A non-linear relationship between blood pressure and mild cognitive impairment in elderly individuals: A cohort study based on the Chinese longitudinal healthy longevity survey (CLHLS)

BACKGROUND

Hypertension is an established risk factor for mild cognitive impairment (MCI) in elderly individuals. Nevertheless, the impact of different levels of blood pressure on the progression of MCI remains uncertain. This study aims to investigate the non-linear relationship between blood pressure and MCI in the elderly and detect the critical blood pressure threshold, thus, improving blood pressure management for individuals at high risk of MCI.

METHODS

Data was obtained from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) cohort. We chose normal cognitive elderly individuals who entered the cohort in 2014 for a 5-year follow-up to observe the progression of MCI. Subsequently, we utilized the Cox regression model to identify risk factors for MCI and conducted a Cox-based restricted cubic spline regression (RCS) model to examine the non-linear relationship between systolic blood pressure (SBP) and diastolic blood pressure (DBP) with MCI, determining the critical blood pressure threshold for MCI progression.

RESULTS

In the elderly population, female (HR = 1.489, 95% CI: 1.017-2.180), lacking of exercise in the past (HR = 1.714, 95% CI: 1.108-2.653), preferring animal fats (HR = 2.340, 95% CI: 1.348-4.061), increased age (HR = 1.061, 95% CI: 1.038-1.084), increased SBP (HR = 1.036, 95% CI: 1.024-1.048), and increased DBP (HR = 1.056, 95% CI: 1.031-1.081) were associated with MCI progression. After adjusting factors such as gender, exercise, preferred types of fats, and age, both SBP (P non-linear < 0.001) and DBP (P non-linear < 0.001) in elderly individuals exhibited a non-linear association with MCI. The risk of MCI rose when SBP exceeded 135 mmHg and DBP was in the range of 80-88 mmHg. However, when DBP exceeded 88 mmHg, there was a declining trend in MCI progression, although the HR remained above 1. The identified critical blood pressure management threshold for MCI was 135/80 mmHg.

CONCLUSION

In this study, we discovered that risk factors affecting the progression of MCI in elderly individuals comprise gender (female), preferring to use animal fat, lack of exercise in the past, increased age, increased SBP, and increased DBP. Additionally, a non-linear relationship between blood pressure levels and MCI progression was confirmed, with the critical blood pressure management threshold for MCI onset falling within the prehypertensive range.

Association between multipollutant exposure and thyroid hormones in elderly people: A cross-sectional study in China

Environmental chemicals have been indicated to cause disruption of thyroid homeostasis in human populations. However, previous studies mostly focused on single group of chemicals. Herein, we investigate the independent and combined effects of multiple pollutants on thyroid homeostasis, including thyroid-stimulating hormone (TSH), total and free thyroxine (tT4 and fT4) and total and free triiodothyronine (tT3 and fT3) in elderly people. These environmental pollutants (n = 144) are from ten categories, including phenols, parabens, perfluoroalkyl substances (PFASs), polychlorinated biphenyls (PCBs), phthalate esters (PAEs), polycyclic aromatic hydrocarbons (PAHs), organochlorine pesticides (OCPs), organophosphate pesticides (OPPs), synthetic pyrethroids (SPs), herbicides, and metals. Few studies have evaluated the health risks of these 144 chemicals, especially their joint effects. In single-pollutant evaluations, multiple linear regression (MLR) models were used to estimate the independent associations between multiple exposures and thyroid biomarkers. In multi-pollutant evaluations, elastic net regression and Bayesian kernel machine regression (BKMR) models were used to estimate the combined associations. The MLR models showed that 41 chemicals were significantly related to THs levels. BKMR models revealed the most important chemical groups: metals for TSH, PAHs, SPs and PCBs for tT4, herbicides and SPs for tT3. This study will contribute to the understanding of multipollutant exposure and help prioritize specific chemical groups related to thyroid hormone disruption.

Results of objective brushing data recorded from a powered toothbrush used by elderly individuals with mild cognitive impairment related to values for oral health

OBJECTIVES

The study aimed to investigate how the objective use of a powered toothbrush in frequency and duration affects plaque index, bleeding on probing, and periodontal pocket depth ≥ 4 mm in elderly individuals with MCI. A second aim was to compare the objective results with the participants' self-estimated brush use.

MATERIALS AND METHODS

Objective brush usage data was extracted from the participants' powered toothbrushes and related to the oral health variables plaque index, bleeding on probing, and periodontal pocket depth ≥ 4 mm. Furthermore, the objective usage data was compared with the participants' self-reported brush usage reported in a questionnaire at baseline and 6- and 12-month examination.

RESULTS

Out of a screened sample of 213 individuals, 170 fulfilled the 12-month visit. The principal findings are that despite the objective values registered for frequency and duration being lower than the recommended and less than the instructed, using powered toothbrushes after instruction and information led to improved values for PI, BOP, and PPD ≥ 4 mm in the group of elderly with MIC.

CONCLUSIONS

Despite lower brush frequency and duration than the generally recommended, using a powered toothbrush improved oral health. The objective brush data recorded from the powered toothbrush correlates poorly with the self-estimated brush use.

CLINICAL RELEVANCE

Using objective brush data can become one of the factors in the collaboration to preserve and improve oral health in older people with mild cognitive impairment.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT05941611, retrospectively registered 11/07/2023.

Optimal cut-off MoCA score for screening for mild cognitive impairment in elderly individuals in China: A systematic review and meta-analysis

AIM

To evaluate the optimal cut-off MoCA score for elderly individuals with MCI.

DESIGN

A systematic review and meta-analysis.

METHOD

Articles were retrieved from PubMed, Ovid, Embase, The Cochrane Library, PsycINFO, CBM, CNKI, WanFang and CQVIP and were assessed by using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). Figures of the assessment were made by using Review Manager 5.3, and a meta-analysis of the data was conducted by using Bivariate Random-effects Meta-Analysis (BRMA) via Stata 14.0.

RESULTS

Seventeen articles were retrieved from the database, and when the cut-offs were 24/25 and 25/26, they represented the same diagnostic value; in addition, the AUC was 0.96, which demonstrated high predictive validity for mild cognitive impairment screening. However, the sensitivity was higher with 25/26 (se=0.95, sp=0.80), whereas the specificity was higher with 24/25 (se=0.92, sp=0.89).

Nomogram prediction model called "ADPLCP" for predicting linezolid-associated thrombocytopenia in elderly individuals

Background

Linezolid-associated thrombocytopenia (LAT) leads to drug withdrawal associated with a poor prognosis. Some risk factors for LAT have been identified; however, the sample size of previous studies was small, data from elderly individuals are limited, and a simple risk score scale was not established to predict LAT at an early stage, making it difficult to identify and intervene in LAT at an early stage.

Methods

In this single-center retrospective case-control study, we enrolled elderly patients treated with linezolid in the intensive care unit from January 2015 to December 2020. All the data of enrolled patients, including demographic information and laboratory findings at baseline, were collected. We analyzed the incidence and risk factors for LAT and established a nomogram risk prediction model for LAT in the elderly population.

Results

A total of 428 elderly patients were enrolled, and the incidence of LAT was 35.5% (152/428). Age ≥80 years old (OR=1.980; 95% CI: 1.179-3.325; P=0.010), duration of linezolid ≥ 10 days (OR=1.100; 95% CI: 1.050-1.152; P <0.0001), platelet count at baseline (100-149×109/L vs. ≥200×109/L, OR=8.205, 95% CI: 4.419-15.232, P <0.0001; 150-199 ×109/L vs. ≥200×109/L, OR=3.067, 95% CI: 1.676-5.612, P <0.001), leukocyte count at baseline ≥16×109/L (OR=2.580; 95% CI: 1.523-4.373; P <0.0001), creatinine clearance <50 mL/min (OR=2.323; 95% CI: 1.388-3.890; P=0.001), and total protein <60 g/L (OR=1.741; 95% CI: 1.039-2.919; P=0.035) were associated with LAT. The nomogram prediction model called "ADPLCP" (age, duration, platelet, leukocyte, creatinine clearance, protein) was established based on logistic regression. The area under the curve (AUC) of ADPLCP was 0.802 (95% CI: 0.748-0.856; P <0.0001), with 78.9% sensitivity and 69.2% specificity (cut-off was 108). Risk stratification for LAT was performed based on "ADPLCP." Total points of <100 were defined as low risk, and the possibility of LAT was <32.0%. Total points of 100-150 were defined as medium risk, and the possibility of LAT was 32.0-67.5%. A total point >150 was defined as high risk, and the probability of LAT was >67.5%.

Conclusions

We created the ADPLCP risk score scale to predict the occurrence of LAT in elderly individuals. ADPLCP is simple and feasible and is helpful for the early determination of LAT to guide drug withdrawal or early intervention.

The effect of aroma massage on constipation in elderly individuals

BACKGROUND

Constipation is a health problem commonly seen in the elderly individuals. Abdominal massage is thought to stimulate the rectal loading by increasing intra-abdominal pressure.

PURPOSE

To determine effects of aromatherapy massage on constipation in the elderly individuals.

METHODS

Forty eight elderly individuals with constipation were randomized to aromatherapy massage, and control groups. Massage was applied with oil blend to the experimental group during 3 weeks, once a day and lasting 15 min.

RESULTS

During aroma massage and after aroma massage in intervention group, mean scores related to 'defecation number', 'amount of feces' and 'consistency of feces' were increased and these increases were statistically significant. The mean scores related to 'straining during defecation' and 'feeling of incomplete discharge of feces' were decreased.

CONCLUSION

It was determined that aroma massage practice has increased 'frequency of defecation', 'amount of feces' and 'consistency of feces' but decreased the 'straining during defecation' and 'feeling of incomplete discharge of feces'.

Neutralising antibody responses to SARS-CoV-2 omicron among elderly nursing home residents following a booster dose of BNT162b2 vaccine: A community-based, prospective, longitudinal cohort study

BACKGROUND

The protective immunity against omicron following a BNT162b2 Pfizer booster dose among elderly individuals (ie, those aged >65 years) is not well characterised.

METHODS

In a community-based, prospective, longitudinal cohort study taking place in France in which 75 residents from three nursing homes were enrolled, we selected 38 residents who had received a two-dose regimen of mRNA vaccine and a booster dose of Pfizer BNT162b2 vaccine. We excluded individuals that did not receive three vaccine doses or did not have available sera samples. We measured anti-S IgG antibodies and neutralisation capacity in sera taken 56 (28-68) and 55 (48-64) days (median (range)) after the 2^nd and 3^rd vaccine doses, respectively. Antibodies targeting the SARS-CoV-2 Spike protein were measured with the S-Flow assay as binding antibody units per milliliter (BAU/mL). Neutralising activities in sera were measured as effective dilution 50% (ED50) with the S-Fuse assay using authentic isolates of delta and omicron BA.1.

FINDINGS

Among the 38 elderly individuals recruited to the cohort study between November 23^rd, 2020 and April 29^th, 2021, with median age of 88 (range 72-101) years, 30 (78.95%) had been previously infected with SARS-CoV-2. After three vaccine doses, serum neutralising activity was lower against omicron BA.1 (median ED50 of 774.5, range 15.0-34660.0) than the delta variant (median ED50 of 4972.0, range 213.7-66340.0), and higher among previously infected (ie, convalescent; median ED50 against omicron: 1088.0, range 32.6-34660.0) compared with infection-naive residents (median ED50 against omicron: 188.4, range 15.0-8918.0). During the French omicron wave in December 2021-January 2022, 75% (6/8) of naive residents were infected, compared to 25% (7/30) of convalescent residents (P=0.0114). Anti-Spike antibody levels and neutralising activity against omicron BA.1 after a third BNT162b2 booster dose were lower in those with breakthrough BA.1 infection (n=13) compared with those without (n=25), with a median of 1429.9 (range 670.9-3818.3) BAU/mL vs 2528.3 (range 695.4-8832.0) BAU/mL (P=0.029) and a median ED50 of 281.1 (range 15.0-2136.0) vs 1376.0 (range 32.6-34660.0) (P=0.0013), respectively.

INTERPRETATION

This study shows that elderly individuals who received three vaccine doses elicit neutralising antibodies against the omicron BA.1 variant of SARS-CoV-2. Elderly individuals who had also been previously infected showed higher neutralising activity compared with naive individuals. Yet, breakthrough infections with omicron occurred. Individuals with breakthrough infections had significantly lower neutralising titers compared to individuals without breakthrough infection. Thus, a fourth dose of vaccine may be useful in the elderly population to increase the level of neutralising antibodies and compensate for waning immunity.

FUNDING

Institut Pasteur, Fondation pour la Recherche Médicale (FRM), European Health Emergency Preparedness and Response Authority (HERA), Agence nationale de recherches sur le sida et les hépatites virales - Maladies Infectieuses Emergentes (ANRS-MIE), Agence nationale de la recherche (ANR), Assistance Publique des Hôpitaux de Paris (AP-HP) and Fondation de France.

Effects of low-density lipoprotein cholesterol on cardiovascular disease and all-cause mortality in elderly patients (≥75 years old)

PURPOSE

Although increased low-density lipoprotein cholesterol (LDL-C) is one of the major risk factors for the cardiovascular disease (CVD), the associations of LDL-C with CVD and all-cause mortality are unclear in elderly (≥75 years) individuals.

METHODS

A total of 3674 individuals aged 75 or older underwent medical examinations at the Kailuan Group from 2006 to 2007, including 3478 males (94.67%) and 196 females (5.33%). Participants were divided into three groups based on the LDL-C level: the ideal level (LDL-C < 100 mg/dl), appropriate level (100 mg/dl ≤ LDL-C < 130 mg/dl) and elevated level (LDL-C ≥ 130 mg/dl) groups. CVD and all-cause mortality events were recorded during the follow-up period. The Cox proportional hazards regression model was applied to evaluate the effects of LDL-C on CVD and all-cause mortality events.

RESULTS

The average follow-up time was 9.87 ± 3.60 years. After adjustment for confounding factors, the multivariate Cox proportional hazards regression model showed that the CVD risk in the elevated level group was 1.45 (95% CI, 1.08-1.95), acute myocardial infarction risk was 1.96 (95% CI, 1.19-3.24) and all-cause mortality risk was 1.18 (95% CI, 1.02-1.37) compared with those in the ideal level group. For every standard deviation increase in LDL-C levels, the CVD risk increased by 10%, acute myocardial infarction risk increased by 21% and all-cause mortality event risk increased by 4%. No association was observed between elevated LDL-C levels and the risk of stroke.

CONCLUSIONS

In the sample of older Chinese individuals investigated in the present study, elevated LDL-C levels (≥130 mg/dl) are a risk factor for CVD and all-cause mortality.

Evaluation of rehabilitation exercise effects by using gradation-based skeletal muscle echo intensity in older individuals: a one-group before-and-after trial study

Background

Higher muscle echo intensity (EI) reflects higher content of fat and/or connective tissue within skeletal muscle, eventually inducing lower muscle strength, physical dysfunction, and metabolic impairment. Continuous exercise decreases muscle EI in older individuals; however, it is not well understood how several months’ rehabilitation exercise affects gradation-based EI. The purpose of this study was to investigate the effects of 6 months of rehabilitation exercise on gradation-based higher and lower EI in older men and women.

Methods

Twenty-seven men and women (7 men, 20 women; age, 75.6 ± 6.4 years; height, 154.3 ± 8.5 cm; weight, 55.8 ± 9.7 kg) participated in this study. This study was a one-group before-and-after trial. They needed long-term care for activities of daily living. They performed rehabilitation exercises consisting of resistance exercises using a hydraulic resistance machine, stretching, and aerobic exercises using a recumbent bicycle once or twice a week for 6 months. B-mode ultrasonographic transverse image was taken from thigh muscles, e.g., rectus femoris, vastus lateralis, and biceps femoris. We calculated gradation-based cross-sectional area (CSA) from thigh muscles by dividing 256 greyscale level to 10 different components levels (e.g., 0–24, 25–49, 50–74, …, 200–224 and 225–249 a.u.).

Results

Lowest EI (e.g., 0–24 a.u.) CSA of thigh muscle was significantly increased after the exercise (0.3 ± 0.3 to 1.0 ± 0.8 cm²; P < 0.05). Middle to higher EI (e.g., 50–74, 75–99, 100–124, 125–149, 150–174, 175–199 and 200–224 a.u.) CSAs were significantly decreased from 23.0 to 68.7% after the exercise (P < 0.05).

Conclusions

Several months’ rehabilitation exercise affected both lower and higher EI in older men and women. This result suggests that rehabilitation exercise changes muscle composition by increasing contractile muscle tissue and decreasing fat and connective tissues.

Early warning of bloodstream infection in elderly patients with circulating microparticles

Background

The difficulty of early diagnosis of bloodstream infection in the elderly patients leads to high mortality. Therefore, it is essential to determine some new methods of early warning of bloodstream infection in the elderly patients for timely adjustment of treatment and improvement of prognosis.

Methods

Patients aged over 65 years with suspected bloodstream infections were included and divided into bloodstream infection (BSI) and non-bloodstream infection (non-BSI) groups based on blood culture results. The morphology of microparticles (MPs) was observed by using transmission electron microscopy, and the number of MPs was dynamically monitored by flow cytometry.

Results

A total of 140 patients were included in the study: 54 in the BSI group and 86 in the non-BSI group. Total MPs (T-MPs) ≥ 6000 events/µL (OR, 7.693; 95% CI 2.944–20.103, P < 0.0001), neutrophil-derived MPs (NMPs) ≥ 500 events/µL (OR, 12.049; 95% CI 3.574–40.623, P < 0.0001), and monocyte counts ≤ 0.4 × 10⁹/L (OR, 3.637; 95% CI 1.415–9.348, P = 0.007) within 6 h of fever were independently associated with bloodstream infection in the elderly patients. We also developed an early warning model for bloodstream infection in the elderly patients with an area under the curve of 0.884 (95% CI 0.826–0.942, P < 0.0001), sensitivity of 86.8%, specificity of 76.5%, positive predictive value of 70.8%, and negative predictive value of 89.8%.

Conclusion

The early warning model of bloodstream infection based on circulating T-MPs, NMPs, and monocyte counts within 6 h of fever in the elderly patients was helpful in early detection of bloodstream infection and therefore promptly adjustment of treatment plan.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13613-021-00901-w.

Dental implant status in elderly individuals requiring domiciliary dental care in Japan

Background

The presence of implants is a significant burden not only for dentists but also for caregivers and families of elderly individuals requiring nursing and domiciliary dental care. However, few reports have assessed the status of domiciliary dental care or measures employed to deal with related issues. Hence, we aimed to evaluate the dental implant status in elderly patients requiring nursing and domiciliary dental care and to determine the suitable measures for overcoming the associated limitations. A questionnaire was mailed to 1000 dentists who provided domiciliary dental care in the Tokyo metropolitan area of Japan. The questions were classified into three categories: basic information of the dentists, actual implant status of patients requiring domiciliary dental care, and implants in an aging society.

Results

The response rate was 36.5%. Approximately 2% of patients requiring domiciliary dental care were implant patients. Many implant-related problems were associated with insufficiency or difficulty in cleaning around the implant, resulting in peri-implantitis. Prosthetic and more serious complications such as implant body fracture or loss were reported and frequently managed by routine follow-ups, cleaning the area around the implant, scaling and polishing, and/or pharmacological modalities. Oral care mainly involved simple toothbrushing instructions, which was not adequate.

Conclusions

Our findings suggest the necessity of simplifying the oral environment and making oral care a simple task before aging individuals require nursing and domiciliary dental care.

A quasi-experimental evaluation of advance care planning improves consistency between elderly individuals and their surrogates regarding end-of-life care preferences: Development and application of a decision aid with cartoon pictures

OBJECTIVE

This study sought to develop a decision aid with cartoon pictures and evaluate its effectiveness in increasing consistency between elderly individuals and their surrogates regarding end-of-life care.

METHODS

A pre-post quasi-experimental design was adopted using the Life Support Preferences Questionnaire. The intervention had two components: (1) increasing participants' knowledge of medical treatments related to end-of-life care, and (2) sharing their end-of-life wishes. The experimental group received an intervention, whereas the control group received usual care.

RESULTS

A total of 110 participants in 55 pairs of elderly individuals with average aged 86.4 and their surrogates (27 in the experimental group, 28 in the control group) were recruited from a veterans hospital in northern Taiwan. Nearly 90 % of elderly individuals were male. The multiple linear regression showed that the inconsistent gap between elderly individuals and their surrogates in the experimental group decreased 12 points than the control group after controlling the covariances (B = -12.116, p = 0.032).

CONCLUSION

The intervention improved the consistency between elderly individuals and their surrogates regarding end-of-life care.

PRACTICE IMPLICATIONS

A decision aid with cartoon pictures may support the discussion of end-of-life care in older Asian populations.

Rural-urban and gender differences in the association between community care services and elderly individuals' mental health: a case from Shaanxi Province, China

Background

While community care services have been developing rapidly as a new way to meet the growing demands of elderly individuals in China, their health benefits are virtually unknown. Thus, the aim of this study was to examine the Chinese elderly individuals’ utilisation of community care services and its association with the mental health with comparing rural-urban and gender differences.

Methods

For this 2019 cross-sectional study, 687 elderly people from 7 counties (districts) of China’s Shaanxi province were enrolled. Respondents’ mental health level was assessed using a self-reported mental health measure. Four categories of community care services utilisation were examined: daily care services, medical care services, social and recreational services and spiritual comfort services. The binary logistic regression model was used in examining the association between community care services utilisation and mental health.

Results

Our results showed that there was a noted difference in mental health level between the male and female groups. Utilisation of medical care services and social and recreational services was significantly higher in the rural group than that in the urban group. Regression analysis showed that utilisation of daily care services (β = 0.809, p = 0.008) and social and recreational service (β = 0.526, p = 0.035) was significantly and positively associated with elderly individuals’ mental health level. Specifically, daily care services utilisation predicted a better mental health of the rural elderly (β = 1.051, p = 0.036) and the male elderly (β = 1.133, p = 0.053), while social and recreational services utilisation predicted a better mental health of the urban elderly (β = 0.927, p = 0.008) and the female elderly (β = 0.864, p = 0.007).

Conclusions

Our findings indicated varied levels of community care services utilisation and mental health are common among the elderly people in China. Community care services utilisation has a positive, albeit selective, association with elderly individuals’ mental health. Further policies should strengthen the equitable development of high-quality community care services in urban and rural areas to improve the mental health of elderly individuals, and focus more on gender differences in terms of community care services needs.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-06113-z.

Relationship between tongue pressure and back muscle strength in healthy elderly individuals

BACKGROUND

Aging is associated with a decrease in muscle mass and strength in swallowing muscles, as well as in whole-body muscles. A decrease in tongue pressure (TP) is related with whole-body function, and the trunk, including abdominal and back muscles, forms the core of the body. However, the direct relationship between TP and trunk muscle strength remains unclear.

AIMS

To clarify the association between back muscle strength, an indicator of trunk muscle strength, and TP in healthy elderly individuals.

METHODS

In all, 112 healthy community-dwelling individuals aged ≥ 60 years (men: 35, median age 74.0; women: 77, median age 69.0) were included. Body mass index (BMI), TP, and back muscle strength (BMS) were measured. Tooth loss pattern was evaluated by the Eichner classification. Participants were divided into two groups based on the median of the BMS and classified into three groups based on the Eichner index (Eichner A, B, and C). The effects of BMS and occlusal support on TP were analyzed.

RESULTS

In the low BMS group, there was a significant difference in TP between the Eichner B and Eichner C (p = 0.017) groups. However, in the high BMS group, occlusal support did not affect TP. Moreover, the explanatory factors for TP were BMS (β = 0.373, p = 0.001) and the Eichner index (β = 0.190, p = 0.036).

CONCLUSIONS

TP was correlated more with BMS than aging and occlusal support in healthy elderly individuals. This study indicated that the clinical evaluation of the whole body is important when assessing oral and swallowing function.

The neighborhood effect of exposure to blue space on elderly individuals' mental health: A case study in Guangzhou, China

Within the urban setting, blue space refers to all visible surface waters, including lakes, rivers, and coastal waters. Exposure to the natural environment, especially blue space, has been consistently linked to better mental health. While previous studies have disentangled the positive relationship between neighborhood blue space and mental health, scant attention has been paid to pathways through which neighborhood blue space affects mental health among Chinese urban elderly individuals. Based on questionnaire data collected from Guangzhou in 2018, remote sensing images, street-scapes, and other such sources, we extracted various blue space indicators. We employed multilevel linear regression modeling, mediating effect modeling to examine bio-psychosocial pathways and mechanisms linking exposure to blue space and elderly individuals' mental health. Propensity score matching method was employed to deal with selection bias. According to this empirical analysis, firstly, neighborhood exposure to blue space was significantly associated with elderly individuals' mental health. Secondly, environmental harm reduction, stress reduction, and social contact facilitation played a separate role in mediating the effect of blue space exposure on elderly individuals' mental health. These findings confirm the mediation pathways in the context of Chinese cities. Our research enriches the empirical research on blue space and public health from the perspective of health geography, and suggests the need for "healthy neighborhood" and "health aging" planning in Chinese settings.

Microbial contamination in herbal medicines: a serious health hazard to elderly consumers

Introduction

The use of herbal medicine is on the rise worldwide, and safety issues associated with herbal medicines may have an exacerbated impact in elderly because this population has an increased susceptibility and sensitivity to health complications due to the aging process.

Methods

This cross-sectional study was carried out at a primary health care unit in the city of Macapa, Brazil. The herbal medicines used and the sociodemographic characteristics of 123 voluntarily consenting participants were collected using a structured questionnaire. A total of 132 herbal medicines with oral or topical administration were donated by the elderly for microbial analysis before consumption, and 18 water samples used in the preparation of homemade herbal medicines were collected. Bacterial and fungal counts and identification of bacterial pathogens (Escherichia coli, Salmonella spp., Pseudomonas aeruginosa and Staphylococcus aureus) were performed according to the regulations of the Brazilian Pharmacopoeia and World Health Organization. Water analysis for the detection of coliforms and E. coli was carried out using Colilert® according to the manufacturer’s instructions and the techniques established by Standard Methods.

Results

Of the study participants, 78.8% were women. Bacterial growth was observed in samples from 51.5% of study and 35.6% had fungal growth. A total of 31.8% of the herbal medicine samples exceeded the safety limits (CFU/g ≤ 10⁵), including 16.7% of the homemade herbal medicines and 15.1% of the commercial herbal medicines. It was also found that 31.0% of the samples exceeded the safety limit for fungal growth. The microorganisms most commonly isolated from the herbal medicines were S. aureus (49.2%), followed by Salmonella spp. (34.8%), E. coli (25.8%), and P. aeruginosa (14.4%). Of water samples analyzed, 77.8% were positive for total coliforms (1 ml) and in 66.7% water samples E. coli was detected (1 ml), making them unfit for consumption.

Conclusions

The use of homemade and commercial herbal medicines is a major risk to the health of elderly who use these therapies due to the lack of microbial quality standards. We observed levels of viable bacteria and fungi that were above safety limits; in addition, we were able to isolate pathogenic bacteria from these herbal medicines.

Higher and Lower Muscle Echo Intensity in Elderly Individuals Is Distinguished by Muscle Size, Physical Performance and Daily Physical Activity

This study was performed to identify factors that discriminate muscle echo intensity (EI) among parameters of body composition, physical function and daily physical activity in elderly individuals. A total of 209 men and women (73.7 ± 2.8 y) were evaluated. EI was measured on ultrasonographic axial thigh muscle images. The participants were categorized into the low, mid and high EI groups. We measured the skeletal muscle mass index (SMI) and physical functions. The high EI group exhibited a significantly lower SMI, slower 5-m walking time and shorter 6-min walking distance than the low EI group and had a shorter moderate-intensity activity time than the mid EI group. As a result of the discriminant analysis, elderly individuals were categorized into EI groups by SMI, daily activity and physical function. The data indicate that morphologic and functional parameters and the daily activity level help to discriminate higher and lower muscle EI.

The Montreal Cognitive Assessment: Normative Data from a German-Speaking Cohort and Comparison with International Normative Samples

Background:

The Montreal Cognitive Assessment (MoCA) is used to evaluate multiple cognitive domains in elderly individuals. However, it is influenced by demographic characteristics that have yet to be adequately considered.

Objective:

The aim of our study was to investigate the effects of age, education, and sex on the MoCA total score and to provide demographically adjusted normative values for a German-speaking population.

Methods:

Subjects were recruited from a registry of healthy volunteers. Cognitive health was defined using the Mini-Mental State Examination (score ≥27/30 points) and the Consortium to Establish a Registry for Alzheimer’s Disease-Neuropsychological Assessment Battery (total score ≥85.9 points). Participants were assessed with the German version of the MoCA. Normative values were developed based on regression analysis. Covariates were chosen using the Predicted Residual Sums of Squares approach.

Results:

The final sample consisted of 283 participants (155 women, 128 men; mean (SD) age = 73.8 (5.2) years; education = 13.6 (2.9) years). Thirty-one percent of participants scored below the original cut-off (<26/30 points). The MoCA total score was best predicted by a regression model with age, education, and sex as covariates. Older age, lower education, and male sex were associated with a lower MoCA total score (p < 0.001).

Conclusion:

We developed a formula to provide demographically adjusted standard scores for the MoCA in a German-speaking population. A comparison with other MoCA normative studies revealed considerable differences with respect to selection of volunteers and methods used to establish normative data.

Altered immunogenicity of 23-valent pneumococcal polysaccharide vaccine in elderly patients with diabetes who revealed lower responses to concomitant administration of BIKEN varicella zoster vaccine: Results of post hoc analysis of a randomized double-blind trial

AIMS

This double-blind randomized controlled study of 52 elderly patients with diabetes assessed cell-mediated immunity and safety of BIKEN varicella-zoster vaccine (BVZV). Cellular and humoral responses to VZV at 3 months after BVZV and 23-valent polysaccharide pneumococcal vaccine (PPSV23) vaccination elicited poor results. Post-hoc analyses assessed the effects of immunogenicity of PPSV23.

METHODS

Using standardized enzyme-linked immunosorbent assay, pneumococcal 6B and 23F serotype-specific immunoglobulin G (IgG)-binding antibody concentrations were measured in stored samples retrospectively before administration and 3 months after. Responders increased more than twofold in at least one serotype-specific IgG.

RESULTS

The geometric mean concentration ratio (GMCR) of serum anti-pneumococcal 6B IgG was 1.76 (95%C.I.: 0.58, 5.34) in patients receiving concurrent PPSV23 and BVZV, compared to 2.39 (95%C.I.: 0.53, 10.76) in patients receiving PPSV23 and placebo (P = .055). The GMCR of serum anti-pneumococcal 23F IgG was 2.54 (95%C.I.: 0.57, 11.43) in PPSV23/BVZV vaccinees compared to 3.34 (95%C.I.: 0.84, 12.92) in PPSV23/placebo vaccinees (P = .424). Responder rates, those who developed antibodies to either/both serotypes, were 68% in the BVZV group and 85% in the placebo group (P = .007).

CONCLUSIONS

Results suggest that concurrent administration of BVZV influenced humoral responses to PPSV23 in elderly subjects with diabetes.

Norm values and psychometric properties of the brief symptom inventory-18 regarding individuals between the ages of 60 and 95

Objective

The SCL-90 and the SCL-90-R are the most applied measures regarding psychological distress. To reduce and prevent an overload to of the individuals, the Brief Symptom Inventory with 18 items (BSI-18) was developed based on the SCL-90. Since psychological disorders more frequently occur at an older age, there is a growing need for efficient instruments to measure distress in the elderly. However, the BSI-18’s psychometric properties, norm values, and factorial structure have not yet been investigated in this age group.

Methods

The aim of this study was to evaluate the BSI-18 in a sample of elderly people and to establish norm values for this specific population. Subsequently, demographic information and BSI-18 results were collected from a sample totaling 884 (55% female, mean age of 70.75 years, SD = 7.08, age range = 60–95 years). The questionnaire contains three six-item scales: somatization (SOMA), anxiety (ANX), and depression (DEPR), which form a general symptom index (GSI).

Results

We found an acceptable to good model fit for a three-factor-model with a general GSI factor. The BSI-18’s psychometric properties were satisfactory. Strict measurement invariance was shown for age and gender. Additionally, we found differences in psychological distress based on sociodemographic variables.

Conclusions

These findings underline the growing need for preventive mechanisms for elderly people such as, e.g., (re)activating their social networks and strengthening their physical and psychological well-being.

Immediate effects of wearing knee length socks differing in compression level on postural regulation in community-dwelling, healthy, elderly men and women

BACKGROUND

Stimulation of lower limbs' cutaneous receptors and mechanoreceptors through compression garments could potentially increase somatosensory system efficiency and aid postural regulation in elderly individuals.

RESEARCH QUESTION

This study examined immediate effects of wearing knee length socks (KLS) of various compression levels on somatosensory function in community-dwelling healthy elderly men and women during a double-limb standing, balancing task.

METHODS

A total of forty-six elderly participants (Male = 23), aged between 65 and 84 years old, randomly selected from the Singapore community-dwelling, healthy population. Three treatment interventions (wearing clinical compression socks; wearing non-clinical compression socks; wearing commercial socks) and one control condition (barefoot), in a counterbalanced order, were administered to participants while they performed a 30-s Romberg test, with four levels of performance difficulty: (1) standing on a stable surface with vision (SO); (2) a stable surface without vision (SC); (3) a foam surface with vision (FO); and (4), a foam surface without vision (FC).

RESULTS

Results showed that immediate effects of applying KLS of various compression levels significantly reduced sway area, trace length, velocity, and anterior-posterior (AP) sway as compared to barefoot condition (control) during the FO task condition.

SIGNIFICANCE

This finding indicates the positive immediate effects of garments on somatosensory system function and postural regulation in the elderly men and women, especially when standing on the unstable surface. Wearing compression KLS could be included as a viable intervention on top of other forms of balance training to reduce risk of falling in elderly people.

Epidemiology of facial fractures in the elderly

Facial fractures are considered more common in young individuals. However, they are also increasing in the aging population. Investigation of the characteristics of such fractures is important so as to be able to devise preventive measures and specifications for their proper treatment. We carried out a descriptive retrospective epidemiological study. The information was taken from a database of medical files of patients over 65 years of age in the setting of the emergency ward. Patient information was included for 157 patients aged 65 to 100 years. Two-thirds of the individuals with facial trauma were women. Twenty-eight had a prior history of cognitive impairment. For half of the cases, the trauma occurred at their place of residence, while accidents and falls in public areas were not uncommon. The most frequent site for the fractures was the middle third of the face. These facial fractures were serious in light of their location, as well as the associated skeletal and intracranial lesions. The number of such fractures can be expected to increase with time. Their hospital cost is higher than with younger individuals. Preventative measures need to be devised and the treatment should be all-encompassing.

What Does Successful Aging Mean? Lay Perception of Successful Aging Among Elderly Singaporeans

Objectives

We explore the culturally specific meaning of successful aging in Singapore, an ethnically diverse city-state in Asia. We aim to investigate lay perceptions of successful aging among the elderly individuals in Singapore and further examine variations of these perceptions.

Methods

We applied a mixed-method research design. Firstly, we conducted qualitative interviews with 49 elderly respondents, generating 12 main subjective components of successful aging. Next, we did a national survey with a sample of 1,540 local residents aged 50 to 69 years, in which respondents were asked to evaluate the importance of each subjective component of successful aging. We used the regression models and latent class analysis to analyze the correlatives of successful aging and to classify the elderly individuals by perception types.

Results

Among 12 components of successful aging, those related to self-sufficiency received the highest acknowledgment among the elderly individuals in Singapore. At least half of them simultaneously highlighted independence from family and dependence on family. Malays and Indians in Singapore valued more of the roles of spouse and children in successful aging, as compared with Chinese. The latent class analysis classified four groups of the elderly individuals according to their lay views on successful aging.

Discussion

As compared with the western model of successful aging, the elderly individuals in Singapore perceived successful aging with a strong focus on familism. These lay perceptions also significantly varied among these elderly individuals.

Effect of a physical training program using the Pilates method on flexibility in elderly subjects

The adaptations of the human body resulting from the aging process especially loss of flexibility can increase the risk of falls and the risk of developing other health conditions. Exercise training, in particular the Pilates exercise method, has become an important form of physical activity that minimizes the deleterious effects of aging on flexibility. Few studies have evaluated the effect of this training method on body flexibility among elderly. We aimed to evaluate the effects of physical training using the Pilates method on body flexibility of elderly individuals. Eighteen elderly women and two elderly men (aged 70 ± 4 years) followed a 10-week Pilates training program. Individuals were recruited from the local community via open invitations. At study entry, none of them had limited mobility (walking requiring the use of walkers or canes). Furthermore, those with neurologic, muscular, or psychiatric disorders as well as those using an assistive device for ambulation were excluded secondary to limited participation. Flexibility assessment tests (flexion, extension, right and left tilt, and right and left rotation of the cervical and thoracolumbar spine; flexion, extension, abduction, and lateral and medial right and left rotation of the glenohumeral joint; flexion, extension, abduction, adduction, and lateral and medial rotation of the right and left hip; and flexion of the right and left knee) were performed by a blinded evaluator using a flexometer before and after the training period. All assessments were carried out at the same time of day. There was an observed increase in flexion (22.86%; p < 0.001), extension (10.49%; p < 0.036), and rotation to the left side (20.45%; p < 0.019) of the cervical spine; flexion (16.45%; p < 0.001), extension (23.74%; p = 0.006), lateral bending right (39.52%; p < 0.001) and left (38.02%; p < 0.001), and right rotation (24.85%; p < 0.001) and left (24.24%; p < 0.001) of the thoracolumbar spine; flexion (right--8.80%, p = 0.034; left--7.03%, p = 0.050), abduction (right--20.69%, p < 0.001; left--16.26%, p = 0.005), and external rotation (right--116.07% and left--143%; p < 0.001 for both directions) of the glenohumeral joint; flexion (right--15.83%, p = 0.050; left--9.55%, p = 0.047) of the hips; and bending (right--14.20%, p = 0.006; left--15.20%, p = 0.017) the knees. The joint with the greatest magnitude of improvement was the thoracolumbar spine. Thus, this type of training may minimize the deleterious effects of aging and may improve the functionality of elderly individuals, which would reduce the likelihood of accidents (especially falls).

Cod liver oil consumption at different periods of life and bone mineral density in old age

Cod liver oil is a traditional source of vitamin D in Iceland, and regular intake is recommended partly for the sake of bone health. However, the association between lifelong consumption of cod liver oil and bone mineral density (BMD) in old age is unclear. The present study attempted to assess the associations between intake of cod liver oil in adolescence, midlife, and old age, and hip BMD in old age, as well as associations between cod liver oil intake in old age and serum 25-hydroxyvitamin D (25(OH)D) concentration. Participants of the Age, Gene/Environment Susceptibility-Reykjavik Study (age 66-96 years; n 4798), reported retrospectively cod liver oil intake during adolescence and midlife, as well as the one now in old age, using a validated FFQ. BMD of femoral neck and trochanteric region was measured by volumetric quantitative computed tomography, and serum 25(OH)D concentration was measured by means of a direct, competitive chemiluminescence immunoassay. Associations were assessed using linear regression models. No significant association was seen between retrospective cod liver oil intake and hip BMD in old age. Current intake of aged men was also not associated with hip BMD, while aged women with daily intakes had z-scores on average 0.1 higher, compared with those with an intake of < once/week. Although significant, this difference is small, and its clinical relevance is questionable. Intake of aged participants was positively associated with serum 25(OH)D: individuals with intakes of < once/week, one to six time(s)/week and daily intake had concentrations of approximately 40, 50 and 60 nmol/l respectively (P for trend < 0.001).

Elderly arrestees in police custody cells: implementation of detention and medical decision on fitness to be detained

INTRODUCTION

Most individuals detained in police custody are male adolescents or young adults. Demeaning custody conditions, which are common in French police cells, bring to light legitimate questions about the detention of elderly people. We aimed to determine the proportion of detainees over age 60, their health characteristics and conditions of detention, and the factors included in medical decisions on fitness to be detained.

METHODS

We studied all arrestees over age 60 examined in one year (January 1st-December 31st, 2009) by forensic physicians from our department. We collected data concerning their medical histories, their experiences in police custody, and their reported assaults.

RESULTS

Individuals over 60 accounted for 180 of 15,481 detainees (1%) and were predominantly male (92%). Some arrestees were examined several times during one or more detentions such that a total of 265 medical examinations were performed. Most individuals (133 of 172, 77%) reported one or more chronic somatic disorders and 115 of 160 (72%) were currently receiving treatment for a condition. Less half of two detainees (78 of 170, 46%) expressed some complaints during examination, commonly including pain (54 of 170, 32%), and 115 of 160 arrestees (72%) received medication while in custody. Detainees were considered to be completely fit for police custody in 119 of 259 cases (46%), and 25 of 259 cases (10%) were considered to be unfit to be detained.

DISCUSSION

The harsh conditions of police custody are particularly inappropriate for elderly individuals. Guidelines for custody officers and attending physicians that take the specific health needs of older detainees into account should be implemented.