Glycine supplementation can partially restore oxidative stress-associated glutathione deficiency in ageing cats

Intracellular levels of glutathione, the major mammalian antioxidant, are reported to decline with age in several species. To understand whether ageing affects circulating glutathione levels in cats, blood was sampled from two age groups, < 3 years and > 9 years. Further, to determine whether dietary supplementation with glutathione precursor glycine (GLY) affects glutathione concentrations in senior cats (> 8 years), a series of free GLY inclusion level dry diets were fed. Subsequently, a 16-week GLY feeding study was conducted in senior cats (> 7 years), measuring glutathione, and markers of oxidative stress. Whole blood and erythrocyte total, oxidised and reduced glutathione levels were significantly decreased in senior cats, compared with their younger counterparts (P ≤ 0·02). The inclusion level study identified 1·5 % free GLY for the subsequent dry diet feeding study. Significant increases in erythrocyte total and reduced glutathione were observed between senior cats fed supplemented and control diets at 4 weeks (P ≤ 0·03; maximum difference of 1·23 µM). Oxidative stress markers were also significantly different between groups at 8 (P = 0·004; difference of 0·68 nG/ml in 8-hydroxy-2'-deoxyguanosine) and 12 weeks (P ≤ 0·049; maximum difference of 0·62 nG/mG Cr in F2-isoprostane PGF2α). Senior cats have lower circulating glutathione levels compared with younger cats. Feeding senior cats a complete and balanced dry diet supplemented with 1·5 % free GLY for 12 weeks elevated initial erythrocyte glutathione and altered markers of oxidative stress. Dietary supplementation with free GLY provides a potential opportunity to restore age-associated reduction in glutathione in cats.

Nutrition and Aging in Dogs and Cats

Aging is often associated with chronic inflammation and declining health. Both veterinarians and owners of aging dogs and cats are interested in nutritional solutions and strategies to prevent signs of age-related disease, increase longevity, and improve quality of life. Physiological decreases in muscle mass, decreased immunity, and a decrease in sense acuity are some of the changes often seen in otherwise healthy senior pets; however, there may also be an increase in risk for pathologies such as renal, cardiovascular, musculoskeletal, and neoplastic diseases. Aging may also lead to cognitive decline and even cognitive dysfunction. Some nutritional strategies that may be helpful with the prevention and treatment of age-related diseases include supplementation with ω3 polyunsaturated fatty acids and antioxidant nutrients that can help modulate inflammation and benefit osteoarthritis, renal disease, cancer, and more. Supplementation with medium-chain triglycerides shows promise in the treatment of canine cognitive dysfunction as these may be metabolized to ketone bodies that are utilized as an alternative energy source for the central nervous system. Additionally, a high intake of dietary phosphorus in soluble and bioavailable forms can lead to renal disease, which is of greater concern in senior pets. There are no published guidelines for nutritional requirements specific to senior pets and as a result, products marketed for senior dogs and cats are highly variable.

Predictors of older people's intention to engage in cycling violation behaviour with an integrative model

In China, bicycles are a popular mode of transportation for senior citizens. A disproportionate number of traffic-related fatalities and injuries involve cyclists. The violation of cycling laws is a significant cause of cyclist crashes. Few studies have analyzed the cycling violation behaviour of seniors. Therefore, it is essential to examine the factors that influence older individuals' intention to engage in cycling violation behaviours. In this study, the effects of social-demographic characteristics, the exogenous constructs in the health belief model (HBM), and the theory of planned behaviour (TPB) on senior cyclists' violation intention were investigated using hierarchical regression analysis. Interviews were conducted with older cyclists in urban areas of Wuhan City, all above 60 years of age. The results showed that very little variance in behavioural intention could be explained by social-demographic factors. The TPB has a significantly greater capacity than the HBM to explain variance in behavioural intention. Perceived susceptibility, perceived benefit, cues to action, subjective norm and attitude significantly impacted behavioural intention, whereas perceived severity, perceived barrier and self-efficacy did not.

Healthy aging reduces dynamic balance control as measured by the simplified Star Excursion Balance Test

BACKGROUND

Detecting and classifying factors that contribute to age-related balance decline are essential for targeted interventions. Dynamic postural tests that challenge neuromuscular balance control are important to detect subtle deficits that affect functional balance in healthy aging.

RESEARCH QUESTION

How does healthy aging affect specific components of dynamic postural control as measured by the simplified Star Excursion Balance Test (SEBT)?

METHODS

Twenty healthy younger (18-39 years) and twenty healthy older (58-74 years) adults performed the standardized simplified SEBT, which involved standing on one leg and reaching the contralateral leg as far as possible in the anterior, posteromedial, and posterolateral directions. Optical motion capture was used to quantify the maximum reach distance normalized by body height (%H) for three repeated trials in each direction per leg. Linear mixed effects models and pairwise comparisons of estimated marginal means were used to assess differences (p < 0.05) in normalized maximum reach distance by age group, reach direction, and leg dominance. Intersubject and intrasubject variability were also assessed by age group using coefficients of variation (CV).

RESULTS

Healthy older adults had less dynamic postural control compared to younger adults, with shorter reach distances in the anterior (7.9 %), posteromedial (15.8 %), and posterolateral (30.0 %) directions (p < 0.05). Leg dominance and sex did not significantly affect SEBT score for either age group (p > 0.05). Low intrasubject variability (CV<0.25 %) was found for repeated trials in both the older and younger participants. Therefore, the comparatively higher intersubject variability (Range CV=8-25 %) was mostly attributed to differences in SEBT performance across participants.

SIGNIFICANCE

Quantifying dynamic postural control in healthy older adults in a clinical setting is important for early detection of balance decline and guiding targeted and effective treatment. These results support that the simplified SEBT is more challenging for healthy older adults, who may benefit from dynamic postural training to mitigate age-related decline.

The Experience of Families Accompanying a Senior to the Emergency Department: A Scoping Review

INTRODUCTION

Seniors are often accompanied by a family member to the emergency department. Families advocate for their needs and contribute to the continuity of care. However, they often feel excluded from care. To improve the quality and safety of care for seniors, it is necessary to consider the experience of families in the emergency department. The aim was to identify and synthesize the available scientific literature dealing with the experience of families accompanying a senior to the emergency department. To identify and synthesize the available scientific literature dealing with the experience of families accompanying a senior to the emergency department.

METHODS

A scoping review was conducted using the Arksey and O'Malley framework. Six databases were targeted. A description of the identified scientific literature and an inductive content analysis were performed.

RESULTS

Of the 3082 articles retrieved, 19 met the inclusion criteria. Most articles (89%) were published since 2010, were from nursing (63%), and used a qualitative research design (79%). The content analysis identified 4 main categories related to the experience of families accompanying a senior to the emergency department: (1) process leading to the emergency department, families feel uncertainty and ambiguity with the decision to go to the emergency department; (2) staying in the emergency department, families' experiences are influenced by the triage, the ED environment, and the interactions with ED personnel; (3) discharge from the emergency department, families consider that they should be part of the discharge planning; and (4) recommendations and possible solutions, there is a paucity of recommendations specifically focused on families.

DISCUSSION

The experience of families of seniors in the emergency department is multifactorial and part of a trajectory of care and health services.

Inflammaging and Osteoarthritis

Osteoarthritis is a highly prevalent disease particularly in subjects over 65 years of age worldwide. While in the past it was considered a mere consequence of cartilage degradation leading to anatomical and functional joint impairment, in recent decades, there has been a more dynamic view with the synovium, the cartilage, and the subchondral bone producing inflammatory mediators which ultimately lead to cartilage damage. Inflammaging is defined as a chronic, sterile, low-grade inflammation state driven by endogenous signals in the absence of infections, occurring with aging. This chronic status is linked to the production of reactive oxygen species and molecules involved in the development of age-related disease such as cancer, diabetes, and cardiovascular and neurodegenerative diseases. Inflammaging contributes to osteoarthritis development where both the innate and the adaptive immune response are involved. Elevated systemic and local inflammatory cytokines and senescent molecules promote cartilage degradation, and antigens derived from damaged joints further trigger inflammation through inflammasome activation. B and T lymphocyte populations also change with inflammaging and OA, with reduced regulatory functions, thus implicating self-reactivity as an additional mechanism of joint damage. The discovery of the underlying pathogenic pathways may help to identify potential therapeutic targets for the management or the prevention of osteoarthritis. We will provide a comprehensive evaluation of the current literature on the role of inflammaging in osteoarthritis and discuss the emerging therapeutic strategies.

Sex differences in risk factors for metabolic syndrome in middle-aged and senior hospital employees: a population-based cohort study

BACKGROUND

Several cross-sectional studies have reported risk factors for metabolic syndrome (MetS). However, these studies did not focus on sex differences in middle-aged and senior populations or employ a longitudinal design. These study design differences are important, as there are sex differences in lifestyle habits associated with MetS, and middle-aged and senior individuals have increased MetS susceptibility. Therefore, the purpose of this study was to examine whether sex differences influenced MetS risk over a ten-year follow-up period among middle-aged and senior hospital employees.

METHODS

This population-based and prospective cohort study enrolled 565 participants who did not have MetS in 2012 for a ten-year repeated-measurement analysis. Data were retrieved from the hospital's Health Management Information System. Analyses included Student's t tests, χ² tests and Cox regression. P < 0.05 indicated statistical significance.

RESULTS

Male middle-aged and senior hospital employees had an elevated MetS risk (hazard ratio (HR) = 1.936, p < 0.001). Men with more than four family history risk factors had an increased risk of MetS (HR = 1.969, p = 0.010). Women who worked shift duty (HR = 1.326, p = 0.020), had more than two chronic diseases (HR = 1.513, p = 0.012), had three family history risk factors (HR = 1.623, p = 0.010), or chewed betel nuts (HR = 9.710, p = 0.002) had an increased risk of MetS.

CONCLUSIONS

The longitudinal design of our study improves the understanding of sex differences in MetS risk factors in middle-aged and senior adults. A significantly elevated risk of MetS over the ten-year follow-up period was associated with male sex, shift work, the number of chronic diseases, the number of family history risk factors, and betel nut chewing. Women who chewed betel nuts had an especially increased risk of MetS. Our study indicates that population-specific studies are important for the identification of subgroups susceptible to MetS and for the implementation of hospital-based strategies.

Increasing pneumococcal vaccine uptake in older adults: a scoping review of interventions in high-income countries

BACKGROUND

There is low uptake of the pneumococcal vaccination in eligible older adults, even in high-income countries that offer routine and universal vaccination programs.

OBJECTIVE

To systematically characterize interventions aimed at improving pneumococcal vaccine uptake in older adults.

DESIGN

We conducted a scoping review following PRISMA-SCr guidelines of five interdisciplinary databases: Medline-Ovid, Embase, CINAHL, PsychInfo, and Cochrane Library. Databases were searched from January 2015 until April 2020. The interventions were summarized into three pillars according to the European Union Conceptional Framework for Action: information campaigns, prioritization of vaccination schemes, and primary care interventions.

RESULTS

Our scoping review included 39 studies that summarized interventions related to pneumococcal vaccine uptake for older adults, encompassing 2,481,887 study participants (945 healthcare providers and 2,480,942 older adults) across seven countries. Examples of interventions that were associated with increased pneumococcal vaccination rate included periodic health examinations, reminders and decision-making tools built into electronic medical records, inpatient vaccination protocols, preventative health checklists, and multimodal educational interventions. When comparing the three pillars, prioiritization of vaccination schemes had the highest evidence for improved rates of vaccination (n = 14 studies), followed by primary care interventions (n = 8 studies), then information campaigns (n = 5 studies).

CONCLUSION

Several promising interventions were associated with improved outcomes related to vaccine uptake, although controlled study designs are needed to determine which interventions are most effective.

Prevalence of healthy aging among community dwelling adults age 70 and older from five European countries

Background

To compare the prevalence of healthy aging among adults age 70 and older from 5 European countries recruited for the DO-HEALTH clinical trial. Participants were selected for absence of prior major health events.

Methods

Cross-sectional analysis of DO-HEALTH baseline data. All 2,157 participants (mean age 74.9, SD 4.4; 61.7% women) were included and 2,123 had data for all domains of the healthy aging status (HA) definition. HA was assessed based on the Nurses` Health Study (NHS) definition requiring four domains: no major chronic diseases, no disabilities, no cognitive impairment (Montreal Cognitive Assessment, MoCA ≥25), no mental health limitation (GDS-5 <2, and no diagnosis of depression). Association between HA and age, BMI, gender, and physical function (sit-to-stand, gait speed, grip strength) was assessed by multivariate logistic regression analyses adjusting for center.

Results

Overall, 41.8% of DO-HEALTH participants were healthy agers with significant variability by country: Austria (Innsbruck) 58.3%, Switzerland (Zurich, Basel, Geneva) 51.2%, Germany (Berlin) 37.6%, France (Toulouse) 36.7% and Portugal (Coimbra) 8.8% (p <0.0001). Differences in prevalence by country persisted after adjustment for age. In the multivariate model, younger age (OR = 0.95, 95% CI 0.93 to 0.98), female gender (OR = 1.36, 95% CI 1.03 to 1.81), lower BMI (OR = 0.94, 95% CI 0.91 to 0.96), faster gait speed (OR = 4.70, 95% CI 2.68 to 8.25) and faster performance in sit-to-stand test (OR = 0.90, 95% CI 0.87 to 0.93) were independently and significantly associated with HA.

Conclusions

Despite the same inclusion and exclusion criteria preselecting relatively healthy adults age 70 years and older, HA prevalence in DO-HEALTH varied significantly between countries and was highest in participants from Austria and Switzerland, lowest in participants from Portugal. Independent of country, younger age, female gender, lower BMI and better physical function were associated with HA.

Trial registration

DO-HEALTH was registered under the protocol NCT01745263 at the International Trials Registry (clinicaltrials.gov), and under the protocol number 2012–001249-41 at the Registration at the European Community Clinical Trial System (EudraCT).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-02755-8.

The price elasticity of senior housing demand: is it a necessity or a luxury?

Senior housing properties provide tailored lifestyle, housing, and personal care services to aging adults. Having emerged from needs-based settings, senior housing is typically viewed as a necessity. As a result, demand estimates often rely on assumed utilization rates. We use monthly data beginning in 2017 to model occupied senior housing units as a function of price and a time trend. Our two-stage least squares approach provides an estimate of senior housing's price elasticity of demand. Results show elasticity coefficients of greater than one, implying senior housing market is more of a luxury than a necessity.

Distinct health-related risk profiles among middle-aged and older adults with risky alcohol use from the Danish general population

BACKGROUND

Knowledge is lacking on distinct health-related risk profiles among the substantial group of middle-aged and older adults with risky alcohol use (AU). Such profiles could inform the planning of interventions and prevention.

AIMS

To 1) identify distinct health-related profiles based on different types of health-related functioning limitations and distress and 2) assess associations between these profiles and age, sex, and health-relevant behaviors (e.g., smoking).

METHODS

Cross-sectional nation-wide Danish health survey with n = 6630 adults aged 55-64 and n = 7605 aged 65-74 with at least risky AU (>84 g ethanol/week in women, >168 in men). Health-related risk profiles were identified with Latent Class Analysis (LCA). Multinomial regression was applied for the association between risk profiles and auxiliary variables.

RESULTS

A six-class LCA solution was found among 55-64 year-olds (classes: 'Normative' [61%], 'Distress' [6%], 'Mental health limitations [5%]', 'Pain-related distress [10%]', 'Broad limitations and pain distress [7%]', 'High overall burden' [11%]) and a five-class solution among 65-74 year-olds. Most classes were comparable across age groups. The 'Distress'-class characterized by pain-distress, tiredness-distress, and sleep-related distress (6%) only showed in the younger group. In both age groups, auxiliary covariates (high-risk AU, possible alcohol use disorder, weekly smoking) were positively associated with problematic profile membership (vs. normative class membership).

CONCLUSION

Middle-aged and older adults with risky AU have distinct health-related profiles relevant for the form and content of prevention and interventions. Despite their distinct features, almost all problematic health profiles warrant careful attention regarding high-risk AU and probable alcohol use disorder.

Clinical characteristics of central serous chorioretinopathy in patients by age

PURPOSE

To investigate the clinical characteristics of central serous chorioretinopathy (CSC) with age.

STUDY DESIGN

Retrospective, cross-sectional study.

METHODS

One-hundred and forty-seven CSC patients were classified into three age groups (aged <50 years (younger group; n=53), 50-70 years (middle group; n=68), and >70 years (senior group; n=26)) and the characteristics were compared. Bilateral ophthalmic evaluation included the best corrected visual acuity (BCVA), spherical equivalents, fundus examination, fundus autofluorescence, optical coherence tomography (OCT), fluorescein angiography (FA), and indocyanine green angiography.

RESULTS

The male/female ratio became lower at more advanced ages (P=0.011). Bilateral macular abnormalities were observed more frequently in the senior group than the other groups (p=0.018) and multiple drusen were characteristic in the senior group (p<0.0001). The more advanced age groups displayed a worse BCVA (P=0.002). The rate of eyes with flat retinal pigment epithelium (RPE) elevation on OCT was significantly higher in the middle group than the other groups (P=0.024). The mean subfoveal choroidal thickness (SCT) was thickest in the younger group (P<0.0001). Unifocal leakage on FA and choroidal vascular hyperpermeability were mostly found in eyes of the younger group (P<0.001,P=0.020).

CONCLUSION

CSC cases in those aged >70 years were associated with an increased proportion of women and having bilateral macular abnormalities, multiple drusen, and multifocal leakage sites. The BCVA and the SCT decreased with age. Patients with CSC aged 50-70 years had the highest rate of flat RPE elevation on OCT. These characteristics need to be considered to make an accurate diagnosis, particularly in elderly patients.

The needs of older patients in hospital care: a scoping review

BACKGROUND

Research into care for older patients in the hospital environment has become an increasingly valuable source of information, as it gives feedback on the quality of hospital care provided. The aim of this study is to provide a comprehensive overview of the self-reported needs of older people in hospital care.

METHODS

The scoping review was conducted by searching the following databases: Medline, Web of Science, ProQuest Central, Scopus, Cinahl, PsycINFO and Summon.

RESULTS

The search identified articles focusing on older people in hospital care. The majority of these articles address the system and quality of care for seniors at a somewhat general and theoretical level. Met and unmet needs were assessed by a variety of test methods focusing mainly on medical issues (e.g., Mini-Nutritional Assessment, ADLs-activities of daily living, Abbey Pain Scale) and mostly from the perspective of hospital staff, carers and relatives. Only 15 articles used assessments based on information and opinions obtained from the seniors themseAbstract_Paralves (self-reported needs). A thematic analysis revealed seven main themes: conduct and care in emergency departments, dignity, nutritional care, satisfaction of patients' needs, pain, caring with respect, decision-making and spiritual needs.

CONCLUSION/DISCUSSION

The results of this scoping review suggest that more attention should be focused on information acquired from the patients themselves, as it is only the patient, however, old or frail, who can offer an accurate perspective on met or unmet needs and the quality of care provided.

2021 AAFP Feline Senior Care Guidelines

The '2021 AAFP Feline Senior Care Guidelines' are authored by a Task Force of experts in feline clinical medicine and serve as an update and extension of those published in 2009. They emphasize the individual patient evaluation and the process of aging, with references to other feline practice guidelines for a more complete discussion of specific diseases. Focusing on each cat encourages and empowers the owner to become a part of the cat's care every step of the way. A comprehensive discussion during the physical examination and history taking allows for tailoring the approach to both the cat and the family involved in the care. Videos and analysis of serial historical measurements are brought into the assessment of each patient. These Guidelines introduce the emerging concept of frailty, with a description and methods of its incorporation into the senior cat assessment. Minimum database diagnostics are discussed, along with recommendations for additional investigative considerations. For example, blood pressure assessment is included as a minimum diagnostic procedure in both apparently healthy and ill cats. Cats age at a much faster rate than humans, so practical timelines for testing frequency are included and suggest an increased frequency of diagnostics with advancing age. The importance of nutrition, as well as senior cat nutritional needs and deficiencies, is considered. Pain is highlighted as its own syndrome, with an emphasis on consideration in every senior cat. The Task Force discusses anesthesia, along with strategies to allow aging cats to be safely anesthetized well into their senior years. The medical concept of quality of life is addressed with the latest information available in veterinary medicine. This includes end of life considerations like palliative and hospice care, as well as recommendations on the establishment of 'budgets of care', which greatly influence what can be done for the individual cat. Acknowledgement is given that each cat owner will be different in this regard; and establishing what is reasonable and practical for the individual owner is important. A discussion on euthanasia offers some recommendations to help the owner make a decision that reflects the best interests of the individual cat.

Senior Pet Nutrition and Management

Senior dogs and cats commonly present to veterinary clinics for wellness examinations and for illness. Nutritional needs change in healthy elder pets compared with the young adult life stage. Veterinary health care teams must provide nutritional assessments and individual recommendations, recognizing there is no defined nutrient profile for seniors. Individual variation prevents a one-size-fits-all approach. Advancing age places pets at risk for developing medical conditions. Early detection can lead to earlier nutritional intervention to support recovery, health, and quality of life. However, comorbidities may present a nutritional conundrum, requiring prioritization of problems and nutritional triage to balance needs.

Available active surveillance follow-up protocols for small renal mass: a systematic review

PURPOSE

To evaluate follow-up strategies for active surveillance of renal masses and to assess contemporary data.

METHODS

We performed a comprehensive search of electronic databases (Embase, Medline, and Cochrane). A systematic review of the follow-up protocols was carried out. A total of 20 studies were included.

RESULT

Our analysis highlights that most of the series used different protocols of follow-up without consistent differences in the outcomes. Most common protocol consisted in imaging and clinical evaluation at 3, 6, and 12 months and yearly thereafter. Median length of follow-up was 42 months (range 1-137). Mean age was 74 years (range 67-83). Of 2243 patients 223 (10%) died during the follow-up and 19 patients died of kidney cancer (0.8%). The growth rate was the most used parameter to evaluate disease progression eventually triggering delayed intervention. Maximal axial diameter was the most common method to evaluate growth rate. CT scan is the most used, probably because it is usually more precise than kidney ultrasound and more accessible than MRI. Performing chest X-ray at every check does not seem to alter the clinical outcome during AS.

CONCLUSION

The minimal cancer-specific mortality does not seem to correlate with the follow-up scheme. Outside of growth rate and initial size, imaging features to predict outcome of RCC during AS are limited. Active surveillance of SRM is a well-established treatment option. However, standardized follow-up protocols are lacking. Prospective, randomized, trials to evaluate the best follow-up strategies are pending.

Impact of comorbid mental disorders on outcomes of brief outpatient treatment for DSM-5 alcohol use disorder in older adults

BACKGROUND

Relatively little is known about the prognostic value of comorbid mental disorders in alcohol use disorder (AUD) treatment for older adults (OA).

AIMS

This article aimed to investigate 1) the impact of current unipolar mood and anxiety disorders in AUD treatment success in OA, 2) the timing of this putative comorbidity impact over six months, and 3) the role of treatment length in comorbidity effects.

METHODS

We analyzed baseline and one-, three-, and six-month follow-up data from the international multicenter RCT "ELDERLY-Study" (baseline n = 693, median age: 64.0 years) using mixed effects regression models. In adults aged 60+ with DSM-5 AUD "ELDERLY" compared outpatient motivational enhancement therapy (MET, four sessions) with outpatient MET plus community reinforcement approach for seniors (MET & CRA-S; up to 12 sessions). Aiming for abstinence or minimal alcohol use (AU), both conditions included CBT-elements. We assessed AU with Form 90, and mental disorders with the Mini International Neuropsychiatric Interview (M.I.N.I.).

RESULTS

Mood-related disorders were associated with more drinks per day at baseline and greater reductions in drinks per day at one and six months (main effect mood disorder: Coef. 2.1, 95% CI 0.6-3.6; one month interaction effect: Coef. -1.9, 95% CI -3.3- -0.5; six months interaction effect: Coef. -2.1, 95% CI -3.5 - -0.6). These results were replicated within MET & CRA-S but not within MET.

CONCLUSION

Comorbid mental disorders had modest effects on short-term outpatient treatment outcomes. OA with AUD and unipolar mood-related disorders may profit from short interventions based on motivational interviewing and CBT-elements. ClinicalTrials.gov:NCT02084173.

Pharmacist and patient perspectives on recruitment strategies for randomized controlled trials: a qualitative analysis

BACKGROUND

Although recruitment is a major challenge for most randomized controlled trials, few report on the difficulties of recruitment, or how it might be enhanced. The objective of our study was to qualitatively explore the experiences of both patients and pharmacists related to recruitment for ACCESS, a large trial involving low-income seniors, given that two of our most successful recruitment strategies were direct patient recruitment materials and use of community pharmacists.

METHODS

Using qualitative descriptive methods, we collected data from pharmacists and study participants. Pharmacists were asked about their impressions of the study, as well as challenges they faced and methods they used to recruit potential participants. Focus groups with trial participants centered on the patient recruitment materials. Interviews and focus groups were recorded, transcribed and analyzed using thematic analysis.

RESULTS

Pharmacists noted that their first impressions of the study were positive as they described being enticed to help the study team by the potential benefit of copayment elimination for their patients and the low time commitment. Pharmacists noted they were more likely to recruit if they were well informed on the study, as they could answer their patients' questions. Participants noted that their primary motivations for participating were the tangible benefits of free medications and the intrinsic value of participating in research.

CONCLUSIONS

We noted that recruitment through pharmacies was an effective method as most patients have trusting relationships with their pharmacist. To optimize recruitment through pharmacies, study procedures should be straightforward, and pharmacists need to be equipped with good knowledge of the study. When promoting a study to potential participants, messaging should ensure the individuals are aware of the tangible benefits of participation while still presenting a full overview of the trial.

TRIAL REGISTRATION

Trial Registration Number: NCT02579655 - initially registered Oct 19, 2015.

Level of active aging: Influence of environmental, social and health-related factors

OBJECTIVE

To analyze social, environmental and health-related inequalities in the level of active aging among older adults who participated in the Health Survey conducted in the city of Campinas, Brazil.

METHODS

The level of active aging was estimated based on a ranking of engagement in activities using factor analysis. More active older adults (situated in the highest tertile of the ranking) were compared with the others through the prevalence ratios (PR) and respective 95 % confidence intervals (CI) estimated by Poisson regression.

RESULTS

The study population thus consisted of 986 older adults. The majority of the respondents were female (57.6 %), in the 60-69 years age group (56.7 %), had less than 8 years of schooling (65.3 %) and had a per capita family income of 1-3 minimum salaries (55.3 %). Access to public spaces for the practice of physical activity near the home (PR = 1.44; 95 % CI, 1.07-1.94) and higher level of education (PR = 2.14; 95 % CI, 1.60-2.86), income (PR = 1.73; 95 % CI, 1.25-2.40), physical health (PR = 1.44; 95 % CI, 1.13-1.82) and mental health (PR = 1.62; 95 % CI, 1.05-2.49) were more prevalent among older adults with a high level of active aging.

DISCUSSION

The findings demonstrate that the level of involvement in activities does not solely depend on personal choices. Social, economic, environmental, physical and mental contexts all exert a strong influence.

Longitudinal mixed methods study assessing caregivers of seniors across diverse populations: research protocol

Background

Canada’s aging population is increasing, along with the number of caregivers providing support to seniors. Caregiving is a taxing responsibility that often results in loneliness and distress. Creating awareness of available supports for caregivers is essential for their health and to provide the best support to the care recipients. This study aims to better understand and improve the caregiving experience for caregivers from diverse ethnic communities and the LGBTQI2S+ communities. The goal is to improve the well-being and resilience of caregivers and optimize outcomes for care recipients by delivering educational workshops that resemble the design of existing workshops currently offered by the participating social service agency. Content will be adapted based on identified participant learning needs. These workshops will be offered to the English-speaking community, diverse newcomer ethnic groups and the LGBTQI2S+ community.

Methods

This mixed-methods, longitudinal study includes two streams of caregivers; Stream One consists of English-speaking caregivers and care recipients while Stream Two includes individuals from the Afghan, Iranian, Somali-, Tamil- and Spanish-speaking populations and those belonging to LGBTQI2S+ communities. Each stream has two phases; Phase One includes needs assessments using focus groups and semi-structured interviews with caregivers and care recipients while Phase Two includes a pre-test post-test evaluation of educational workshops. The anticipated sample size for Phase One is 30 caregivers from the English-speaking community, 150 from the five linguistic/cultural communities combined and 30 from the LGBTQI2S+ group. For Phase Two, we plan to recruit 250 caregivers from the English-speaking community, 250 from the five linguistic/cultural communities, and 50 from the LGBTQI2S+ group.

Discussion

To provide caregivers with optimal support, we must acknowledge the caregivers and care recipients from diverse communities. Currently, at least two focus groups have been conducted with caregivers from each of the seven targeted groups and workshops have begun for all communities. Recruitment has been a challenge for all groups, but our team continues to conduct outreach with caregivers and will use our learning to inform the delivery of educational caregiver workshops.

Development of a senior-specific, citizen-oriented healthcare service system in South Korea based on the Canadian 48/6 model of care

Background

In the age of aging, Korea’s current medical delivery system threatens to increase the number of medical and caring refugees. This study attempts to develop an integrated senior citizen-oriented healthcare service system in which daily care, professional care, and rehabilitation are organically organized between medical institutions and local communities, thereby meeting the daily life needs of the elderly and inducing well-being, wellness, and well-dying.

Methods

To develop the integrated healthcare system, data collection and analyses were conducted through a systematic review, literature review, benchmarking, focus group interviews, and expert consultation.

Results

The senior-specific, citizen-oriented healthcare service system developed in this study is designed to screen patients aged 65 or older within 24 h of being admitted, using the Geriatric Screening for Care-10. If there is reason for concern as a result of the screening, further evaluation is performed through assessment. Doctors and nurses create a care plan and a discharge plan based on the results from the screening and assessment. The nurse further uses the screening to monitor the patient’s condition before discharge. Based on the screening results at the time of discharge, a transitional care plan is prepared and provided to elderly patients and/or their families. This process enables a systematic link between medical institutions and community resources, aiming for the continuous management of health issues. It also establishes a multidisciplinary treatment plan that considers patients and their families so that diseases common to the elderly are diagnosed and treated promptly.

Conclusions

The most important issue for the elderly is to be able to live healthily and independently for the rest of their lives through well-being, wellness, and well-dying. The senior-specific, citizen-oriented healthcare service proposed in this study is an integrated medical treatment system for elderly users the implementation of which requires the daily care, professional care, and rehabilitation of elderly members of society to be organically organized according to the role of the patients, their families, and the caregiver.

Relationships of inflamm-aging with circulating nutrient levels, body composition, age, and pituitary pars intermedia dysfunction in a senior horse population

Similarly to aged humans, senior horses (≥20 years) exhibit chronic low-grade inflammation systemically, known as inflamm-aging. Inflamm-aging in the senior horse has been characterized by increased circulating inflammatory cytokines as well as increased inflammatory cytokine production by lymphocytes and monocytes in response to a mitogen. Little is currently known regarding underlying causes of inflamm-aging. However, senior horses are also known to present with muscle wasting and often the endocrinopathy pituitary pars intermedia dysfunction (PPID). Despite the concurrence of these phenomena, the relationships inflamm-aging may have with measures of body composition and pituitary function in the horse remain unknown. Furthermore, nutrition has been a focus of research in an attempt to promote health span as well as life span in senior horses, with some nutrients, such as omega-3 fatty acids, having known anti-inflammatory effects. Thus, an exploratory study of a population of n = 42 similarly-managed senior horses was conducted to determine relationships between inflamm-aging and measures of circulating nutrients, body composition, age, and PPID. Serum was collected to determine vitamin, mineral, and fatty acid content. Peripheral blood mononuclear cells were also isolated to determine inflammatory cytokine production of interferon-γ (IFN-γ) and tumor necrosis factor-α (TNF-α) following stimulation with a mitogen, as well as to determine gene expression of interleukin(IL)-1β, IL-6, IL-10, IFN-γ, and TNF-α. Serum IL-6 and C-reactive protein were determined by enzyme-linked immunosorbent assay. Whole blood was collected for hematological and biochemical analysis. Body composition was evaluated via ultrasound and muscle scoring for all 42 horses as well as by deuterium oxide dilution for a subset of n = 10 horses. Pituitary function was evaluated by measuring basal adrenocorticotropin hormone concentrations as well as by thyrotropin releasing hormone stimulation testing (to determine PPID status). Results showed various relationships between inflammatory markers and the other variables measured. Most notably, docosadienoic acid (C22:2n6c), docosapentaenoic acid (C22:5n3c), and folate were positively associated with numerous inflammatory parameters (P ≤ 0.05). Although no relationships were found between inflamm-aging and PPID, being positive for PPID was negatively associated with vitamin B12 (P ≤ 0.01). No relationships between inflammation and body composition were found. Even within this senior horse population, age was associated with multiple parameters, particularly with numerous inflammatory cytokines and fatty acids. In summary, inflamm-aging exhibited relationships with various other parameters examined, particularly with certain fatty acids. This exploratory study provides insights into physiological changes associated with inflamm-aging in the senior horse.

Minimizing the impact of colorectal surgery in the older patient: The role of minimally invasive surgery in the geriatric population

With an aging population comes a greater incidence of colorectal cancer and a corresponding need for surgical resection in the geriatric population. This heterogeneous group of patients may benefit from multidisciplinary pre-operative evaluation and optimization, prehabilitation, enhanced recovery protocols, and a minimally invasive approach to resection. Concerns regarding the ability of the older patient to tolerate the physiologic demands of pneumoperitoneum have not been validated. Conversely, these vulnerable patients may experience a greater reduction in morbidity than their younger counterparts through the use of minimally invasive techniques.

[Psychometric properties of the questionnaire data on individual history of activity : Validity and reliability of the lifetime leisure physical activity questionnaire in community-dwelling older adults]

BACKGROUND

The lifetime leisure physical activity questionnaire (LLPAQ) is a derivative of the historical leisure activity questionnaire (HLAQ) of Kriska et al. (1988) for capture of the complete activity biography. The present study investigated the reliability and the validity of the LLPAQ of Engeroff and Vogt (2018).

METHODS

A total of 47 seniors (75-90 years old) participated in an objective measurement of activity and completed the LLPAQ. For validation of the questionnaire accelerometer-based data were compared with the subjective report in the LLPAQ on physical activity from the last year of life using a correlation analysis. Data from a second LLPAQ filled out by 14 participants (after 6 weeks) were used for reliability analysis (difference and correlation).

RESULTS

Subjectively captured data on the physical activity of the last year correlated with the objectively measured activity data (r = 0.311, p = 0.033). Although self-reporting overestimated the amount by almost 176%, test-retest data on MET-hours per episode showed a correlation (r = 0.824; p < 0.001). Check for internal consistency of individual episodes across the lifespan yielded a Cronbach's alpha of 0.8 (p < 0.001).

DISCUSSION

The LLPAQ showed good reliability values in the retest at 6 weeks, particularly considering the problem of manifold errors of subjective activity measurement in participants at old age. Regarding the discrepancy between the time periods of objective (1 week) and subjective (1 year) surveys, the proven medium effect strength indicates the high validity of the questionnaire.

Effect of medications on prevention of secondary osteoporotic vertebral compression fracture, non-vertebral fracture, and discontinuation due to adverse events: a meta-analysis of randomized controlled trials

BACKGROUND

Bone loss with aging and menopause increases the risk of fragile vertebral fracture, osteoporotic vertebral compression fracture (OVCF). The fracture causes severe pain, impedes respiratory function, lower the quality of life, and increases the risk of new fractures and deaths. Various medications have been prescribed to prevent a secondary fracture, but few study summarized their effects. Therefore, we investigated their effects on preventing subsequent OVCF via meta-analyses of randomized controlled trials.

METHODS

Electronic databases, including MEDLINE, EMBASE, CENTRAL, and Web of Science were searched for published randomized controlled trials from June 2015 to June 2019. The trials that recruited participants with at least one OVCF were included. We assessed the risk of bias of every study, estimated relative risk ratio of secondary OVCF, non-vertebral fracture, gastrointestinal complaints and discontinuation due to adverse events. Finally, we evaluated the quality of evidence.

RESULTS

Forty-one articles were included. Moderate to high quality evidence proved the effectiveness of zoledronate (Relative Risk, RR: 0.34; 95% CI, 0.17-0.69, p = 0.003), alendronate (RR: 0.54; 95% CI: 0.43-0.68; p < 0.0001), risedronate (RR: 0.61; 95% CI: 0.51-0.73; p < 0.0001), etidronate (RR, 0.50; 95% CI, 0.29-0.87, p < 0.01), ibandronate (RR: 0.52; 95% CI: 0.38-0.71; p < 0.0001), parathyroid hormone (RR: 0.31; 95% CI: 0.23-0.41; p < 0.0001), denosumab (RR, 0.41; 95% CI, 0.29-0.57; p < 0.0001) and selective estrogen receptor modulators (Raloxifene, RR: 0.58; 95% CI: 0.44-0.76; p < 0.0001; Bazedoxifene, RR: 0.66; 95% CI: 0.53-0.82; p = 0.0002) in preventing secondary fractures. Moderate quality evidence proved romosozumab had better effect than alendronate (Romosozumab vs. alendronate, RR: 0.64; 95% CI: 0.49-0.84; p = 0.001) and high quality evidence proved that teriparatide had better effect than risedronate (risedronate vs. teriparatide, RR: 1.98; 95% CI: 1.44-2.70; p < 0.0001).

CONCLUSION

Zoledronate, alendronate, risedronate, etidronate, ibandronate, parathyroid hormone, denosumab and selective estrogen receptor modulators had significant secondary prevention effects on OVCF. Moderate quality evidence proved romosozumab had better effect than alendronate. High quality evidence proved PTH had better effect than risedronate, but with higher risk of adverse events.

Measurement instruments for quantifying physical resilience in aging: a scoping review protocol

BACKGROUND

Physical resilience is the ability to optimize or recover motor function in the face of disease, injury, or aging-related decline. Greater knowledge of how some individuals regain or maintain function despite pathology may help identify protective factors and approaches that promote healthy aging. To date, a scoping review on physical resilience has not been conducted. The aims are to (1) identify measurement instruments for physical resilience, (2) synthesize and map the key concepts of physical resilience, and (3) identify gaps and make recommendations for future research.

METHODS

A scoping review of Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Medline Ovid, PsycINFO, and AgeLine databases will take place using the search strategy "resilience" AND (aging OR elderly OR older adult). The initial electronic search will be supplemented by hand searching the reference lists and review articles to identify any missing studies. Two parallel independent assessments of study eligibility will be conducted for the title, abstract, and full-text screens. To meet study inclusion criteria, the term "resilience" must be applied in relation to the physical health of older adults. Any disagreement will be resolved by consensus and a third reviewer consulted to make a decision if consensus is not achieved initially. Physical resilience information to be extracted are measurement instruments that describe the core domains of (1) body function or structure (signs or symptoms, etc.), (2) activity and participation (quality of life, etc.), and (3) societal impact. Tables and/or charts will map the data with distribution of studies by core domains. Finally, the amalgamation of results will be an iterative process whereby reviewers will refine the plan for presenting results after data extraction is completed so that all of the contents of the extraction may be included in the results.

DISCUSSION

The information gleaned in this scoping review will be essential to understand how physical resilience is currently measured and identify gaps for further research.

Identification and feasibility of social participation initiatives reducing isolation and involving rural older Canadians in the development of their community

BACKGROUND

Although some social participation initiatives exist to counter the isolation of older adults, none were identified and prioritized according to the needs of rural regional county municipalities (RCM), including in Canada.

AIMS

To identify and prioritize social participation initiatives for older Canadians, and to document the feasibility of their implementation in a rural RCM.

METHODS

An action research was used to identify, based on a review of scientific and grey literature, social participation initiatives, enriched and prioritized by the community. Facilitators, challenges, and advice for the implementation of these initiatives were documented through nine group discussions (n = 85).

RESULTS

Two social participation initiatives were identified as more relevant to the RCM, combined and adapted as the Benevolent Community to locate and assist isolated older adults. Two other initiatives were prioritized to identify transportation needs and solutions, and create a website on social participation activities available. Most participants perceived these initiatives as feasible, and will address older adults' social participation needs. Two facilitators were a field worker for older adults and the preoccupations of the community toward isolated older adults. The main challenges concerned the difficulty in recruiting volunteers and locating isolated older adults, exacerbated by the RCM's vast territory. Main advice involved suggestions of people for the recruitment of volunteers.

DISCUSSION

Through valuable collaboration with the community, initiatives were identified and prioritized, and challenges were raised, with anticipated success.

CONCLUSIONS

Further studies are needed to document the implementation and effects of these initiatives on the social participation of older adults in the RCM.

Persistence of pain quality in community-dwelling older adults with chronic non-cancer pain

Longitudinal assessment of chronic geriatric pain is complicated by an age-associated plateau in pain severity and increase in widespread pain, calling for innovative measures such as pain quality descriptors that characterize how pain may feel. We characterized persistence of pain quality and its relation to severity, activity interference and distribution of sites, in a population-based sample of adults aged≥70 years with chronic pain (n = 398). Persistent pain quality was defined as reporting descriptors within the same category: sensory, cognitive/affective, or neuropathic at baseline and 18 months. A count variable indicated number of persistent categories. Pain quality was highly persistent. Adjusted for baseline covariates, individuals endorsing 3 persistent categories were 2-2.5x more likely to experience more widespread pain at 18 months compared to fewer persistent categories. No associations were noted in changes in pain severity or interference. A comprehensive pain assessment that includes diverse pain quality descriptors may improve individualized pain management.

STEADI: CDC's approach to make older adult fall prevention part of every primary care practice

INTRODUCTION

Primary care providers play a critical role in protecting older adult patients from one of the biggest threats to their health and independence-falls. A fall among an older adult patient cannot only be fatal or cause a devastating injury, but can also lead to problems that can effect a patient's overall quality of life.

METHODS

In response, the Centers for Disease Control and Prevention (CDC) developed the STEADI initiative to give health care providers the tools they need to help reduce their older adult patient's risk of a fall.

RESULTS

CDC's STEADI resources have been distributed widely and include practical materials and tools for health care providers and their patients that are designed to be integrated into every primary care practice.

CONCLUSION

As the population ages, the need for fall prevention efforts, such as CDC's STEADI, will become increasingly critical to safeguard the health of Americans.

PRACTICAL APPLICATIONS

STEADI's electronic health records (EHRs), online trainings, assessment tools, and patient education materials are available at no-cost and can be downloaded online at www.cdc.gov/STEADI. Health care providers should look for opportunities to integrate STEADI materials into their practice, using a team-based approach, to help protect their older patients.

Active Surveillance in Small Renal Masses in the Elderly: A Literature Review

CONTEXT

Small renal masses have become increasingly common due to widespread imaging; however, optimal management of these lesions in the elderly can be complex due to the competing risks of intervention, natural history of disease, patient comorbidities, and expectations. In the properly selected elderly patient, active surveillance remains an accepted and attractive treatment approach.

OBJECTIVE

We completed a literature review of small renal masses (enhancing, <4cm, T1aN0M0 disease) in the elderly, aged ≥70 yr, aimed at identifying the utility of active surveillance in this population. The primary outcomes were conversion to active treatment while on active surveillance and cancer-specific mortality. Secondary outcomes included predictors of treatment, type of treatment performed (partial nephrectomy, radical nephrectomy, and ablation), progression to metastases, all-cause mortality, tumor growth rate, and demographic data including age and Charlson Comorbidity Index.

EVIDENCE ACQUISITION

A comprehensive search of electronic databases (e.g., MEDLINE, EMBASE, SCOPUS, Web of Science, and the Cochrane Library) using search terms "small renal mass" OR "SRM", AND "elderly," "senior," "aging," "geriatric," OR "octogenarian" was completed. All randomized controlled trials, nonrandomized comparison studies, and case series were included and screened by the reviewers. All comparison studies included in the systematic review were assessed for methodological quality using the Cochrane Risk of Bias tools.

EVIDENCE SYNTHESIS

Seventeen primary studies including 36495 patients met the inclusion criteria for the systematic review. All studies were retrospective institutional chart or the Surveillance, Epidemiology, and End Results database reviews. There was a low (4-26%) rate of conversion to active treatment for active surveillance in the identified studies over a follow-up interval of up to 91.5 mo. Overall mortality was substantial in this elderly cohort, with 15-51% of patients being deceased over the course of study follow-up; however, there was minimal cancer-specific mortality due to patients succumbing to alternative comorbid disease. In the future, patient comorbidity and biological age versus the natural history of the individualized tumor biology may play an increasing role in the discussion regarding treatment options and consideration of active surveillance.

CONCLUSIONS

Active surveillance is an effective management strategy in the elderly population. Few patients required the conversion to active treatment and there was low cancer-specific mortality. The majority of patients who expired over the course of the identified studies succumbed to alternative disease. The goal of treatment strategies should include weighing patient-specific prognosis relative to their competing health risks and treatment goals against the natural history of disease and risks of intervention.

PATIENT SUMMARY

In this review article, the authors examined the utility of active surveillance in the setting of a small localized renal mass in the elderly population. Despite being on surveillance, we found that cancer-specific outcomes were excellent, and overall mortality was often a result of comorbid disease. However, there is significant heterogeneity among elderly patients, and treatment approaches should be focused around patient-centered goals and prognosis.

Utilising dog-computer interactions to provide mental stimulation in dogs especially during ageing

Aged dogs suffer from reduced mobility and activity levels, which can affect their daily lives. It is quite typical for owners of older dogs to reduce all activities such as walking, playing and training, since their dog may appear to no longer need them. Previous studies have shown that ageing can be slowed by mental and physical stimulation, and thus stopping these activities might actually lead to faster ageing in dogs, which can result in a reduction in the quality of life of the animal, and may even decrease the strength of the dog-owner bond. In this paper, we describe in detail a touchscreen apparatus, software and training method that we have used to facilitate dog computer interaction (DCI). We propose that DCI has the potential to improve the welfare of older dogs in particular through cognitive enrichment. We provide hypotheses for future studies to examine the possible effects of touchscreen use on physiological, behavioural and cognitive measures of dogs' positive affect and well-being, and any impact on the dog-owner bond. In the future, collaborations between researchers in animal-computer interaction, dog trainers, and cognitive scientists are essential to develop the hardware and software necessary to realise the full potential of this training and enrichment tool.

Senior driving under the influence: A five-year retrospective study of alcoholized road-users aged 70 and over

The demographic development in Germany shows a steady increase to senior citizens. The driving suitability of older road-users is of large social and political concern, because awareness and reactivity can be influenced by age-related diseases and potential medication, particularly in combination with the consumption of alcohol. This study provides an overview of senior road-users under the influence of alcohol. Therefore, 404 cases of drunken-driving by road-users aged 70 and over within the purview of the Institute of Legal Medicine at Justus-Liebig-University, Giessen, from the years 2009-2013 were evaluated in retrospect. The vast majority of the drivers were male (88.4% of the cases). Distribution of the blood alcohol concentrations were almost equally in male and female drivers with 62.8% of all cases showing a blood alcohol concentration (BAC) of more than 1.1‰ and 10.9% a BAC of more than 2.0‰. In 48.5% of the cases, drunk driving was associated with an accident. 54.5% of the drivers stated suffering from at least one disease and 60% admitted a regular medication or an intake prior to the incident. Moreover, the collected data includes aspects such as the kind of traffic participation as well as neurological and physiological deficits of the road-users. If accidents were caused by drunk driving, the external circumstances and consequences of these accidents were analyzed, too. The evaluation revealed, that the standard medical examination protocol proved to be improbable to cover polypharmacy and multimorbidity of older alcoholized drivers. So, an evaluation and adaptation of the common medical examination protocol must be considered.

Acetabular Fractures in the Senior Population- Epidemiology, Mortality and Treatments

BACKGROUND

Management of acetabular fractures in the senior population can be one of the most challenging injuries to manage. Furthermore, treating surgeons have a paucity of information to guide the treatment in this patient population.

THE PURPOSE OF THIS STUDY WAS TO DETERMINE

(1) demographic and epidemiologic data, (2) mortality rates for nonoperative compared to operative management at different time points, (3) common fracture configurations, and (4) fracture fixation strategies in senior patients treated with acetabular fractures.

METHODS

Retrospective review of prospectively gathered data at a Level I trauma center over a five-year period. 1123 acetabular fractures were identified. 156 of them were for patients over the age of 65 (average age of 78).

RESULTS

Falls and motor vehicle accidents accounted for the two most common mechanisms of injury. 82% of patients had significant medical comorbidities. 51 patients (33%) died within one year, in which 75% of them died within 90 days of their acetabular fracture. 84% of the deceased patients, i.e. from the group of 51 patients, had non-operative treatment. For patients treated with traction alone, there was a 79% one-year mortality and 50% mortality rate within 90 days. Within the entire cohort, 70% had either an associated both-column (ABC) or anterior column/posterior hemitransverse (AC/PHT) fracture pattern. Fifty-seven patients (36.5%) underwent open reduction and internal fixation using standard reduction techniques and surgical implants via two main surgical exposures of ilioinguinal (69%) and Kocher-Langenbeck (29%).

CONCLUSION

Geriatric patients with acetabular fractures are uncommon accounting for only 14% of all acetabular fractures. Patients who undergo surgery show lower mortality rates. ABC and AC/PHT fracture patterns are the two most common fracture patterns. Routine fixation constructs and implants can be used to manage these challenging fractures. Most patients are unable to return to their homes and instead require skilled nursing facility during their convalescence.

Investigating the effectiveness of technologies applied to assist seniors: A systematic literature review

BACKGROUND

Recently, a number of Information and Communication Technologies have emerged with the aim to provide innovative and efficient ways to help seniors in their daily life and to reduce the cost of healthcare. Studies have been conducted to introduce an assistive technology to support seniors and to investigate the acceptance of these assistive technologies; however, research illustrating the effectiveness of assistive technologies is scant.

METHOD

This study undertakes a systematic literature review of ScienceDirect, PubMed, ProQuest and IEEE Explore databases to investigate current empirical studies on the assistive technologies applied in aged care. Our systematic review of an initial set of 2035 studies published from 2000 to 2014 examines the role of assistive technologies in seniors' daily lives, from enhancements in their mobility to improvements in the social connectedness and decreases in readmission to hospitals.

RESULTS

This study found eight key issues in aged care that have been targeted by researchers from different disciplines (e.g., ICT, health and social science), namely, dependent living, fall risk, chronic disease, dementia, social isolation, depression, poor well-being, and poor medication management. This paper also identified the assistive technologies that have been proposed to overcome those problems, and we categorised these assistive technologies into six clusters, namely, general ICT, robotics, telemedicine, sensor technology, medication management applications, and video games. In addition, we analyzed the effectiveness of the identified technologies and noted that some technologies can change and enhance seniors' daily lives and relieve their problems. Our analysis showed a significant growth in the number of publications in this area in the past few years. It also showed that most of the studies in this area have been conducted in North America.

CONCLUSION

Assistive technologies are a reality and can be applied to improve quality of life, especially among older age groups. This study identified various assistive technologies proposed by ICT researchers to assist the elderly. We also identified the effectiveness of the proposed technologies. This review shows that, although assistive technologies have been positively evaluated, more studies are needed regarding the outcome and effectiveness of these technologies.

Hemophilia A in a Senior Patient: A Case Report of Spinal Epidural Hematoma as First Presentation

Hemophilia A is a hereditary coagulation disorder. Most cases are diagnosed at birth or at least during childhood. A spontaneous spinal epidural hematoma was developed in a 74-year-old male patient who hadn't had a family or past medical history of bleeding disorders. On magnetic resonance imaging, epidural hematoma at L1-2 was accompanied by spinal stenosis at L4-5 and spondylolytic spondylolisthesis at L5. Hematoma evacuation and surgery for distal lumbar lesions were performed at once. After transient improvement, complete paraplegia was developed due to redevelopment of large epidural hematomas at L1-2 and L4-S1 which blocked epidural canal completely. Emergency evacuation was performed and we got to know that he had a hemophilia A. Factor VIII was 28% of normal value. Mild type hemophilia A could have not been diagnosed until adulthood. Factor VIII should have been replaced before the surgical decompression.

Influence of wedges on lower limbs' kinematics and net joint moments during healthy elderly gait using principal component analysis

The elderly are susceptible to many disorders that alter the gait pattern and could lead to falls and reduction of mobility. One of the most applied therapeutical approaches to correct altered gait patterns is the insertion of insoles. Principal Component Analysis (PCA) is a powerful method used to reduce redundant information and it allows the comparison of the complete waveform. The purpose of this study was to verify the influence of wedges on lower limbs' net joint moment and range of motion (ROM) during the gait of healthy elderly participants using PCA. In addition, discrete values of lower limbs' peak net moment and ROM were also evaluated. 20 subjects walked with no wedges (control condition) and wearing six different wedges. The variables analyzed were the Principal Components from joint net moments and ROM in the sagittal plane in the ankle and knee and joint net moments in frontal plane in the knee. The discrete variables were peak joint net moments and ROM in sagittal plane in knee and ankle. The results showed the influence of the wedges to be clearer by analyzing through PCA methods than to use discrete parameters of gait curves, where the differences between conditions could be hidden.

Nutrition of aging dogs

Aging is a normal process characterized by a variety of physiologic changes. Geriatric dogs are also more likely to be afflicted with certain disease conditions. Both normal and abnormal physiologic changes associated with aging in the dog may be amenable to nutritional intervention. Specific alterations in nutrients or in dietary characteristics can be beneficial; however, these are best done in the context of an individualized nutritional assessment and monitoring paradigm.

Development of a comprehensive multidisciplinary geriatric oncology center, the Thomas Jefferson University Experience

BACKGROUND

The proportion of older patients with cancer is expected to grow exponentially in the next two decades. This population has large heterogeneity and it is well known that chronologic age is a poor predictor of outcomes. Research has shown that these patients are best served with a Comprehensive Geriatric Assessment (CGA) to formulate individualized treatment plans for better outcomes. However, the best model for CGA has yet to be determined.

MATERIALS AND METHODS

Our objective was to develop a highly functional model for the establishment of a comprehensive multidisciplinary geriatric oncology center in the setting of a university based NCI-designated cancer center. Each patient is evaluated by medical oncology, geriatric medicine, pharmacy, social work and nutrition. Expert navigation is provided to enhance the patient experience. At the conclusion, the inter-professional team meets to review each case and formulate a comprehensive treatment plan. The patient is classified as Fit, Vulnerable, or Frail based on the complete CGA.

RESULTS

The average age of patients seen was 80.7 with the most common diagnoses being breast, colorectal and lung cancers. Twenty four percent of patients were determined to be Fit, 47% Vulnerable, and 29% Frail. Twenty one percent of patients determined to be Frail by CGA received an ECOG score of 0-1 by the oncologist. Our pharmacists made specific recommendations in over 75% of patients and social work provided assistance in over 50% of patients.

CONCLUSIONS

We were able to observe some interesting trends such as potential discordance with ECOG score and assessment of Fit/Vulnerable/Frail but due to limitations in the data, this paper is not able to illustrate definitive correlations. Several challenges with the development of the clinic include 1) patient related issues, 2) navigation, 3) financial reimbursement, 4) referral patterns, and 5) coordination of care during office hours. We feel that we have been able to establish a model for a comprehensive multidisciplinary geriatric oncology evaluation center in the setting of a university based cancer center.

Impact of diabetes mellitus on pneumonia mortality in a senior population: results from the NHANES III follow-up study

Objective

To examine whether diabetes mellitus increases the risk of pneumonia mortality among seniors in the U.S. general population.

Methods & Results

The NHANES III follow-up study data were used. After excluding individuals from other minorities, being hospitalized with pneumonia in the previous year at baseline, or death of pneumonia during the first year of follow-up, a total of 3,707 subjects aged 65 years or older (1,794 men and 1,913 women) who had no missing information on variables for the analysis were included. Approximately 16% of seniors at baseline were diabetics, which was defined as either having been diagnosed by a physician, currently taking pills/insulin lowering blood glucose, or HbA1c higher than 6.4%. During an average 11 years of follow-up, a total of 98 deaths due to pneumonia were recorded (ICD-10: J12–J18). Cox-regression models were used to estimate the risk association between pneumonia mortality and diabetes mellitus. After adjustment for the covariates at baseline, the hazard ratios of pneumonia death were 1.30 (95% CI: 0.64–2.70) for pre-diabetics and 2.28 (95% CI: 1.18–4.39) for diabetics, respectively. Among those covariates, only age (HR (95% CI); 1.16 (1.13–1.20)), gender as female (0.35 (0.22–0.61)) and physical fitness measured as having no problem walking 1⁺ mile during the previous month (0.38 (0.20–0.67)) reached statistical significance.

Conclusions

The results suggest that diabetes mellitus is a strong risk predictor of pneumonia mortality and the evaluation of physical fitness may also be useful in the risk prediction of pneumonia mortality for seniors.