 years (analytic sample: n = 3113 observations). For the pooled sample, the average age was 85.4 years (range 80-117 years). Established measurements were used to assess LADL. Linear fixed effects regression was applied to assess the time-varying determinants and outcomes.

RESULTS

Linear fixed effects regressions showed that increasing age, an increase in the number of chronic conditions, an increase in depressive symptoms, higher religious involvement and being underweight increased LADL, whereas increases in exercise frequency and increases in subjective life expectancy decreased LADL. In addition, in subgroup analysis among 60-79-year-olds, transitioning to widowhood and work status decreased LADL. Further differences between ≥80-year-olds and 60-79-year-olds include that an increase in depressive symptoms and increase in chronic conditions only increased LADL among ≥80-year-olds and not among 60-79-year-olds.

CONCLUSIONS

This longitudinal study enhances our understanding of the determinants of LADL among persons aged ≥80 years. Strategies to delay or decrease depressive symptoms and chronic conditions, proper weight management and increasing physical activity might help in reducing LADL. Geriatr Gerontol Int 2025; 25: 403-410.

Challenges, current innovations, and opportunities for managing type 2 diabetes in frail older adults: a position paper of the European Geriatric Medicine Society (EuGMS)-Special Interest Group in Diabetes

PURPOSE

This position paper aims to address the challenges of managing type 2 diabetes mellitus (T2DM) in frail older adults, a diverse and growing demographic with significant variability in health status. The primary research questions are: How can frailty assessment be effectively integrated into diabetes care? What strategies can optimize glycaemic control and outcomes for frail older adults? How can innovative tools and technologies, including artificial intelligence (AI), improve the management of this population?

METHODS

The paper uses the 5 I's framework (Identification, Innovation, Individualization, Integration, Intelligence) to integrate frailty into diabetes care, proposing strategies such as frailty tools, novel therapies, digital technologies, and AI systems. It also examines metabolic heterogeneity, highlighting anorexic-malnourished and sarcopenic-obese phenotypes.

RESULTS

The proposed framework highlights the importance of tailoring glycaemic targets to frailty levels, prioritizing quality of life, and minimizing treatment burden. Strategies such as leveraging AI tools are emphasized for their potential to enhance personalized care. The distinct management needs of the two metabolic phenotypes are outlined, with specific recommendations for each group.

CONCLUSION

This paper calls for a holistic, patient-centered approach to diabetes care for frail older adults, ensuring equity in access to innovations and prioritizing quality of life. It highlights the need for research to fill evidence gaps, refine therapies, and improve healthcare integration for better outcomes in this vulnerable group.

Longitudinal Relationship Between Activities of Daily Living and Depression in Older Adults Based on Parallel Process Latent Growth Curve Model with Mediation

Objective: The parallel process latent growth curve model (PP-LGCM) was used to examine the longitudinal relationship between activities of daily living (ADL) and depression and further tested whether chronic diseases (CDs) were associated with depression via mediating variable ADL. Methods: A sample of 2014 Chinese older adults aged 60 and over from the China Health and Retirement Longitudinal Survey (CHARLS) was used. The activities of daily living scale, self-rating depression scale, and chronic diseases scale were used to investigate the ADL, depression, and CD levels of older adults. Following certain statistical analysis steps, we used SPSS 26 and Mplus 8.0 to perform statistical analysis on the data. Results: Firstly, ADL significantly declined in older adults from 2011 to 2018, while depression had a significant rise. Secondly, the intercept of ADL was correlated with the intercept of depression (r = 0.487, p < 0.001), and the slope of ADL was positively correlated with the slope of depression (r = 0.844, p < 0.001). Finally, the intercept of ADL mediated 39% of the association of chronic diseases and the intercept of depression. Conclusions: Our findings showed the trajectories of ADL and depression in older adults and demonstrated that ADL have various associations with depression in longitudinal development. In addition, the effect of chronic diseases on depression is partially mediated by ADL. The ADL play a partial mediating role between chronic diseases and depression in older adults, with an indirect effect of 39%, indicating that ADL are very important. Grasping the mediating mechanism of ADL will help alleviate depression levels in older adults with chronic diseases.

A Systematic Review of Interventions for Demoralization in Patients with Chronic Diseases

BACKGROUND

Demoralization, a significant mental health concern in patients with chronic diseases, can have a large impact on physical symptom burden and quality of life. The present review aimed to evaluate the effectiveness of interventions for demoralization among patients with chronic diseases.

METHOD

PubMed, Scopus, Embase, and Web of Science were systematically searched. Research on providing interventions to patients with chronic diseases that included quantitative data on demoralization was then systematically reviewed.

RESULTS

Fourteen studies were included, most of which considered demoralization as a secondary outcome. Interventions included evidence-based meaning-centered psychotherapy, dignity therapy, psilocybin-assisted psychotherapy, and others. Ten studies used randomized controlled designs. Six of these investigated evidence-based meaning-centered therapy, and four investigated dignity therapy, showing the best empirical support for these intervention types. Most studies showed significant impacts on demoralization in patients with chronic diseases.

CONCLUSION

This systematic review provides insights into potential psychological interventions for reducing demoralization in patients with chronic diseases. Randomized controlled designs and adequately powered samples, with demoralization as the primary outcome, are needed to more clearly evaluate its effectiveness.

Caregiving experiences of family caregivers of disabled middle-aged and older adults enrolled in long-term care insurance: a qualitative study

BACKGROUND

Long-term care insurance (LTCI) projects were an essential components of health systems designed to support disabled people and their families. Despite LTCI has been getting more and more attention and promotion, there was a lack of qualitative study to explore the experiences of family caregivers who were directly involved in the care of disabled people enrolled in these projects. This study aimed to explore the experiences of family caregivers in the caregiving process within the context of LTCI.

METHODS

This qualitative study used inductive content analysis to explore the experiences of family caregivers of disabled people. Fifteen family caregivers from long-term care service companies and communities in Nantong city were purposively selected to participate in the study between December 2023 to February 2024. Semi-structured in-depth interviews were conducted to collect data. The interviews were audio-recorded and transcribed verbatim.

RESULTS

The results revealed a total of five major themes with thirteen sub-themes including: (1) caregiver fatigue (i.e. heavy daily care tasks, and lack of rest); (2) emotional stress (helplessness and depression, and isolated and alone); (3) perceived benefits of caregiving (emotional connection, and a new outlook on life); (4) more expectations for LTCI (expect respite care, expect medical care facilities, expect longer service duration and frequency, and expect more economic subsidies); and (5) positive evaluations of LTCI (provide psychological support, reduce the burden of care, and professional care services).

CONCLUSIONS

This study's findings improved our understanding of caregiving experiences among family caregivers of disabled people enrolled in LTCI. Identifying caregivers' experiences enabled the authorities to develop support strategies and interventions focused on helping them reduce the caregiver burden.

Effects of population aging on quality of life and disease burden: a population-based study

BACKGROUND

As population aging intensifies, it becomes increasingly important to elucidate the casual relationship between aging and changes in population health. Therefore, our study proposed to develop a systematic attribution framework to comprehensively evaluate the health impacts of population aging.

METHODS

We used health-adjusted life expectancy (HALE) to measure quality of life and disability-adjusted life years (DALY) to quantify the burden of disease for the population of Guangzhou. The HALE and DALY projections were generated using both the Bayesian age-period-cohort models and the population prediction models. Changes in HALE and DALY between 2010-2020 and 2020-2030 were decomposed to isolate the effects of population aging. Three scenarios were analyzed  to examine the relative relationship between disease burden and population aging. In Scenarios 1 and 2, the disease burden rates in 2030 were assumed to  either remain at 2020 levels or follow historical trends. In Scenario 3, it was assumed that the absolute numbers of years of life lost (YLL) and years lived with disability (YLD) in 2030 would remain unchanged from the 2020 levels.

RESULTS

Between 2010 and 2020, 56.24% [69.73%] of the increase in male [female, values in brackets] HALE was attributable to the mortality effects in the population aged 60 and over, while - 3.74% [- 9.29%] was attributable to the disability effects. The increase in DALY caused by changes in age structure accounted for 72.01% [46.68%] of the total increase in DALY. From 2020 to 2030, 61.43% [69.05%] of the increase in HALE is projected to result from the mortality effects in the population aged 60 and over, while - 3.88% [4.73%] will be attributable to the disability effects. The increase in DALY due to changes in age structure is expected to account for 102.93% [100.99%] of the total increase in DALY. In Scenario 1, YLL are projected to increase by 45.0% [54.7%], and YLD by 31.8% [33.8%], compared to 2020. In Scenario 2, YLL in 2030 is expected to decrease by - 2.9% [- 1.3%], while YLD will increase by 12.7% [14.7%] compared to 2020. In Scenario 3, the expected YLL rates and YLD rates in 2030 would need to be reduced by 15.3% [15.4%] and 15.4% [15.6%], respectively, compared to 2020.

CONCLUSIONS

The disability effects among the elderly population hinder improvements in quality of life, while changes in age structure are the primary driver of disease burden accumulation. To mitigate the excess disease burden caused by population aging, it is essential to achieve a reduction of more than 15% in the disease burden by 2030 compared to 2020. Our proposed attribution framework evaluates the health impacts of population aging across two dimensions: quality of life and disease burden. This framework enables comparisons of these effects over time and across different regions.

Identifying Needs and Support Services for Family Caregivers of Older Community-Based Family Members: Mixed-Method Research Findings

A recent Canadian study conducted in one province identified family caregiver support needs and essential support services when caring for older community-based family members requiring assistance with activities of daily living. Weekly interviews of 150 volunteer caregivers over 6 months identified 11 support needs and 5 essential support services. Scoping literature reviews of the 11 needs found they had all been identified before. Program logic investigations of the 5 support services identified a patch-work of temporarily available support services in existence across the province. Two governmental policies are recommended: (a) provincial policy assuring access to the five support services, and (b) federal policy for federal-provincial funding transfers to address the provincial cost of assured community-based support services. Family caregivers require this support to maintain their own and their family member's well-being, particularly as this caregiving prevents or delays older family member hospitalizations and nursing home entry.

Human motor performance assessment with lower limb exoskeletons as a potential strategy to support healthy aging-a perspective article

With increasing age, motor performance declines. This decline is associated with less favorable health outcomes such as impaired activities of daily living, reduced quality of life, or increased mortality. Through regular assessment of motor performance, changes over time can be monitored, and targeted therapeutic programs and interventions may be informed. This can ensure better individualization of any intervention approach (e.g. by considering the current motor performance status of a person) and thus potentially increase its effectiveness with regard to maintaining current performance status or delaying further decline. However, in older adults, motor performance assessment is time consuming and requires experienced examiners and specific equipment, amongst others. This is particularly not feasible in care facility/nursing home settings. Wearable robotic devices, such as exoskeletons, have the potential of being used to assess motor performance and provide assistance during physical activities and exercise training for older adults or individuals with mobility impairments, thereby potentially enhancing motor performance. In this manuscript, we aim to (1) provide a brief overview of age-related changes of motor performance, (2) summarize established clinical and laboratory test procedures for the assessment of motor performance, (3) discuss the possibilities of translating established test procedures into exoskeleton-based procedures, and (4) highlight the feasibility, technological requirements and prerequisites for the assessment of human motor performance using lower limb exoskeletons.

Trends in functional limitations among middle-aged and older adults in the Asia-Pacific: survey evidence from 778,507 observations across six countries

Background

There are few studies comparing health status trends among middle-aged and older adults in countries currently experiencing a rapid demographic and economic transition in the Asia-Pacific, relative to their high-income regional counterparts. This study investigates trends in functional limitations among individuals aged 45 years and above in six major Asia-Pacific countries, ranging from middle- to high-income, from 2001 to 2019 and examines disparities across socioeconomic and demographic sub-groups.

Methods

Data on 778,507 individuals from seven surveys in three high-income countries (Australia, Japan, South Korea) and three middle-income countries (China, Indonesia, and India) were used. Activities of daily living (ADL), instrumental activities of daily living (IADL), and mobility measures served as indicators of functional limitations. Age-standardized prevalence was used to assess prevalence trends in functional limitations and their distribution across sex and age. Multivariate linear probability models were used to examine whether the patterns still hold when controlling for birth cohorts and socioeconomic and demographic factors.

Findings

People aged 45 years and above in Australia, Japan, and South Korea experienced declines in functional limitations, whereas increases were observed in India and Indonesia. The findings for China were unclear and varied depending on the indicator. Changes in prevalence of functional limitations over time were more pronounced among people aged over 60 years. Higher prevalence of functional limitations was observed for respondents with lower education and among those are not currently married across countries.

Interpretation

Study findings highlight the potential for cross-national learning to address functional limitations among older populations in low- and middle-income countries.

Funding

Not applicable.

Health and economic impact of caregiving on informal caregivers of people with chronic diseases in sub-Saharan Africa: A systematic review

With a disproportionate burden of chronic diseases and severe shortage of health workers in sub-Saharan Africa, the region implicitly relies on informal caregivers (ICGs) to support the patients both within and outside the health facilities. The aim of this review is to systematically summarise evidence on the health and economic impact of caregiving on informal caregivers of patients with chronic diseases in sub-Saharan Africa. Medline (Ovid), CINAHL (EBSCOhost), PsycINFO (Ovid), Embase (Ovid), Global Health, and Web of Science databases were systematically searched to identify original articles that considered the economic and/or health impacts of caregiving in sub-Saharan Africa. The results from the included studies were synthesised narratively. After screening 4,951 records, 47 studies were included for synthesis. The articles were from all sub-regions of sub-Saharan Africa with more than half (25/47) of the studies focussing on caregivers for patients with cancer. Although the primary motivation for becoming caregivers was love and responsibility, the caring responsibilities described in twenty studies, had profound effects on the caregiver's lives. Healthwise, the informal caregivers experienced changes in their physical and mental health like developing musculoskeletal problems and depression. Economically, caregiving was expensive, and financially draining. The opportunity cost of caregiving included loss of jobs, loss of income, foregoing planned important activities and missed education opportunities. Informal caregivers reported a range of mainly negative health and economic effects of the work they do. Health care systems should consider how to better support caregivers in terms of their own physical and mental wellbeing. Also, governments should develop strategies to financially support informal caregivers.

Development of ICF-based patient-reported outcome and experience measures to study social participation among people with chronic diseases: a mixed-methods protocol

INTRODUCTION

Living with a chronic disease impacts many aspects of life, including the ability to participate in activities that enable interactions with others in society, that is, social participation (SP). Despite efforts to monitor the quality of care and life of chronically ill people in Belgium, no disease-specific patient-reported measures (PRMs) have been used. These tools are essential to understand SP and to develop evidence-based recommendations to support its improvement. This protocol presents the phases for the disease-specific development of patient-reported outcome and experience measures to assess SP and its potential determinants among people living in Belgium with cancer, cystic fibrosis, diabetes, HIV or a neuromuscular disease.

METHODS AND ANALYSIS

This protocol applies the PROMIS Instrument Development and Validation Scientific Standards and COnsensus-based Standards for the selection of health Measurement INstruments to develop PRMs in a disease-specific manner to quantify the components of the International Classification of Functioning, Disability and Health (ICF). A mixed-method approach is used to create broad initial item pools based on patient (focus groups) and literature perspectives which are compared within ICF-standardised language by applying the refined ICF linking rules. An item set is first created based on this cross-matching exercise and then validated by multidisciplinary expert panels. Cognitive assessment and pilot testing are followed by the dissemination of the survey to a representative sample in Belgium. Advanced psychometric testing (classical test theory and item response theory) is applied to inform an item reduction strategy for the final measures and to develop scales for the ICF components.

ETHICS AND DISSEMINATION

Ethical approval was granted by the Ethics Committee of the Ghent University Hospital on 20 February 2023 to organise the patient focus groups (ONZ-2022-0470). Ethical approval for dissemination of the PRMs and psychometric testing will be sought at the Ghent University Hospital Ethics Committee at the start of Phase 6. Results will be disseminated through peer-reviewed journals and professional conferences.

Longitudinal trends and predictors of limitations in activities of daily living in community-dwelling older adults: evidence from the KLoSA study

Background

As life expectancy increases, the number of older adults with functional limitations is also increasing. Functional limitations are associated with adverse health outcomes such as reduced independence, diminished quality of life (QoL), and disability. Therefore, identifying which activities of daily living (ADLs) are limiting and understanding the influencing factors are crucial for developing tailored interventions. Although various factors influence ADL limitations, few studies have identified the longitudinal factors associated with each ADL. This study explores the longitudinal trends and factors associated with the ADL total score and functional limitations with each ADL among older adults in Korea.

Methods

Using data from the Korean Longitudinal Study of Aging (KLoSA) from 2006 to 2020, we analyzed 1,388 people aged 65 and older who had no ADL limitations in 2006. An ADL limitation was defined as partial or complete dependence in any of the following ADLs: getting dressed, washing face and hands, bathing, eating, transferring, toileting, and continence. We used repeated measures analysis of variance and multivariate logistic regression to investigate the trends and predictors of ADL limitations over a 14-year period.

Results

In 2006, the mean age of the participants was 69.88 years (SD = ±4.11), and 60.20% were female. The prevalence of total ADL limitations and limitations in each of the seven ADLs increased gradually during the 14 years of follow up. In 2020, the ADL items with the highest prevalence of limitations were bathing, getting dressed, and washing face and hands. The common significant predictors for total ADL limitations and limitation in the top three ADLs were age and cognitive function.

Conclusion

ADL limitations among Korean older adults significantly increase over time, which highlights the need for integrated early intervention and continuous support for bathing limitations, including the application of integrated assistive technologies. In particular, because age and cognitive function were identified as the major predictors for limitations in both total ADLs and the top three ADLs, early assessment and appropriate intervention strategies need to consider those factors to prevent ADL limitations in older adults or to meet the immediate needs of those already experiencing ADL limitations. This approach could enhance the QoL for older adults and contribute to the development of long-term healthcare plans.

Intergenerational support, activities of daily living, and the interaction on psychological distress in older adults

Objectives

The purpose of this study is to examine the effects of intergenerational support and activities of daily living (ADL) on psychological distress in older adults, and to analyse the effects of the interaction between ADL and intergenerational support on psychological distress in older adults.

Methods

A probability sample of 1,065 older adults aged 60 and above was conducted in Xuzhou, China, from 18 June to 26 August 2023. ADL was assessed using the ADL scale combined with the Barthel Index; Intergenerational support was measured using the Intergenerational Support Scale; and psychological distress was measured using the Kessler 10 scale. An ordered multichotomous logistic regression model was constructed to analyse the factors influencing psychological distress in the elderly. The interaction model was constructed by one-way analysis of variance to further analyse the effect of the interaction between financial support, instrumental support and emotional support and ADL on psychological distress in the elderly.

Results

Elderly living in rural areas, with an annual household income of less than 30,000 yuan, who engaged in manual labor before retirement, who did not receive financial support and who received instrumental support were more likely to experience psychological distress, and the higher the degree of restriction in ADL, the higher the risk of psychological distress. A significant interaction was observed between ADL and financial support (F = 221.570, p < 0.05), as well as between ADL and emotional support (F = 399.805, p < 0.01). Additionally, a significant interaction was found among ADL, financial support, and instrumental support (F = 227.187, p < 0.05).

Conclusion

(1) A significant association between place of residence, annual household income, occupation, financial support, instrumental support, ADL, and psychological distress in older adults; (2) When the level of ADL was moderate, the risk of psychological distress in older adults who received emotional support was significantly lower than that of older people who did not receive emotional intergenerational support; When the level of ADL was completely independent, financial support was beneficial in reducing psychological distress in the elderly; (3) the risk of psychological distress in the elderly who received instrumental support increased with the severity of ADL limitations, regardless of whether they received additional financial support.

Impacts of chronic diseases and multimorbidity on health-related quality of life among community-dwelling elderly individuals in economically developed China: evidence from cross-sectional survey across three urban centers

OBJECTIVE

As the ageing process in China further accelerates and the average life expectancy increases, chronic disease prevalence and multimorbidity rates are constantly rising, especially among elderly individuals. However, few previous studies have explored the impacts of chronic diseases and multimorbidity on health-related quality of life (HRQoL). This study aimed to investigate this association among community-dwelling elderly individuals in China.

METHODS

A cross-sectional study was conducted in communities in three cities (Suzhou, Qingdao, and Guangzhou). The basic characteristics, chronic diseases and HRQoL of participants were collected, and HRQoL was measured by the EuroQol 5-Dimensions 3-Level version (EQ-5D-3L). Logistic regression, Tobit regression and generalized linear models were used to assess the impacts of chronic diseases and multimorbidity on HRQoL.

RESULTS

Approximately 83.2 percent of the 1,218 respondents had chronic conditions, with 30 percent having multimorbidity. After controlling for sociodemographic and health behaviour factors, patients with stroke were more likely to report problems in all five dimensions of the EQ-5D and had a lower EQ-5D utility index (UI) (b = -0.342) than patients with other chronic conditions. Patients with chronic pulmonary obstruction had a lower EuroQol Visual Analog Scale (EQ-VAS) (b = -11.169) than patients with other chronic conditions. Furthermore, patients with multimorbidity had worse HRQoL (P < 0.001).

CONCLUSIONS

Both chronic condition probability and multimorbidity rates were high among Chinese community-dwelling elderly individuals. Different disease types had varying degrees of impact on HRQoL, and patients with multimorbidity had worse HRQoL. This study proposes that the government enhance the quality of life of community-dwelling elderly individuals with multimorbidity by establishing long-term care insurance and expanding comprehensive community-based home health care services.

Residential Relocation of Community-Dwelling Older Adults: The Role of Physical Function and the Housing Environment

OBJECTIVE

Most older adults in the United States (U.S.) prefer to remain in their current housing as they age, but difficulty with mobility (e.g., walking) may make this more challenging. We estimated the association between difficulty with mobility (mobility) and residential relocation in the following year.

METHODS

We included adults aged ≥65 participating in ≥2 rounds (years 2011-2019) of the National Health and Aging Trends Study. Mobility was self-reported and change in permanent address was captured by study staff. We used a prospective cohort design and logistic regression with a clustering correction to estimate adjusted associations.

RESULTS

We did not find evidence that mobility was associated with relocation versus no relocation in our sample of 26,444 observations from 5699 older adults. However, mobility was positively associated with moves to housing with fewer environmental barriers.

DISCUSSION

Mobility is associated with relocation to housing that is more accessible and may be an indicator of greater need for supports to age in place.

Activities of Daily Living Disability Transition Patterns in Older Adults with Chronic Diseases: A Four-Year Cohort Study in China

BACKGROUND

Older adults with chronic diseases often experience higher rates of Activities of Daily Living (ADL) disability, with research primarily examining the transition between states of ADL disability and non-disability. The current study aims to analyze the patterns and factors of mutual transitions between multiple different ADL disability states in older adults with chronic diseases.

METHODS

This longitudinal study utilized data from the Shanghai Elderly Care Unified Needs Assessment (SECUNA) spanning 2014 to 2017, with 2014 being the baseline. The study included older adults aged 60 years and older with chronic diseases. Using the Markov model, individuals were classified into three states: no ADL disability, mild ADL disability, and severe ADL disability. Transition patterns were analyzed by calculating the frequency, intensity, and probability of transition, and the influencing factors of six transition scenarios were evaluated.

RESULTS

Older adults with mild ADL disability were more likely to experience improvement (transition intensity: 0.4731) rather than deterioration (transition intensity: 0.2226) in their ADL disability states. However, those with severe ADL disability faced challenges in improving their states (transition intensities: 0.0068 and 0.1204). Among the six ADL disability transition scenarios, place of residence was associated with four scenarios, age and economic sources were associated with three scenarios, sex was associated with two scenarios, and other factors were associated with one scenario.

CONCLUSIONS

The transition patterns and factors differ among individuals with varying ADL disability states. It is essential for relevant agencies to implement tailored preventive healthcare strategies to effectively manage the health status of older adults with chronic diseases.

The relationship between self-efficacy, health literacy, and quality of life in patients with chronic diseases: a cross-sectional study in China

Background

Self-efficacy and health literacy are closely related to the quality of life in patients with chronic diseases; however, it remains unclear whether their combined effects on the quality of life (QoL) in these patients operate through mediation, interaction, or a combination of both.

Methods

The research occurred in China between July 10 and September 15, 2021. A multi-stage random sampling technique was utilized to gather information on self-efficacy, health literacy, and QoL among individuals with chronic diseases. Linear regression models investigated the relationships between these patients' self-efficacy, health literacy, and QoL. Additionally, the four-way decomposition method was used to decompose the overall effects of self-efficacy and health literacy on the QoL in patients with chronic diseases.

Results

Significant correlations were found between self-efficacy, health literacy, and QoL among individuals with chronic diseases (all p < 0.05). In the four-way decomposition results, the results of the European Quality of Life Five Dimension Five Level (EQ-5D-5L) displayed the interaction effects mediated by self-efficacy, and the reference interaction effects were not significant, with small effect sizes observed. The influence of health literacy levels on the QoL in these patients was primarily attributed to the controlled direct effect (CDE), accounting for approximately 86.12% [excess relative risk = 0.00415; 95% CI: 0.00326, 0.00504; p < 0.0001]. The proportion solely attributable to the pure indirect effect (PIE) of self-efficacy was 14.5% [excess relative risk = 0.0007; 95% CI: 0.00031, 0.00109; p < 0.0001]. In the EQ visual analog scale (EQ-VAS) results, the proportion of the controlled direct effect was 84.9% [excess relative risk = 0.62443; 95% CI: 0.52269, 0.72618; p < 0.0001], while the proportion solely attributable to the pure indirect effect of mediation was 14.8% [excess relative risk = 0.10876; 95% CI: 0.06409, 0.15344; p < 0.0001].

Conclusion

Self-efficacy and health literacy primarily influence QoL in patients with chronic diseases through controlled and pure indirect effects. Enhancing patients' health literacy and self-efficacy can contribute to improving their QoL.

Trends over time in the deficit of (instrumental) activities of daily living in the Austrian population aged 65 years and older : Results from the Austrian Health Interview Survey series

BACKGROUND

Difficulties in activities of daily living (ADL) and instrumental activities of daily living (IADL) in older adults are associated with diminished quality of life and increased demand for long-term care. The present study examined the prevalence of disability among individuals aged 65 years and older in Austria, using data from the Austrian Health Interview Surveys (ATHIS).

METHODS

The ATHIS 2014 and 2019 surveys were used (N = 5853) for the analysis. Binary logistic regression was performed to measure the association between disability in at least one ADL or IADL limitation and independent variables adjusted for sociodemographic, health-related behavior and survey year.

RESULTS

The prevalence of ADL or IADL limitations increased in both sexes during the 5‑year follow-up period. For ADL limitations, the prevalence rose from 12.8% to 17.9% in men (p < 0.001) and from 19.2% to 25.7% in women (p < 0.001). The IADL limitations increased from 18.9% to 35.1% in men (p < 0.001) and from 38.2% to 50.8% in women (p < 0.001). Women reported significantly higher odds for ADL (odds ratio [OR]: 1.08, 95% confidence interval [CI]: 0.93-1.26) and IADL limitations (OR: 1.74, 95% CI: 1.53-1.98). In both sexes, participants aged 80 years and older reported higher odds for ADL (OR: 4.37, 95% CI:3.77-5.07) and IADL limitations (OR: 4.43, 95% CI: 3.86-5.09) compared to the younger group. Participants with at least one chronic disease reported higher odds for ADL (OR: 4.00, 95% CI: 3.41-4.70) and IADL limitations (OR: 4.37, 95% CI: 3.85-4.96). Primary education, single status, being born in non-EU/EFTA countries, and residing in Vienna were associated with higher odds of ADL and IADL limitations.

CONCLUSION

Gender, age, education, country of birth, residence, partnership status, number of chronic diseases, noncompliance with physical activity, and nutrition recommendations had a strong association with increased vulnerability to disability. Public health policy must address these factors for disability prevention strategies.

Effect of multimorbidity on depressive status in older Chinese adults: evidence from the China Health and Retirement Longitudinal Study (CHARLS)

OBJECTIVE

This study aims to further explore the relevant influencing factors of depression and explore the correlation between multimorbidity coexistence and depression to find the goals and methods of early intervention of depression in the elderly.

DESIGN

This study adopts a cross-sectional approach.

SETTING

The study population of this project came from the China Health and Retirement Longitudinal Study. Depression was grouped according to the 10-item version of Centre for Epidemiological Research Depression Scale. Chronic diseases, height, weight, grip strength, education, marital status, alcohol consumption, exercise and other indicators were included in the analysis.

PARTICIPANTS

2239 adults over 60 years of age were included.

RESULTS

The proportion of women in the depression group was higher (p<0.001). The depression group had a lower grip strength than the control group (p<0.05). The sleep duration was shorter in the depression group (p<0.001). There were differences in education, marital status and alcohol consumption in the depression group (p<0.05). The depression group might have more types of coexisting chronic diseases (p<0.001). The depression group was more likely to have hypertension, dyslipidaemia, chronic lung diseases, heart attack, stroke, stomach disease and memory-related disease. Grip strength was connected with the risk of depression in the elderly (0.971 (95% CI 0.959 to 0.984)). Sleep (0.827 (95% CI 0.785 to 0.872) and education level (0.790 (95% CI 0.662 to 0.942) were related to the risk of depression in the elderly. Concomitant chronic diseases could affect the risk of depression in the elderly (1.455 (95% CI 1.243 to 1.703)).

CONCLUSION

The coexistence of multiple chronic diseases and depression is very common in the elderly. The coexistence of multiple chronic diseases is more common in older women and older depressed people. With the increase in the number of chronic diseases, the risk of depression in the elderly is significantly increased.

Characteristics of Existing Online Patient Navigation Interventions: Scoping Review

BACKGROUND

Patient navigation interventions (PNIs) can provide personalized support and promote appropriate coordination or continuation of health and social care services. Online PNIs have demonstrated excellent potential for improving patient knowledge, transition readiness, self-efficacy, and use of services. However, the characteristics (ie, intervention type, mode of delivery, duration, frequency, outcomes and outcome measures, underlying theories or mechanisms of change of the intervention, and impact) of existing online PNIs to support the health and social needs of individuals with illness remain unclear.

OBJECTIVE

This scoping review of the existing literature aims to identify the characteristics of existing online PNIs reported in the literature.

METHODS

A scoping review based on the guidelines outlined in the Joanna Briggs Institute framework was conducted. A search for peer-reviewed literature published between 1989 and 2022 on online PNIs was conducted using MEDLINE, CINAHL, Embase, PsycInfo, and Cochrane Library databases. Two independent reviewers conducted 2 levels of screening. Data abstraction was conducted to outline key study characteristics (eg, study design, population, and intervention characteristics). The data were analyzed using descriptive statistics and qualitative content analysis.

RESULTS

A total of 100 studies met the inclusion criteria. Our findings indicate that a variety of study designs are used to describe and evaluate online PNIs, with literature being published between 2003 and 2022 in Western countries. Of these studies, 39 (39%) studies were randomized controlled trials. In addition, we noticed an increase in reported online PNIs since 2019. The majority of studies involved White females with a diagnosis of cancer and a lack of participants aged 70 years or older was observed. Most online PNIs provide support through navigation, self-management and lifestyle changes, counseling, coaching, education, or a combination of support. Variation was noted in terms of mode of delivery, duration, and frequency. Only a small number of studies described theoretical frameworks or change mechanisms to guide intervention.

CONCLUSIONS

To our knowledge, this is the first review to comprehensively synthesize the existing literature on online PNIs, by focusing on the characteristics of interventions and studies in this area. Inconsistency in reporting the country of publication, population characteristics, duration and frequency of interventions, and a lack of the use of underlying theories and working mechanisms to inform intervention development, provide guidance for the reporting of future online PNIs.

Compassionate Release: A Call to Social Workers

An increase in the number of older people incarcerated in prisons has given rise to increased costs of correctional health care. Despite the many benefits of compassionate release, it is rarely used. Citing barriers at the micro, mezzo, and macro levels, we contend that social workers are uniquely suited to increase the number of people released through this mechanism owing to a unique knowledge and skill set. We offer eight specific strategies for how social workers can increase the use of compassionate release by working with individuals, conducting and disseminating research, and engaging in advocacy as shaped by core professional principles and values and related curricula.

Association between dietary branched-chain amino acids and multiple chronic conditions among older adults in Chinese communities

BACKGROUND

The association of BCAAs (isoleucine, leucine, and valine) with cardiovascular and cerebrovascular diseases has been widely recognized by researchers, but there is limited evidence to support the relationship between BCAAs and multiple chronic conditions (MCCs) in older adults. This study aimed to explore the correlation between BCAA levels in the diets of older adults and MCCs.

METHODS

Based on a health management cohort project in Nanshan District of Shenzhen, 4278 individuals over 65 years old were selected as participants via multi-stage stratified sampling from May 2018 to December 2019. Data were collected using a validated semi-quantitative food frequency questionnaire, as well as anthropometric and chronic disease reports. MCC was defined as the coexistence of two or more chronic diseases, namely, hypertension, dyslipidemia, diabetes, CAD, stroke, CKD, and CLD. Multivariate unconditional logistic regression analysis was used to analyze the relationship between dietary BCAAs and MCCs in older adults, and then, gender stratification analysis was performed. A restricted cubic spline model (a fitted smooth curve) was used to determine the dose-response relationship of isoleucine with MCCs.

RESULTS

A total of 4278 older adults aged 65 and above were included in this study, with an average age of 72.73 ± 5.49 years. The cohort included 1861 males (43.50%). Regardless of whether confounding factors were corrected, isoleucine was a risk factor for MCCs (OR = 3.388, 95%CI:1.415,8.109). After gender stratification, the relationships between dietary isoleucine and MCCs (OR = 6.902, 95%CI:1.875,25.402) and between leucine (OR = 0.506,95%CI:0.309,0.830) and MCCs were significant in women, but not in men. No significant association between valine and MCCs was observed. In addition, isoleucine was a risk factor for MCCs when its intake was greater than 4.297 g/d.

CONCLUSION

Isoleucine may play an important role in regulating age-related diseases. BCAAs such as isoleucine can be used as risk markers for MCCs in older adults.

Random forest model used to predict the medical out-of-pocket costs of hypertensive patients

Background

Precise prediction of out-of-pocket (OOP) costs to improve health policy design is important for governments of countries with national health insurance. Controlling the medical expenses for hypertension, one of the leading causes of stroke and ischemic heart disease, is an important issue for the Japanese government. This study aims to explore the importance of OOP costs for outpatients with hypertension.

Methods

To obtain a precise prediction of the highest quartile group of OOP costs of hypertensive outpatients, we used nationwide longitudinal data, and estimated a random forest (RF) model focusing on complications with other lifestyle-related diseases and the nonlinearities of the data.

Results

The results of the RF models showed that the prediction accuracy of OOP costs for hypertensive patients without activities of daily living (ADL) difficulties was slightly better than that for all hypertensive patients who continued physician visits during the past two consecutive years. Important variables of the highest quartile of OOP costs were age, diabetes or lipidemia, lack of habitual exercise, and moderate or vigorous regular exercise.

Conclusion

As preventing complications of diabetes or lipidemia is important for reducing OOP costs in outpatients with hypertension, regular exercise of moderate or vigorous intensity is recommended for hypertensive patients that do not have ADL difficulty. For hypertensive patients with ADL difficulty, habitual exercise is not recommended.

Association between standing height and physical disability among U.S. adults aged 60 years and older: findings from NHANES 2015-2018

BACKGROUND

Physical disability is an important cause of affecting the quality of life in the elderly. The association between standing height and physical disability is less studied.

PURPOSE

The purpose of this study is to investigate the possible link between standing height and physical disability among U.S. adults aged 60 years and older.

METHODS

The cross-sectional data were obtained from the US National Health and Nutrition Examination Survey (NHANES) 2015-2018. Physical disability was assessed by six questions: "Have serious difficulty hearing (SDH)?", "Have serious difficulty seeing (SDS)?", "Have serious difficulty concentrating (SDC)?", "Have serious difficulty walking (SDW)?", "Have difficulty dressing or bathing (DDB)?" and "Have difficulty doing errands alone (DDEA)?". Responses to these questions were "yes" or "no". Answer yes to one of the above six questions was identified as physical disability. Standing height (cm) was measured with an altimeter. Multivariate logistic regression was performed to examine the possible link between standing height and physical disability after adjustment for all covariates.

RESULTS

A total of 2624 participants aged ≥ 60 years were included in our study, including 1279 (48.7%) females and 1345 (51.3%) males. The mean age of participants was 69.41 ± 6.82 years. After adjusting for all potential confounders, the inverse relationship between standing height and all physical disability (APD) was statistically significant (OR = 0.976, 95%CI:0.957-0.995). In addition, among six types of physical disability (SDH, SDS, SDC, SDW, DDB, DDEA), standing height was also a protective factor for SDW (OR = 0.961, 95%CI:0.939-0.983) and DDEA (OR = 0.944, 95%CI:0.915-0.975) in the full-adjusted model.

CONCLUSION

The cross-sectional population based study demonstrates that standing height is a protective factor for physical disability among U.S. adults aged 60 years and older.

Remote Evidence-Based Programs for Health Promotion to Support Older Adults During the COVID-19 Pandemic and Beyond: Mixed Methods Outcome Evaluation

BACKGROUND

Evidence-based programs (EBPs) for health promotion were developed to reach older adults where they live, work, pray, and play. When the COVID-19 pandemic placed a disproportionate burden on older adults living with chronic conditions and the community-based organizations that support them, these in-person programs shifted to remote delivery. While EBPs have demonstrated effectiveness when delivered in person, less is known about outcomes when delivered remotely.

OBJECTIVE

This study evaluated changes in remote EBP participants' health and well-being in a national mixed methods outcome evaluation in January 1, 2021, to March 31, 2022.

METHODS

We used the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) for equity framework to guide the evaluation. We purposively sampled for diverse remote EBP delivery modes and delivery organizations, staff, and traditionally underserved older adults, including people of color and rural dwellers. We included 5 EBPs for self-management, falls prevention, and physical activity: videoconferencing (Chronic Disease Self-Management Program, Diabetes Self-Management Program, and EnhanceFitness), telephone plus mailed materials (Chronic Pain Self-Management Program), and enhanced self-directed mailed materials (Walk With Ease). Participant and provider data included validated surveys, in-depth interviews, and open-ended survey questions. We used descriptive statistics to characterize the sample and the magnitude of change and paired t tests (2-tailed) and the Fisher exact test to test for change in outcomes between enrollment and 6-month follow-up. Thematic analysis was used to identify similarities and differences in outcomes within and across programs. Joint display tables facilitated the integration of quantitative and qualitative findings.

RESULTS

A total of 586 older adults, 198 providers, and 37 organizations providing EBPs participated in the evaluation. Of the 586 older adults, 289 (49.3%) provided follow-up outcome data. The mean age of the EBP participants was 65.4 (SD 12.0) years. Of the 289 EBP participants, 241 (83.4%) were female, 108 (37.3%) were people of color, 113 (39.1%) lived alone, and 99 (34.3%) were experiencing financial hardship. In addition, the participants reported a mean of 2.5 (SD 1.7) chronic conditions. Overall, the remote EBP participants showed statistically significant improvements in health, energy, sleep quality, loneliness, depressive symptoms, and technology anxiety. Qualitatively, participants shared improvements in knowledge, attitudes, and skills for healthier living; reduced their social isolation and loneliness; and gained better access to programs. Three-fourths of the providers (149/198, 75.2%) felt that effectiveness was maintained when switching from in-person to remote delivery.

CONCLUSIONS

The findings suggest that participating in remote EBPs can improve health, social, and technological outcomes of interest for older adults and providers, with benefits extending to policy makers. Future policy and practice can better support remote EBP delivery as one model for health promotion, improving access for all older adults.

The FITNESS study: longitudinal geriatric assessment, treatment toxicity, and biospecimen collection to assess functional disability among older adults with lung cancer

Introduction

Older adults with chronic disease prioritize functional independence. We aimed to describe the feasibility of capturing functional disability and treatment toxicity among older adults with lung cancer using a longitudinal comprehensive geriatric assessment (CGA) and molecular biomarkers of aging.

Methods

This prospective study included adults ≥60 years with any newly diagnosed non-small-cell lung cancer. Participants were recruited from central Ohio (2018-2020). Study assessments included the Cancer and Aging Research Group CGA (CARG-CGA), short physical performance battery (SPPB), and the blessed orientation-memory concentration (BOMC) test at baseline, 3, 6, and 12 months. Activities of daily living (ADLs) and instrumental ADLs (IADLs), quality of life (QoL, PROMIS 10), and treatment toxicity were captured monthly. Stool and blood were collected to characterize the gut microbiome and age-related blood biomarkers.

Results

This study enrolled 50 participants with an average age of 71.7 years. Ninety-two percent of participants were Caucasian, 58% were male, and all were non-Hispanic. Most had advanced stage (stage III/IV: 90%; stage I/II: 10%), with adenocarcinoma the predominant histologic subtype (68% vs. 24% squamous). First-line treatments included chemotherapy (44%), immune checkpoint inhibitors (ICIs, 22%), chemotherapy and ICIs (30%), or tyrosine kinase inhibitors (4%). The median baseline CARG toxicity score was 8 (range 2-12). Among patients with treatment-related toxicity (n = 49), 39 (79.6%) cases were mild (grade 1-2), and 10 (20.4%) were moderate to severe (≥ grade 3). Treatment toxicity was greater among those with a CARG score ≥8 (28.0% vs. 13.6%). Higher IADL independence, QoL, and SPPB scores at baseline were positively associated with Candidatus Gastranaerophilales bacterium, Lactobacillus rogosae, and Enterobacteria phage P4. Romboutsia ilealis, Streptococcus, and Lachnoclostridium sp An138 and T cell lag3 and cd8a were associated with worse IADLs, QoL, and SPPB scores at baseline.

Discussion

A longitudinal CGA and biomarker collection is feasible among older adults undergoing lung cancer treatment. Gut microbe and T cell gene expression changes correlated with subjective and objective functional status assessments. Future research will test causality in these associations to improve outcomes through novel supportive care interventions to prevent functional disability.

Effect of long-term care insurance in a pilot city of China: Health benefits among 12,930 disabled older adults

BACKGROUND

The surge of disabled older people have brought enormous burdens to society. The aim of this study was to examine the impact of long-term care insurance (LTCI) implementation on mortality and changes in physical ability among disabled older adults.

METHODS

This was a prospective observational study based on data from the government-led LTCI program in a pilot city of China from 2017 to 2021. Administrative data included the application survey of activities of daily living (ADL), the baseline characteristics and all-cause mortality. Return visit surveys of ADL were conducted between August 2021 and December 2021. A regression discontinuity model was used to analyze the impact of LTCI on mortality.

RESULTS

A total of 12,930 individuals older than 65 years were included in this study, and 10,572 individuals were identified with severe disability and participated in the LTCI program. LTCI implementation significantly reduced mortality by 5.10 % (95 % CI, -9.30 % to -0.90 %) and extended the survival time by 33.74 days (95 % CI, 13.501 to 53.970). The ADL scores of the LTCI group dropped by 2.5 points on average, while the ADL scores of those did not participated in LTCI dropped by 25.0 points. The heterogeneity analysis revealed that the impact of LTCI on mortality reduction was more significant among females, individuals of lower age, those who were married, cared for by family members, and who lived in districts with rich care resources.

CONCLUSIONS

LTCI implementation had a favorable impact on the mortality and physical ability of participants.

Low grip strength and gait speed as markers of dependence regarding basic activities of daily living: the FIBRA study

OBJECTIVE

Marincolo et al. showed that older adults without limitations in basic activities of daily living at baseline presented with an 11.7% concomitant presence of functional dependence, slow gait speed, and low muscle strength at follow-up. Slow gait speed remains a predictor of dependence in basic activities of daily living. To determine whether low muscle strength and low gait speed increase the risk of disability related to basic activities of daily living in community-dwelling older adults.

METHODS

A longitudinal study (9 years of follow-up) was conducted with 390 older adults who were independent in basic activities of daily living at baseline and answered the Katz Index at follow-up. Associations were determined using Pearson's χ2 test with a 5% significance level and logistic regression analysis.

RESULTS

Increases in prevalence between baseline and follow-up were observed for low muscle strength (17.5%-38.2%), slow gait speed (26.0%-81.1%), and functional dependence (10.8%-26.6%). At follow-up, 11.7% of the participants had concomitant functional dependence, slow gait speed, and low muscle strength. Slow gait speed remained a predictor of dependence in basic activities of daily living (odds ratio=1.90; 95% confidence interval=1.06-3.41).

CONCLUSION

Slow gait speed is a predictor of functional dependence, constituting an important variable for screening functional decline.

The bidirectional relationship between activities of daily living and frailty during short-and long-term follow-up period among the middle-aged and older population: findings from the Chinese nationwide cohort study

Objective

Frailty and activities of daily living (ADL) disability are common conditions among older population. Studies on the bidirectional relationship between frailty and ADL are limited. The current study examined the cross-sectional and longitudinal associations between frailty and ADL in middle-aged and older Chinese individuals.

Methods

The data was collected through the China Health and Retirement Longitudinal Study (CHARLS), conducted in 2011, 2013, and 2015, encompassing 17,284 individuals aged ≥45 years. We excluded individuals without follow-up data. 2,631 participants finished the baseline survey. The definition of ADL disability encompasses difficulty in engaging in either basic activities of daily living (BADL) or instrumental activities of daily living (IADL). Frailty was assessed according to the Fried criteria. Logistic regression was utilized to examine odds ratios (ORs) and 95% confidence intervals (CIs) for assessing the cross-sectional relationships between ADL with frailty at baseline. The prediction effects were explored using Cox proportional hazards analysis, testing hazard ratios (HRs) and 95%CIs.

Results

In cross-sectional analysis, BADL [OR = 6.660 (4.519-9.815)], IADL [OR = 5.950 (4.490-7.866)], and ADL [OR = 5.658 (4.278-7.483)] exhibited significant associations with frailty; frailty demonstrated significant associations with BADL [OR = 6.741 (4.574-9.933)], IADL [OR = 6.042 (4.555-8.016)] and ADL [OR = 5.735 (4.333-7.591)]. In longitudinal analysis, IADL and ADL were significantly associated with frailty in participants without baseline frailty in the short-term period [IADL: HR = 1.971 (1.150-3.379), ADL: HR = 1.920 (1.146-3.215)], IADL exhibited a significant association with frailty in the long-term period [HR = 2.056 (1.085-3.895)]. There was no significant link observed between frailty and an elevated risk of disability onset in BADL, IADL and ADL during the short-term period. When considering the long-term perspective, frailty exhibited a significant association with an elevated risk of disability onset in BADL [HR= 1.820 (1.126-2.939)] and IADL [HR = 1.724 (1.103-2.694)].

Conclusion

In middle-aged and older adults, ADL and IADL disability predicted frailty after 2-year follow-up, IADL disability predicted frailty after 4-year follow-up. Moreover, frailty did not predict BADL, IADL and ADL disability after 2-year follow-up. However, frailty predicted BADL and IADL disability after 4-year follow-up.

"Returning to the core tasks": a qualitative interview study about how general practitioners in home health care solved problems during the COVID-19 pandemic

OBJECTIVE

Optimizing care at home, or home health care (HHC), is necessary as the population of care-dependent older people receiving care at home steadily increases. The COVID-19 pandemic tested Swedish primary care professionals as they provided HHC for a population of very frail older homebound people, but a better understanding of what healthcare workers did to manage the crisis may be useful for the further development of HHC. In this study, we aimed to understand how HHC physicians solved the problems of providing home healthcare during the pandemic to learn lessons on how to improve future HHC.

METHODS

This is a qualitative study of individual interviews with 11 primary care physicians working in HHC (8 women) from 7 primary care practices in Region Stockholm, Sweden. Interviews were conducted between 1 December 2020, and 11 March 2021. The data were analyzed using inductive thematic analysis.

RESULTS

We generated an overarching theme in our analysis: Physicians focus on core tasks and professional values in response to crisis. This theme incorporated three underlying subthemes describing this response: physicians prioritize and resolve ethically challenging situations in new ways, cultivate the patient perspective, and build on existing teams.

CONCLUSION

This study indicates that a healthcare system that gives HHC physicians agency to focus on core tasks and professional values could promote person-centered care.

Disability from cardiovascular diseases at Osh city, Kyrgyz Republic

Cardiovascular diseases (CVDs) are the leading global cause of death, contributing to health deterioration and increased healthcare expenses. Therefore, it is of interest to investigate the disability rates related to cardiovascular diseases at Osh city, Kyrgyz Republic. We report the prevalence of disability in both urban and rural areas, highlighting the impact of regional disparities in medical and social services. Data shows that adult cardiovascular disease impairment in Kyrgyzstan suggests challenges in accessing medical and social support, particularly in rural regions. Thus, the rural-urban divide in critical disability metrics impedes equitable research. Comprehensive assessments and interventions are imperative to mitigate cardiovascular diseases and associated disabilities in both rural and urban populations at Kyrgyz Republic.

Factors associated with changes in activities of daily living from admission to discharge among older patients with pneumonia

INTRODUCTION

It has not been fully elucidated that nutritional parameters affect the change of activities of daily living (ADL) during pneumonia treatment. This study assessed the impact of nutritional status, including erector spinae muscle (ESM) size on ADL changes from admission to discharge among older patients with community-acquired pneumonia (CAP).

METHODS

We retrospectively included patients (age: ≥65 years) who were admitted to the hospital for CAP and underwent chest computed tomography (CT) on admission. ADL was evaluated using the Barthel index, and patients were divided into the maintained or improved ADL group and the declined ADL group from admission through discharge. The ESM cross-sectional area was measured on a single-slice CT image. Logistic regression models were applied for assessing factors associated with changes in ADL.

RESULTS

A total of 523 patients hospitalized for CAP (median age 86 years) were evaluated. The declined group had significantly higher ADL levels on admission, a greater frequency of smoking history and malignancy, and a lower frequency of cerebrovascular disease and dementia. No significant difference in ESM size was observed between the groups. Multivariate analysis revealed that higher ADL levels on admission (odds ratio 1.034, interquartile range 1.026-1.043) and malignancy (3.002, 1.150-7.836) were associated with a decline in ADL, whereas cerebrovascular disease (0.579, 0.373-0.900) was related to improvement or maintenance of ADL.

CONCLUSIONS

Although nutritional status might not affect the change of ADL among older patients hospitalized with pneumonia, a cerebrovascular disease history may be a good predictor for ADL improvement.

Prevalence and patterns of comorbidities in people with disabilities and their associated socio-demographic factors

The presence of comorbidities among individuals with disabilities worsens their already complex health and social circumstances. This study aims to explore prevalence and patterns of morbidities among persons with disabilities in Bangladesh and identify associated socio-demographic factors. Data from 4270 persons with disability was analysed extracted from the 2021 Bangladesh National Household Survey on Persons with Disability. Outcome variable considered was the occurrence of morbidity among persons with disabilities. Explanatory variables encompassed factors at the individual, household, and community levels. Adjusted and unadjusted multilevel mixed-effects logistic regression model was used to explore association of outcome variable with explanatory variables. We found that approximately half of individuals with disabilities experienced one or more morbidities, with chronic conditions being the most prevalent (44%). Around 42% of total persons with disability were unable to work. Specifically, hypertension (18.3%), diabetes (9.1%), and heart problems (17.1%) were prevalent chronic conditions. The likelihood of experiencing comorbidity was found to be higher among females (aOR 1.3, 95% CI 1.1, 1.7), increase year of education (aOR, 1.1, 95% CI 1.0-1.2), and those from wealthier households (aOR 1.6, 95% CI 1.2, 2.2). This underscores the need for targeted policies and interventions addressing their distinct healthcare needs.

Loneliness among older Chinese individuals: the status quo and relationships with activity-related factors

BACKGROUND

With the rapid population aging, healthy aging has become a concern for society as a whole. In this study, loneliness and its relationships with activity-related individual factors were examined among older Chinese individuals from the perspective of mental health and daily leisure activities.

METHODS

The data were from the fourth investigation of the Sample Survey of the Aged Population in Urban and Rural China, which had a total of 220,506 participants. Activity ability was assessed by the Barthel Activity of Daily Living Index, a self-designed activity type questionnaire was used to evaluate activity participation, and loneliness was measured with a single-item question.

RESULTS

The prevalence of varying degrees of loneliness among Chinese older individuals was 36.6%. The prevalence of loneliness among the older individuals differed significantly by age gender, age, physical health status, annual household income, education level, marital status, living status, ethnic minority status, religious faith and territory of residence. There were differences in activity participation among older Chinese adults in terms of all the demographic factors mentioned above, while there were no significant differences in living status or religious faith, and significant differences in several other demographic factors in terms of activity ability. Self-care ability, as a form of activity ability, and activity participation significantly predicted loneliness among the older participants.

CONCLUSION

The topic of loneliness among Chinese older individuals is complex and requires greater attention. The buffering effect of activity-related factors on loneliness suggests that old people should improve their activity ability and participate more in daily activities.

The impact of falls on activities of daily living in older adults: A retrospective cohort analysis

BACKGROUND

Falls contribute to impairments in activities of daily living (ADLs), resulting in significant declines in the quality of life, safety, and functioning of older adults. Understanding the magnitude and duration of the effect of falls on ADLs, as well as identifying the characteristics of older adults more likely to have post-fall ADL impairment is critical to inform fall prevention and post-fall intervention. The purpose of this study is to 1) Quantify the association between falls and post-fall ADL impairment and 2) Model trajectories of ADL impairment pre- and post-fall to estimate the long-term impact of falls and identify characteristics of older adults most likely to have impairment.

METHOD

Study participants were from the Ginkgo Evaluation of Memory Study, a randomized controlled trial in older adults (age 75+) in the United States. Self-reported incident falls and ADL scores were ascertained every 6 months over a 7-year study period. We used Cox proportional hazards analyses (n = 2091) to quantify the association between falls and ADL impairment and latent class trajectory modeling (n = 748) to visualize trajectories of ADL impairment pre-and post-fall.

RESULTS

Falls reported in the previous 6 months were associated with impairment in ADLs (HR: 1.42; 95% CI 1.32, 1.52) in fully adjusted models. Based on trajectory modeling (n = 748), 19% (n = 139) of participants had increased, persistent ADL impairment after falling. Participants who were female, lived in a neighborhood with higher deprivation, or experienced polypharmacy were more likely to have ADL impairment post-fall.

CONCLUSIONS

Falls are associated with increased ADL impairment, and this impairment can persist over time. It is crucial that all older adults, and particularly those at higher risk of post-fall ADL impairment have access to comprehensive fall risk assessment and evidence-based fall prevention interventions, to help mitigate the negative impacts on ADL function.

Geriatric Psychiatrists' Perspectives on Palliative Care: Results From A National Survey

OBJECTIVES

Older adults with psychiatric illnesses often have medical comorbidities that require symptom management and impact prognosis. Geriatric psychiatrists are uniquely positioned to meet the palliative care needs of such patients. This study aims to characterize palliative care needs of geriatric psychiatry patients and utilization of primary palliative care skills and subspecialty referral among geriatric psychiatrists.

METHODS

National, cross-sectional survey study of geriatrics psychiatrists in the United States.

RESULTS

Respondents (n = 397) reported high palliative care needs among their patients (46-73% of patients). Respondents reported using all domains of palliative care in their clinical practice with varied comfort. In multivariate modeling, only frequency of skill use predicted comfort with skills. Respondents identified that a third of patients would benefit from referral to specialty palliative care.

CONCLUSIONS

Geriatric psychiatrists identify high palliative care needs in their patients. They meet these needs by utilizing primary palliative care skills and when available referral to subspecialty palliative care.

The Role of Nurses in Rehabilitation in Primary Health Care for Ageing Populations: A Secondary Analysis from a Scoping Review

Introduction

With the ageing of the global population and the rise in noncommunicable diseases, there is an increased need for rehabilitation services, especially those that address the specific needs of ageing populations. Through their proximity to patients, nurses play a critical role in providing rehabilitation interventions for older adults in primary health care. However, they are not yet established as typical rehabilitation providers and further research is needed to clarify their role and competencies to optimize rehabilitation interventions for ageing populations.

Objectives

Therefore, this secondary analysis of a scoping review aims to describe the role of nurses in the provision of rehabilitation interventions to ageing populations in primary health care.

Methods

This review was carried out following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. It is built on all inclusion and exclusion criteria from the primary analysis and focused on studies including nurses and taking place in primary health care. Data analysis included descriptive statistics, as well as qualitative analysis on the role of nurses.

Results

A total of 68 studies from high- and upper-middle income countries were included. Nurses typically had a managerial and clinical role (76%) and worked in multidisciplinary teams (54%), most often with physical therapists. Nurses provided 355 interventions, with assessments (n = 106; 30%), and coordination and management of the rehabilitation process (n = 105; 30%) being the most frequent ones. They had 117 different job titles and little information was available about their educational background.

Discussion

This paper contributes to a better understanding of the key role nurses play in providing rehabilitation interventions to ageing populations in primary health care. Matching nurses' competencies with their level of proficiency is essential to ensure quality care in rehabilitation.

Social isolation and risk of disability in older adults: Effect modification of metabolic syndrome

PURPOSE

Delaying the onset of disabilities is a social challenge, especially in an aging society. Social isolation (SI) and metabolic syndrome (MetS) can coexist and pose the risks of disability onset. However, their interaction is not proven in older adults. Therefore, this study investigated whether SI combined with MetS exacerbates disability onset in older adults.

MATERIALS AND METHODS

A total of 3,738 community-dwelling older adults underwent a health check-up. After baseline assessments, we followed them up to assess disability incidence for five years. SI was defined as a condition in which two or more of the following measures were met: domestic isolation, less social contact, and social disengagement. MetS was defined according to the criteria of the International Diabetes Federation. We used Cox proportional hazard regression used to identify the interaction effect of SI and MetS on the risk of disability onset after adjusting for potential confounding factors.

RESULTS

Multivariate Cox proportional hazard regression showed a significant interaction effect of SI and MetS on disability onset. In the subgroup analysis stratified by MetS status, SI was identified as a risk factor for disability onset only in the MetS group, but not in the non-MetS group.

CONCLUSIONS

This five-year longitudinal study showed that the co-occurrence of SI and MetS increased the risk of disability onset in older adults. This indicates that the assessment of MetS in socially isolated older adults is important for healthcare providers to delay the onset of disabilities.

Percepciones y experiencias de los adultos mayores con respecto a la actividad Sit-to-stand: Un estudio etnográfico de viabilidad previa

Resumen Objetivo: el propósito de este estudio de viabilidad previa fue examinar percepciones y experiencias con respecto a la actividad Sit-to-stand entre los adultos mayores de Brasil que viven en sus hogares en comunidades urbanas. Método: el método de exploración se enfocó en la etnografía. Se utilizó muestreo intencional para reclutar 20 adultos mayores. Se emplearon cinco medios para generar datos, a saber: encuestas sociodemográficas, observaciones participantes, entrevistas informales, entrevistas formales semiestructuradas y notas de campo. Para el análisis de los datos se recurrió a análisis de contenido cualitativo. Resultados: la experiencia de los adultos mayores con problemas de movilidad en relación con la actividad Sit-to-stand dependió de sus expectativas en torno a la movilidad, las cuales implicaron muchos factores que actuaron en conjunto para influenciar sus creencias y actitudes con respecto a la actividad, al igual que preferencias, conductas y percepciones culturales. Aparentemente, a los participantes de este estudio la actividad les resultó amena; sin embargo, los inconvenientes más notorios para adoptar la actividad Sit-to-stand surgió en la forma de déficits en sus necesidades personales e intrapersonales. Conclusión: las recomendaciones resultantes de los hallazgos del estudio indican la necesidad de diseñar estrategias de implementación para la intervención Sit-to-stand a la medida de las necesidades de este grupo poblacional específico.