Towards a comprehensive biomechanical assessment of the elderly combining in vivo data and in silico methods

The aging process is commonly accompanied by a general or specific loss of muscle mass, force and/or function that inevitably impact on a person's quality of life. To date, various clinical tests and assessments are routinely performed to evaluate the biomechanical status of an individual, to support and inform the clinical management and decision-making process (e.g., to design a tailored rehabilitation program). However, these assessments (e.g., gait analysis or strength measures on a dynamometer) are typically conducted independently from one another or at different time points, providing clinicians with valuable yet fragmented information. We hereby describe a comprehensive protocol that combines both in vivo measurements (maximal voluntary isometric contraction test, superimposed neuromuscular electrical stimulation, electromyography, gait analysis, magnetic resonance imaging, and clinical measures) and in silico methods (musculoskeletal modeling and simulations) to enable the full characterization of an individual from the biomechanical standpoint. The protocol, which requires approximately 4 h and 30 min to be completed in all its parts, was tested on twenty healthy young participants and five elderlies, as a proof of concept. The implemented data processing and elaboration procedures allowing for the extraction of several biomechanical parameters (including muscle volumes and cross-sectional areas, muscle activation and co-contraction levels) are thoroughly described to enable replication. The main parameters extracted are reported as mean and standard deviation across the two populations, to highlight the potential of the proposed approach and show some preliminary findings (which were in agreement with previous literature).

Characteristics of Occupational Therapy Interventions to Promote Healthy Aging: Protocol for a Scoping Review

BACKGROUND

Healthy aging is a pressing public health priority. Focusing on what people do every day may be a meaningful approach to lifestyle change, suggesting a need for occupation therapy interventions to promote healthy aging. A preliminary database search was conducted, and no current or underway systematic or scoping reviews on the topic were identified. Developing an overview of studies of occupational therapy interventions to promote healthy aging is a necessary first step to understanding the existing knowledge and increasing the impact of future interventions. This scoping review will build on previously conducted reviews.

OBJECTIVE

This scoping review will identify the following: (1) what occupational therapy interventions exist for promoting healthy aging in community-dwelling adults? and (2) what are the intervention characteristics, their evaluated outcome, and the impact observed?

METHODS

This protocol was reviewed by 2 occupational therapists as part of a patient and public involvement consultation. The review will consider all studies and publications of occupational therapy focused on promoting healthy aging in community-dwelling adults who are aged 18 years and older. Databases to be searched are AMED, CINAHL, Cochrane Library, Embase, JBI EBP database, MEDLINE, OAlster, PsycINFO, PsycArticles, ProQuest Dissertations & Theses, ProQuest nursing and allied health source, PubMed, and Science Direct. Studies published in any language will be included. Titles and abstracts will be screened against the inclusion criteria using Covidence (Veritas Health Innovation). Potentially relevant studies will be retrieved in full and assessed against the inclusion criteria. No date limiters will be used. Study selection will be completed by 2 independent reviewers. Data will be extracted using a data extraction tool, including descriptive characteristics of the participants including age, sex, and socioeconomic status. Data will be charted using the TIDieR (Template for Intervention Description and Replication) checklist in alignment with the review objectives. The scoping review will be reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) statement.

RESULTS

The research began in October 2023, and the results are expected to be published in 2024.

CONCLUSIONS

This scoping review will produce valuable information about occupation-based interventions to promote healthy aging to support the development of an occupational therapy intervention.

TRIAL REGISTRATION

Open Science Framework 5k36d; https://osf.io/5k36d/.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/55198.

Chewing difficulties mediated association between edentulism and depressive symptoms among middle aged and older population

BACKGROUND

Depression is a major health condition among the aging population. Previous studies indicated that edentulism was a risk factor for depression. The link between edentulism and depression has not been fully clarified.

OBJECTIVES

This study aimed to estimate whether chewing difficulties play a mediating role in the association between edentulism and depression among middle-aged and older populations with national cross-sectional data.

METHODS

Data were obtained from the latest fourth wave of the China Health and Retirement Longitudinal Study (CHARLS). The outcome variable was set as depression, which was measured by the Center for Epidemiologic Studies Depression Scale (CES-D-10). Independent and mediated variables were separately set as self-assessed edentulism and chewing difficulties. The nearest neighbour propensity score matching (PSM) method was used to construct a matching group to balance the basic characteristics of individuals with and without edentulism with minimised bias in the estimation. Causal mediation analysis was performed to estimate the degree of contribution of chewing difficulties to the association between edentulism and depression. Several sensitivity analyses were performed to evaluate the robustness of the primary result.

RESULTS

A total of 15 853 individuals remained for analysis. After PSM, 809 individuals with edentulism and 2628 without edentulism remained for analysis. Among the matched individuals, the mean age was 66.3 ± 9.2 years, 58.5% were female, 78.8% lived in rural areas, 23.5% had edentulism, 51.1% had depressive symptoms, and 50.1% had chewing difficulties. Logistic regression results showed that a higher incidence of edentulism was associated with a higher rate of depression (OR: 1.39, 95% CI: 1.19-1.63) in the matching group. Causal mediation analysis results indicated that the average mediation effect of chewing difficulties on the association between edentulism and depression was 0.010 (95% CI: 0.005-0.015), and the average direct effect was 0.072 (95% CI: 0.036-0.11). The mediation proportion of chewing difficulties was 11.7% (95% CI: 0.079-0.21).

CONCLUSION

A higher prevalence of edentulism was associated with a higher rate of depression among middle-aged and elderly populations. Chewing difficulties moderately mediated the association between edentulism and depression. Fundamental oral function should not be neglected to improve mental health among the aging population.

The Influence of Marriage and Cohabitation on Physical Activity Among Middle-Aged and Older People

Using data from a nationally representative longitudinal study, Midlife in the United States (waves 1-3; N = 1113; aged 49-93), this study investigated whether partnered living status (partnered vs. non-partnered) and partnered living quality (support/strain from partner, partner disagreements) were associated with physical activity in middle-aged/older adults. Regressions were performed to test the effect of change or stability in partnered living status across three waves and relationship quality on the frequency of moderate and vigorous physical activity at Wave 3. Subjects who changed from non-partnered to partnered living had the highest moderate and vigorous physical activity levels. Partner support was positively associated with moderate physical activity (β = .50, p < .01), and partner disagreement was negatively associated with vigorous physical activity (β = -.27, p < .01). Results suggest that partnered living status and quality can influence physical activity among the aging population. Physical activity interventions among older adults may benefit from including social support as a key component.

Cognitive Impairment and Non-Communicable Diseases in Egypt's Aging Population: Insights and Implications from the 2021-2022 Pilot of "A Longitudinal Study of Egyptian Healthy Aging" "AL-SEHA"

As the global population ages, the prevalence of cognitive impairment among older individuals has been steadily rising. Like many countries, Egypt is grappling with the challenges an aging demographic poses. The global network of longitudinal aging studies, modeled after the US Health and Retirement Study (HRS), includes over 40 countries but lacks representation from the Arab/North African region. The proposed 'A Longitudinal Study of Egyptian Healthy Aging' (AL-SEHA) will address this gap by providing data on aging in Egypt, the largest Arab/North African country, shedding light on the intricate relationship between cognitive impairment and non-communicable diseases (NCDs) in Egypt's aging population between 2021 and 2022. This study took place in five governments in Egypt and recruited 299 participants from a population of 50+. The results of the study are from the pilot stage of the original longitudinal study (AL-SEHA).

Reconsidering the Role of Nurse Practitioners in Japan: What Direction Should Japanese Nurse Practitioners Aim for?

This article explores the dynamic role of nurse practitioners in Japan, contextualized against an aging population and declining birth rates. It emphasizes the imperative for Japanese nurse practitioners to broaden their scope of practice to effectively meet the nation's diverse healthcare demands within a constrained resource framework. The study highlights the critical need for Japan to align its nurse practitioners' training with international educational standards, advocating for a graduate-level curriculum that blends in-depth theoretical knowledge with practical skillsets. Central to the discourse is task shifting, wherein nurse practitioners progressively undertake duties traditionally associated with physicians. This expansion of roles requires meticulous evaluation to ensure its contribution to the efficacy of the healthcare system. The article identifies nurse practitioners as pivotal in team-based medical care, proficient in merging medical and nursing perspectives, and essential in facilitating communication and coordination among varied medical professionals. Comparative analysis of international nurse practitioner practice models reveals a necessity for Japan to enhance the scope and responsibilities of its nurse practitioners. Furthermore, the paper addresses the need for a comprehensive reevaluation of Japan's legal and policy framework concerning clinical nursing, aiming to redefine roles and responsibilities more distinctly. The article advocates for systemic reforms, particularly in education and multi-professional collaboration. These changes are deemed vital for Japanese nurse practitioners to respond to evolving healthcare needs effectively, ultimately elevating the standard of healthcare provision in Japan for a global audience.

Missed Healthcare Visits During the COVID-19 Pandemic: A Longitudinal Study

INTRODUCTION

Missed visits have been estimated to cost the U.S. healthcare system $50 billion annually and have been linked to healthcare inefficiency, higher rates of emergency department visits, and worse outcomes. COVID-19 disrupted existing outpatient healthcare utilization patterns. In our study, we sought to examine the frequency of missed outpatient visits over the course of the COVID-19 pandemic and to examine patient-level characteristics associated with non-attendance.

METHODS

This study utilized data from a longitudinal cohort study (the Chicago COVID-19 Comorbidities (C3) study). C3 participants were enrollees in 1 of 4 active, "parent" studies; they were rapidly enrolled in C3 at the onset of the pandemic. Multiple waves of telephone-based interviews were conducted to collect experiences with the pandemic, as well as socio-demographic and health characteristics, health literacy, patient activation, and depressive and anxiety symptoms. For the current analysis, data from waves 3 to 8 (05/01/20-05/19/22) were analyzed. Participants included 845 English or Spanish-speaking adults with 1 or more chronic conditions.

RESULTS

The percentage of participants reporting missed visits due to COVID-19 across study waves ranged from 3.1 to 22.4%. Overall, there was a decline in missed visits over time. No participant sociodemographic or health characteristic was consistently associated with missed visits across the study waves. In bivariate and multivariate analysis, only patient-reported anxiety was significantly associated with missed visits across all study waves.

CONCLUSION

Findings reveal that anxiety was consistently associated with missed visits during the COVID-19 pandemic, but not sociodemographic or health characteristics. Results can inform future public health initiatives to reduce absenteeism by considering patients' emotional state during times of uncertainty.

Health care in future community: innovatively discover and respond to the needs of today's seniors

Introduction

In the context of the digital economy, the emergence and application of emerging technologies have accelerated the integration of traditional social structures with new technologies, leading to the inception of the "Future Community" as an innovative urban unit. With an aging population's rapid and sustained rise, integrating health care for older adults with modern information technology is gradually moving towards holistic governance. This approach utilizes the Future Community as a medium and aims for quality enhancement and increased efficiency, which instrumentally addresses the diversified health care needs of China's aging era.

Methods

In this study, we employed a questionnaire survey method that covered 11 communities in Tianjin City to understand better the current status and characteristics of their health care services.

Results

The survey results show that the means of community health care for older adults are gradually being upgraded, and the demands are shifting. Then, we arrive at three conclusions: firstly, technological innovation and smart approaches have the potential to positively influence the quality of health care in these communities. Secondly, allocating health care resources within communities can have a salutary effect on the psychological well-being of seniors. Thirdly, actively involving seniors in community life and governance can elevate their self-worth.

Discussion

At last, in conjunction with current challenges, we think that deepening multi-party collaboration, educating specialized talents, and bridging the "digital gap" would be effective ways to establish a future community for seniors.

Mitigating COVID-19 Mortality and Morbidity in China's Aging Population: A Focus on Available Medications and Future Developments

The COVID-19 pandemic, often referred to as the geropandemic, has put immense pressure on global healthcare systems worldwide, leading to a rush in the development and approval of medications for the treatment of the viral infection. Clinical trials on efficacy and safety had a limited spectrum on inclusion and endpoints because of the urgent need for fast results. The chronologically and biologically aged population is especially at risk for severe or lethal disease, as well as treatment-associated toxicity. In China, the growing elderly population segment has been a focus in public health measurements of COVID-19, guiding towards herd immunity with a mild variant, thus minimizing overall deaths and morbidity. While the COVID-19 pandemic has now been reclassified and the virus weakened, there is a clear need for novel therapies to protect the elderly. This paper reviews the current safety and efficacy of available COVID-19 medications in China, with a specific focus on 3CL protease inhibitors and the aging population. The current COVID wave in China has demonstrated a significant impact on the elderly and the need for new drugs that are effective at low doses and can be used alone, without harmful side effects, generation of viral resistance, and drug-drug interactions. The rush to develop and approve COVID-19 medications has brought up important questions about the balance between speed and caution, resulting in a pipeline of novel therapies now moving through clinical trials, including third-generation 3CL protease inhibitors. A majority of those therapeutics are being developed in China.

[Development of Human Vital Signs and Body Posture Monitoring and Positioning Alarm Systems]

In view of the high incidence of malignant diseases such as malignant arrhythmias in the elderly population, accidental injuries such as falls, and the problem of no witnesses when danger occurs, the study developed a human vital signs and body posture monitoring and positioning alarm system. Through the collection and analysis of electrocardiogram (ECG), respiration (RESP) and acceleration (ACC) signals, the system monitors human vital signs and body posture in real time, automatically judges critical states such as malignant arrhythmias and accidental falls on the local device side, and then issues alarm information, opens the positioning function, and uploads physiological information and patient location information through 4G communication. Experiments have shown that the system can accurately determine the occurrence of ventricular fibrillation and falls, and issue position and alarm information.

From Recognition to Remedy: The Significance of Biomarkers in Neurodegenerative Disease Pathology

With the inexorable aging of the global populace, neurodegenerative diseases (NDs) like Alzheimer's disease (AD), Parkinson's disease (PD), and amyotrophic lateral sclerosis (ALS) pose escalating challenges, which are underscored by their socioeconomic repercussions. A pivotal aspect in addressing these challenges lies in the elucidation and application of biomarkers for timely diagnosis, vigilant monitoring, and effective treatment modalities. This review delineates the quintessence of biomarkers in the realm of NDs, elucidating various classifications and their indispensable roles. Particularly, the quest for novel biomarkers in AD, transcending traditional markers in PD, and the frontier of biomarker research in ALS are scrutinized. Emergent susceptibility and trait markers herald a new era of personalized medicine, promising enhanced treatment initiation especially in cases of SOD1-ALS. The discourse extends to diagnostic and state markers, revolutionizing early detection and monitoring, alongside progression markers that unveil the trajectory of NDs, propelling forward the potential for tailored interventions. The synergy between burgeoning technologies and innovative techniques like -omics, histologic assessments, and imaging is spotlighted, underscoring their pivotal roles in biomarker discovery. Reflecting on the progress hitherto, the review underscores the exigent need for multidisciplinary collaborations to surmount the challenges ahead, accelerate biomarker discovery, and herald a new epoch of understanding and managing NDs. Through a panoramic lens, this article endeavors to provide a comprehensive insight into the burgeoning field of biomarkers in NDs, spotlighting the promise they hold in transforming the diagnostic landscape, enhancing disease management, and illuminating the pathway toward efficacious therapeutic interventions.

Effect of nutrition education intervention to improve dietary diversity practice and nutritional status of the older people: A cluster randomized controlled trial

The growing aging population raises nutrition and health concerns, with malnutrition in the elderly linked to negative health outcomes. Our objective was to implement theory-based nutritional education interventions to improve the nutritional status of the elderly through diversified dietary practices. A cluster randomized controlled trial was conducted from December 1, 2021, to May 30, 2021, among 782 older persons randomly selected from two urban and 12 semi-urban areas in southwest Ethiopia. We used Social cognitive theory (SCT) in guiding the nutritional education intervention. Data were collected using an interviewer-administered questionnaire. The Mini Nutritional Assessment (MNA) tool was used to assess nutritional status, and a qualitative 24-h eating recall was used to evaluate dietary diversity. Difference-in-difference and generalized estimating equation models were used to assess the intervention effect. In total, 720 participants (361 in the intervention group and 359 in the control group) were included for analysis. The mean dietary diversity score differed significantly between the intervention group and the control group (p < .001). According to the multivariable generalized estimating equations model, the intervention group was 7.7 times (AOR = 7.746, 95% CI: 5.012, 11.973) more likely to consume a diverse diet than the control group. The nutrition status of the elderly in the intervention group improved significantly at the end of the intervention (p < .001). SCT-based nutritional education interventions can effectively improve healthy eating and nutritional status. For older adults, with its convenient approach and low cost, SCT should be considered an effective and efficient nutritional education approach for behavior change.

The Effect of Family Wealth on Physical Function Among Older Adults in Mpumalanga, South Africa: A Causal Network Analysis

Objectives: The aging of the South African population could have profound implications for the independence and overall quality of life of older adults as life expectancy increases. While there is evidence that lifetime socio-economic status shapes risks for later function and disability, it is unclear whether, and how, the wealth of family members shapes these outcomes. We investigated the relationship between outcomes activities of daily living (ADL), grip strength, and gait speed, and the household wealth of non-coresident family members. Methods: Using data from Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI) and the Agincourt Health and Demographic Surveillance System (AHDSS), we examined the relationship between physical function and household and family wealth in the 13 preceding years. HAALSI is a cohort of 5,059 adults who were 40 years or older at baseline in 2014. Using auto-g-computation-a recently proposed statistical approach to quantify causal effects in the context of a network of interconnected units-we estimated the effect of own and family wealth on the outcomes of interest. Results: We found no evidence of effects of family wealth on physical function and disability. Conclusion: Further research is needed to assess the effect of family wealth in early life on physical function and disability outcomes.

The Relationship between the Distribution of Home Medical Clinics and Home Care Service Offices in Japan

The increasing number of older people in Japan has led to a need for cooperation between home medical and care services. The collaboration between medical and care provisions in home settings is thus a matter for concern. The present study examines the distribution of and relationship between the number of home medical clinics (HMCs) and home care service offices (HCOs) in Japan. We used national data, detailing the total population, percentage of older adults, and number of HMCs and HCOs. Overall, 23,428 HMCs and 35,612 HCOs were identified nationwide. While the southwestern region of Japan had a high number of HMCs relative to the northeastern region, there was not such a clear difference in the regional distribution of number of HCOs. A linear regression analyses, adjusted for the percentage of older people, revealed a significant positive correlation between the number of HMCs per 10,000 older people and HCOs per 10,000 older people (β = 0.58, p < 0.001). These findings may allow us to understand advances in cooperation between home medical and care services in Japan.

The "double jeopardy" of midlife and old age mortality trends in the United States

Since 2010, US life expectancy growth has stagnated. Much research on US mortality has focused on working-age adults given adverse trends in drug overdose deaths, other external causes of death, and cardiometabolic deaths in midlife. We show that the adverse mortality trend at retirement ages (65+ y) has in fact been more consequential to the US life expectancy stagnation since 2010, as well as excess deaths and years of life lost in 2019, than adverse mortality trends at working ages. These results reveal that the United States is experiencing a "double jeopardy" that is driven by both mid-life and older-age mortality trends, but more so by older-age mortality. Understanding and addressing the causes behind the worsening mortality trend in older ages will be essential to returning to the pace of life expectancy improvements that the United States had experienced for decades.

Linking current dental education to gerontological education to meet the oral health needs of growing aging populations

Objective

This study aimed to recognize the gaps in dental education by studying the current level of geriatric oral health training of recent graduated dentists who have been admitted into an Advanced Education in General Dentistry (AEGD) program.

Methods

The AEGD program was developed along with the Age-Friendly 4Ms model to enhance current dental education. We adopted the Rapid Cycle Quality Improvement model to test the effectiveness of the training for AEGD residents from 2019 to 2022. A total of 18 residents participated (6 residents each year). A 5-question survey was administered before and after the rotation and Wilcoxon signed-rank with Fisher Exact tests were conducted to compare pre- and post- rotation results.

Results

All 18 residents have completed pre- and post-program surveys. They self-reported minimal to no training in preparation to provide care to older adults with multiple chronic conditions. After the rotation, residents' confidence in treating older adults was significantly increased (p = 0.011). Meanwhile, residents gained knowledge to apply the 4Ms framework (what matters, medication, mentation, and mobility) to their practices (p = 0.015) and provide age-friendly care for older adults.

Conclusion

The study identified and addressed the missing link in dental education to gerontological and geriatrics education. More clinical rotations and didactic training to equip residents with competences of providing geriatric oral health are strongly recommended.

Age, ASA-status, and Changes in NSQIP Comorbidity Indices Reporting in Facial Fracture Repair

OBJECTIVE

To evaluate the impact of age and the American Society of Anesthesiologists (ASA) classification on post operative outcomes as well as the changes in the National Surgical Quality Improvement Program (NSQIP) database reporting of comorbidity index variables in patients with facial fractures.

METHODS

The NSQIP database was queried for facial fracture repair CPT codes between 2012 and 2019 and for modified Frailty Index (mFI) and modified Charlson Comorbidity Index (mCCI) variables between years 2006 and 2018. The predominant question analyzed two preoperative risk factors: patient and ASA classification. Chi-square analysis, Kruskal-Wallis, Mann-Whitney, Spearman correlation, and multivariable logistic regression were used to evaluate age and ASA classification with wound dehiscence, superficial surgical site infection (SSSI), deep wound infection (DWI), readmission status, and return to the OR. The reporting of indices variables was evaluated with descriptive statistics.

CONCLUSION

In this large database with univariate analysis, patients with a higher ASA classification and older patients experience significantly increased risks of readmission, return to the OR, and longer hospital stays. On multivariate analyses, ASA classes II, III, and IV are independently associated with increased risk of readmission and return to the OR, while controlling for patient age. The reporting of all mFI and mCCI variables were consistent from 2006 to 2010, but after 2011, there has been inconsistent or absent reporting of variables, therefore, conclusions on the impact of comorbidities on facial fracture repair are unreliable.

LEVEL OF EVIDENCE

4 Laryngoscope, 133:2572-2577, 2023.

Are men dominant? Evidence of differences between physical activity and quality of life among older adults in China

At present, the aging population is one of China's basic national concerns, and physical exercise offers endless potential to cope with it. However, the life expectancy of men in China is generally lower than that of women, and the health status of older men is more worrying. Could it be that differences in physical exercise cause the difference in life expectancy between older men and women? This study analyzes the exercise regimen of older men and women and its influence on their quality of life. Approximately 200 respondents aged over 60 were investigated using the SF-36 and exercise questionnaires. Our findings revealed the following: (1) The scores of seven dimensions of life quality of older men were significantly lower than those of older women (p < 0.001), but there was no significant difference only in physiological function (p > 0.05); (2) The exercise frequency and persistence of older men were significantly lower than those of older women (p < 0.001), but there was no significant difference in exercise time (p > 0.05); and (3) All eight indices of quality of life of older men were positively correlated with the four indices of exercise (0.250 < R < 0.597). Our study offered the following conclusions: (1) The health of older men who lack physical exercise is poor. From the perspective of healthy aging, older men are a vulnerable group that deserves more attention. (2) Within an appropriate range, the more older men participate in physical activity programs, the more conducive they are to improved health. (3) This study focuses on promoting physical exercise for older adults and suggests organizing them to participate in sports activities as an important measure to promote healthy aging in China.

Predictability of Fall Risk Assessments in Community-Dwelling Older Adults: A Scoping Review

Fall risk increases with age, and one-third of adults over 65 years old experience a fall annually. Due to the aging population, the number of falls and related medical costs will progressively increase. Correct prediction of who will fall in the future is necessary to timely intervene in order to prevent falls. Therefore, the aim of this scoping review is to determine the predictive value of fall risk assessments in community-dwelling older adults using prospective studies. A total of 37 studies were included that evaluated clinical assessments (questionnaires, physical assessments, or a combination), sensor-based clinical assessments, or sensor- based daily life assessments using prospective study designs. The posttest probability of falling or not falling was calculated. In general, fallers were better classified than non-fallers. Questionnaires had a lower predictive capability compared to the other assessment types. Contrary to conclusions drawn in reviews that include retrospective studies, the predictive value of physical tests evaluated in prospective studies varies largely, with only smaller-sampled studies showing good predictive capabilities. Sensor-based fall risk assessments are promising and improve with task complexity, although they have only been evaluated in relatively small samples. In conclusion, fall risk prediction using sensor data seems to outperform conventional tests, but the method's validity needs to be confirmed by large prospective studies.

Depressive symptoms decrease health-related quality of life of patients with coronary artery disease and diabetes: a 12-month follow up study in primary care

OBJECTIVE

Health-related quality of life (HRQoL) is a multidimensional patient-related outcome. Less is known about the role of depressive symptoms on HRQoL in chronic diseases. This follow-up study analyzed depressive symptoms' association with HRQoL change measured with 15D in patients with chronic diseases.

DESIGN AND SETTING

A total of 587 patients from the Siilinjärvi Health Center, Finland were followed up due to the treatment of hypertension (HA), coronary artery disease (CAD) or diabetes (DM). Depressive symptoms were based on Beck Depression Inventory (BDI) (BDI ≥10 =depressive symptoms). HRQoL was assessed at the baseline and after 12 months.

RESULTS

There were 244 patients with HA (mean age 70 years, 59% women); 103 patients (72 years, 38%) with CAD and 240 with DM (67 years, 52%). The change from baseline to the 12-month follow-up in 15D was significantly different between patients without and with depressive symptoms in CAD (p < 0.001) and DM (p = 0.024). In CAD with depressive symptoms, the change was -0.064 (95% CI: -0.094 to -0.035) and in DM -0.018 (95% CI: -0.037 to 0.001). In the 15 HRQoL dimensions of 15D, a depressive symptoms-related decrease was found in three dimensions with HA, in 9 with CAD and in 7 with DM. As a function of the BDI at baseline, the 15D score decreased significantly among patients with CAD and DM.

CONCLUSIONS

Depressive symptoms impact negatively on future HRQoL among primary care patients with coronary artery disease and diabetes emphasizing that mood should be acknowledged in their care and follow-up.

TRIAL REGISTRATION

Clinical Trials registration number: NCT02992431, registered December 14th 2016.

Effects of Robot Animacy and Emotional Expressions on Perspective-Taking Abilities: A Comparative Study across Age Groups

The global population is inevitably aging due to increased life expectancy and declining birth rates, leading to an amplified demand for innovative social and healthcare services. One promising avenue is the introduction of companion robots. These robots are designed to provide physical assistance as well as emotional support and companionship, necessitating effective human-robot interaction (HRI). This study explores the role of cognitive empathy within HRI, focusing on the influence of robot facial animacy and emotional expressions on perspective-taking abilities-a key aspect of cognitive empathy-across different age groups. To this end, a director task involving 60 participants (30 young and 30 older adults) with varying degrees of robot facial animacy (0%, 50%, 100%) and emotional expressions (happy, neutral) was conducted. The results revealed that older adults displayed enhanced perspective-taking with higher animacy faces. Interestingly, while happiness on high-animacy faces improved perspective-taking, the same expression on low-animacy faces reduced it. These findings highlight the importance of considering facial animacy and emotional expressions in designing companion robots for older adults to optimize user engagement and acceptance. The study's implications are pertinent to the design and development of socially effective service robots, particularly for the aging population.

Problems with Medical Claims that Artificial Intelligence (AI) and Blockchain Can Fix

In medical insurance, there are both valid and legitimate claims that should be covered by the insurer and fraudulent or inappropriate claims that should not be paid. Problems arise in scenarios when valid claims are not paid and when fraudulent or inappropriate claims are paid.  Hospitals and insurers play critical roles in these cases. Artificial Intelligence (AI) and blockchain technologies can play significant roles in addressing the problems associated with medical insurance claims. Some of the ways in which these technologies can help are using AI algorithms to analyze data stored on the blockchain for fraud detection, and leveraging blockchain's transparency to improve the accuracy of AI models by providing access to a larger dataset. The author addresses approaches for each senario.

Research on care preferences for the elderly and influencing factors in Zhejiang Province: A statistical and geographical approach

The aging of the population is becoming an increasingly severe issue. How can we develop caring services for the elderly and promote healthy aging? Investigating care preferences is an essential step in addressing this issue. A self-designed questionnaire was employed to collect data online. The impact of personal circumstances on care preferences was ascertained using the chi-squared test and multivariate logistic regression. An optimal parameters-based geographical detector was introduced to examine the influence of spatially heterogeneous regional factors on care preferences. The online survey produced 1178 valid questionnaires. Home-based elderly care was the preference of 91.9% of respondents, followed by community-based care and medical-nursing care; institutional care was the least preferred alternative. Age, education, living style, and health states of the elderly significantly influenced the preferred care option. When compared to home-based elderly care, older respondents (odds ratio [OR] = 3.776) preferred institutional care, highly educated respondents preferred community-based care (higher education: OR = 5.206; secondary education: OR = 3.049) and medical-nursing care (higher education: OR = 4.484); the elderly living alone (OR = 0.101) excluded institutional care, and the elderly living with their children excluded non-family care method of institutional care (OR = 0.031) and medical-nursing care (OR = 0.391). Regional medical resources and old-age security significantly affect the preferences of the elderly (q-statistic [q] > 0.5); local economic development significantly affects community-based care (q > 0.6); the availability of financial subsidies significantly affects home-based care and medical-nursing care (q > 0.9); and the availability of institutional resources significantly affects the preference for institutional care (q > 0.8). We found that it is necessary to improve the level of medical care given by non-family members and care facilities, vigorously develop new methods of elderly care, promote humanistic care in non-family care settings, and increase available regional medical resources, financial subsidies, and social security. This study integrates economic and social perspectives to examine and analyze retirement willingness, thereby broadening the scope of social surveys and research methodologies, and offering valuable insights with potential directive implications.

Long-Term Outcomes of Transvenous Lead Extraction: A Comparison in Patients with or without Infection from the Italian Region with the Oldest Population

BACKGROUND

The gold standard for the treatment of cardiac implantable electronic devices (CIEDs)-related infection and lead malfunction is transvenous lead extraction (TLE). To date, the risk of mortality directly related to TLE procedures is relatively low, but data on post-procedural and long-term mortality are limited, even more in the aging population.

METHODS

Consecutive patients with CIEDs who underwent TLE were retrospectively studied. The primary outcome was the endpoint of death, considering independent predictors of long-term clinical outcomes in the TLE aging population comparing patients with and without infection.

RESULTS

One hundred nineteen patients (male 77%; median age 76 years) were included in the analysis. Eighty-two patients (69%) documented infection, and thirty-seven (31%) were extracted for a different reason. Infected patients were older (80 vs. 68 years, p-value > 0.001) with more implanted catheters (p-value < 0.001). At the last follow-up (FU) available (median FU 4.1 years), mortality reached 37% of the patient population, showing a statistically significant difference between infected versus non-infected groups. At univariable analysis, age at TLE, atrial fibrillation, and anemia remained significant correlates of mortality; at multivariable analysis, only patients with anemia and atrial fibrillation have a 2.3-fold (HR 2.34; CI 1.16-4.75) and a 2.5-fold (HR 2.46; CI 1.33-4.54) increased rate of death, respectively.

CONCLUSION

Our long-term data showed that aging patients who underwent TLE for CIED-related infection exhibit a high mortality risk during a long-term follow-up, potentially leading to a rapid and effective procedural approach in this patient population.

Aging Population, Balanced Diet and China's Grain Demand

The need to make more accurate grain demand (GD) forecasting has become a major topic in the current international grain security discussion. Our research aims to improve short-term GD prediction by establishing a multi-factor model that integrates the key factors: shifts in dietary structures, population size and age structure, urbanization, food waste, and the impact of COVID-19. These factors were not considered simultaneously in previous research. To illustrate the model, we projected China's annual GDP from 2022 to 2025. We calibrated key parameters such as conversion coefficients from animal foods to feed grain, standard person consumption ratios, and population size using the latest surveys and statistical data that were either out of date or missing in previous research. Results indicate that if the change in diets continued at the rate as observed during 2013-2019 (scenario 1), China's GD is projected to be 629.35 million tons in 2022 and 658.16 million tons in 2025. However, if diets shift to align with the recommendations in the Dietary Guideline for Chinese Residents 2022 (scenario 2), GD would be lower by 5.9-11.1% annually compared to scenario 1. A reduction in feed grain accounts for 68% of this change. Furthermore, for every 1 percentage point increase in the population adopting a balanced diet, GD would fall by 0.44-0.73 million tons annually during that period. Overlooking changes in the population age structure could lead to an overprediction of annual GDP by 3.8% from 2022 to 2025. With an aging population, China's GD would fall slightly, and adopting a balanced diet would not lead to an increase in GD but would have positive impacts on human health and the environment. Our sensitivity analysis indicated that reducing food waste, particularly cereal, livestock, and poultry waste, would have significant effects on reducing GD, offsetting the higher demand due to rising urbanization and higher incomes. These results underscore the significance of simultaneous consideration of multiple factors, particularly the dietary structure and demographic composition, resulting in a more accurate prediction of GD. Our findings should be useful for policymakers concerning grain security, health, and environmental protection.

Functional outcomes and associated factors of cerebral infarction and intracerebral hemorrhage in an area with aging populations in change over time: Evidence from the Akita Stroke Registry

AIM

To examine secular change in functional outcomes and associated factors of stroke in a rapidly aging region.

METHODS

We retrospectively analyzed cerebral infarction and intracerebral hemorrhage incidence registered cases in the Akita Stroke Registry from 1985 to 2014, divided into three of 10 years each. Functional outcome was defined as good with a modified Rankin scale score of 0-1 and poor with a score of 3-6 at discharge. Mixed effects logistic regression analysis with the location of medical facility as a random effects variable by disease type was used to examine the results.

RESULTS

There were 81 254 eligible patients (cerebral infarction: 58 217, intracerebral hemorrhage: 23 037). Age at onset increased over time in both diseases (cerebral infarction: median [interquartile range] age, 70 [63-77] years in 1985-1994 to 77 [69-83] years in 2005-2014; intracerebral hemorrhage: 64 [56-72] years in 1985-1994 to 72 [61-80] years in 2005-2014). Multivariate analysis showed that the odds ratio associated with good outcomes increased over time for cerebral infarction, and cerebral hemorrhage increased in periods 2 and 3 compared with period 1, but decreased from period 2 to period 3. For cerebral infarction, the odds ratios of prior diabetes associated with poor outcomes decreased over time.

CONCLUSION

The age at onset increased over time. In cerebral infarction, functional outcomes improved over time, and the association between diabetes and poor outcome declined over time. It was speculated that these results were related to advances in the healthcare system and improved management of vascular risk factors during the study period. Intracerebral hemorrhage improved during the first 20 years, with no apparent improvement thereafter. Geriatr Gerontol Int 2023; ••: ••-••.

Using Smart Home Technologies to Promote Physical Activity Among the General and Aging Populations: Scoping Review

BACKGROUND

Health-monitoring smart homes are becoming popular, with experts arguing that 9-to-5 health care services might soon become a thing of the past. However, no review has explored the landscape of smart home technologies that aim to promote physical activity and independent living among a wide range of age groups.

OBJECTIVE

This review aims to map published studies on smart home technologies aimed at promoting physical activity among the general and aging populations to unveil the state of the art, its potential, and the research gaps and opportunities.

METHODS

Articles were retrieved from 6 databases (PubMed, CINAHL, Scopus, IEEE Xplore, ACM Library, and Web of Science). The criteria for inclusion were that the articles must be user studies that dealt with smart home or Active Assisted Living technologies and physical activity, were written in English, and were published in peer-reviewed journals. In total, 3 researchers independently and collaboratively assessed the eligibility of the retrieved articles and elicited the relevant data and findings using tables and charts.

RESULTS

This review synthesized 20 articles that met the inclusion criteria, 70% (14/20) of which were conducted between 2018 and 2020. Three-quarters of the studies (15/20, 75%) were conducted in Western countries, with the United States accounting for 25% (5/20). Activities of daily living were the most studied (9/20, 45%), followed by physical activity (6/20, 30%), therapeutic exercise (4/20, 20%), and bodyweight exercise (1/20, 5%). K-nearest neighbor and naïve Bayes classifier were the most used machine learning algorithms for activity recognition, with at least 10% (2/20) of the studies using either algorithm. Ambient and wearable technologies were equally studied (8/20, 40% each), followed by robots (3/20, 15%). Activity recognition was the most common goal of the evaluated smart home technologies, with 55% (11/20) of the studies reporting it, followed by activity monitoring (7/20, 35%). Most studies (8/20, 40%) were conducted in a laboratory setting. Moreover, 25% (5/20) and 10% (2/20) were conducted in a home and hospital setting, respectively. Finally, 75% (15/20) had a positive outcome, 15% (3/20) had a mixed outcome, and 10% (2/20) had an indeterminate outcome.

CONCLUSIONS

Our results suggest that smart home technologies, especially digital personal assistants, coaches, and robots, are effective in promoting physical activity among the young population. Although only few studies were identified among the older population, smart home technologies hold bright prospects in assisting and aiding older people to age in place and function independently, especially in Western countries, where there are shortages of long-term care workers. Hence, there is a need to do more work (eg, cross-cultural studies and randomized controlled trials) among the growing aging population on the effectiveness and acceptance of smart home technologies that aim to promote physical activity.

EQ-5D-3L Norms for the European Older Population: Country-Specific Norms for 15 European Countires Based on the Survey of Health, Ageing, and Retirement in Europe

OBJECTIVES

This study presents a country-specific 3-level version of EQ-5D population norms for the European older population.

METHODS

Norm data were obtained from the fourth wave of the Survey of Health, Ageing and Retirement in Europe, and determined, for each EQ-5D dimension, the EQ-visual analog scale (EQ-VAS) and EQ-5D index values by 7 age groups and sex for 15 European countries. The EQ-5D index values were calculated using the European VAS value set for all countries.

RESULTS

Data resulting from 50 013 older respondents (mean age 65.9 years, range 50-111 years, 55.6% women) revealed an increasing number of self-reported health problems on EQ-5D dimensions and decreasing EQ-VAS scores with increasing age and for women compared with men. There are notable differences between countries in terms of the age gradient, the proportion of respondents in full health, and sex. Across all age groups, problems with pain & discomfort are the most frequent (36%-73% any problems), whereas problems with self-care are the least frequent (3%-31% any problems). The mean EQ-VAS score is 71.2 and the mean European VAS score is 0.79.

CONCLUSIONS

Given the growing number of older adults and elderly people in Europe, these population norms provide a valuable source of reference data that can be used to compare older adults or patient subgroups to the average of the general elderly population in a similar age or sex group in 15 European countries. The index value results may be further used to assess the burden of disease across older European populations and to identify the unmet needs of targeted older patient populations.

The Association of Caregivers' Socio-Economic Conditions with Family Caregiving Norms: Evidence from China

Similar to her neighboring country, Japan, China faces significant difficulties in providing long-term care to the elderly. Female household members who traditionally provided necessary caregiving are no longer available as much as in the past due to the demographic and socioeconomic changes over the past few decades. Against this backdrop, we investigated how socioeconomic factors affect the perception of family caregiving norms in China, using an international comparative household dataset that allowed us to compare China with Japan, the latter being extensively investigated. We used ordered probit regression to estimate the model equation. Our results show that rural residency, household assets, and government dependency are positively associated with the perception of care. A notable difference from the Japanese results is that rural residents have a rather positive perception of family caregiving norms. Furthermore, urban-rural subsample analyses revealed that women in rural areas perceive caregiving negatively.

Clinical role of radiofrequency ablation for early-stage hepatocellular carcinoma in an advanced aging society

AIM

It is unclear whether prognosis differs by age for early-stage hepatocellular carcinoma (HCC). We aimed to examine prognosis and recurrence after radiofrequency ablation (RFA) for early-stage HCC and to determine its prognostic factors for different age groups.

METHODS

This retrospective study enrolled 1079 patients with initial early-stage HCC treated with RFA at two institutions. All patients in this study were divided into four groups: <70 years old (group1, n = 483), 70-74 years old (group2, n = 198), 75-79 years old (group3, n = 201), and ≥80 years old (group4, n = 197). Prognostic factors were evaluated by comparing survival and recurrence rates between each group.

RESULTS

The median survival time and 5-year survival rates for each group were 113 months and 70.8% in group1, 99.2 months and 71.5% in group2, 91.3 months and 66.5% in group3, and 71 months and 52.6% in group 4, respectively. Group4 had a significantly shorter survival than the other groups (p < 0.05). There were no significant differences in recurrence-free survival among the groups. In group4, the most common cause of death was nonliver-related disease (69.4%). In all groups, modified albumin-bilirubin index grade was a factor contributing to prolonged prognosis, but only in group4 performance status (PS) was a significant factor (hazard ratio, 2.46; 95% confidence interval, 1.16-3.00; p = 0.009).

CONCLUSION

For early-stage HCC in the elderly, preoperative evaluation of PS and management of other diseases could contribute to a prolonged prognosis.

The Effects of Population Aging on Sports Industry Development: The Mediating Effect of Technological Innovation

It is of great practical significance to rationally formulate a development strategy for the sports industry to deeply understand and comprehensively grasp the impact of population aging on the development of the sports industry. To study the impact of population aging on the development of the sports industry, panel data at the provincial level in China from 2014 to 2020 are selected, and a mediation effect model is established to test how the aging of the population affects the development of the sports industry through technological innovation. The results show that technological innovation can explain 59.87% of the impact of population aging on the development of the sports industry without considering the control variables, and the impact of population aging on labor productivity through technological innovation is positive. Under the condition of considering the control variables, technological innovation can explain 56.74% of the impact of population aging on the development of the sports industry, and the impact of population aging on the development of the sports industry through technological innovation is positive. The proportion of the population aged 65 and above in the total population was used as a proxy variable for population aging to test the robustness test, and the impact of technological innovation on the development of the sports industry was positive without considering the control variables. In the robustness test considering the control variables, the impact of technological innovation on the development of the sports industry is positive.

Caregivers with Cancer Patients: Focus on Hispanics

Cancer is a public health concern and causes more than 8 million deaths annually. Cancer triggers include population growth, aging, and variations in the prevalence and distribution of the critical risk factors for cancer. Multiple hallmarks are involved in cancer, including cell proliferation, evading growth suppressors, activating invasion and metastasis, resisting cell death, enabling replicative immortality, reprogramming energy metabolism, and evading immune destruction. Both cancer and dementia are age-related and potentially lethal, impacting survival. With increasing aging populations, cancer and dementia cause a burden on patients, family members, the health care system, and informal/formal caregivers. In the current article, we highlight cancer prevalence with a focus on different ethnic groups, ages, and genders. Our article covers risk factors and genetic causes associated with cancer and types of cancers and comorbidities. We extensively cover the impact of cancer in Hispanics in comparison to that in other ethnic groups. We also discuss the status of caregivers with cancer patients and urgent needs from the state and federal support for caregivers.

Socio-ecological determinants of older people's mental health and well-being during COVID-19: A qualitative analysis within the Irish context

Background

Evidence indicates that older people with biological and social vulnerabilities are at high risk of short- and long-term consequences related to the COVID-19 pandemic. However, studies have also highlighted that the crisis may present opportunities for personal growth if older individuals are met with appropriate resources and support.

Objective

The aim of this study was to explore the perceptions of older people regarding how individual, social, and environmental factors have supported or hindered their well-being and health during COVID-19.

Methods

We analyzed data collected between April-May and October-November 2021 from the Well-being, Interventions and Support during Epidemics (WISE) study, a qualitative investigation of community-dwellers based in Ireland and aged 65 years or over. Participants (n = 57) completed written submissions, narrative interviews and/or go-along interviews detailing their experiences during the pandemic. Framework analysis was carried out in NVivo 12 to identify determinants, linkages, and explanations within Bronfenbrenner's socio-ecological model.

Results

The mean age of participants was 74.9 years, 53% were female, 45% lived alone, and 86% lived in areas with high urban influence. Our findings highlight the heterogeneous effect of COVID-19 across diverse older individuals who held distinct concerns, capabilities, and roles in society before and during the pandemic. Multi-scalar contextual characteristics such as individual's living arrangements, neighborhood social and built environments, as well as social expectations about aging and help seeking, had an influential role in participants' well-being and available supports. We identified mixed views regarding public health restrictions, but a consensus emerged questioning the suitability of one-size-fits-all approaches based on chronological age.

Conclusions

Our results suggest that some negative pandemic consequences could have been avoided by increasing collaboration with older people and with the provision of clearer communications. The interdependencies identified between individual characteristics and socio-ecological factors that influenced participants' availability of supports and development of adaptive strategies represent areas of opportunity for the development of age-friendly interventions during and beyond public health crises.

Long-term care insurance, mental health of the elderly and its spillovers

The paper studies the effects of the long-term care insurance (LTCI) program in China on the mental health of older adults and the wellbeing of their families. We employ the staggered difference-in-differences approach based on the LTCI pilots from 2015 to 2017. First, we find the LTCI program improves older adults' happiness and reduces depression symptoms significantly. The effects on the improvement in memory and cognition are associated with the elderly with activities of daily living-related need for care. Second, the effects of LTCI are partially mediated through providing community services, relieving care burdens, and reducing the incidence of diseases. More importantly, LTCI coverage improves caregivers' physical health and social activities, reflecting its welfare spillover effects. Furthermore, the relationship between LTCI and mental health differs due to the difference in LTCI designs and older adults' demographic characteristics. This presents a need to consider mental health in the services and evaluation criteria of LTCI.

Ensuring Population Health in the Era of Aging in Vietnam: Policy Review and Factors Associated with Intentions of Childbearing before the Age of 30 among Youths

Background: Delayed childbearing has become a concern among policymakers across the world. In Vietnam, population policies have been adjusted to cope with this issue. In 2020, Decision 588/QD-TTg was ratified to encourage people to marry and give birth before the age of 30. This study reviewed recent changes in Vietnam's population policies and assessed the intention of giving birth before 30 in young Vietnamese to provide insights into the potential effectiveness of the policy changes among young people. Methods: This study combined two approaches: a desk review and a survey of a group of youths. An online cross-sectional study was conducted on 116 respondents aged 16 to 30 in Vietnam from June to July 2020. The intention of childbearing before 30 and the importance and responsiveness of different social-environmental factors were asked using a structured questionnaire. We used multivariate logistic regression to identify associated factors of such intention. Results: The incentives set out by the Vietnamese government shared similarities with those of other countries. The plan of childbearing before the age of 30 among young adults in Vietnam was demonstrated to correlate with age, socioeconomic and biological characteristics, resources of the local health systems, as well as a clean and safe living environment. Conclusion: This study highlighted the recent crucial shift in Vietnam's population policy. However, the quantitative analysis suggested that measures relating to environmental factors should be incorporated under this policy, implying that further interventions need to be taken into account to cope with delayed childbearing.

Health shocks, basic medical insurance and common prosperity: Based on the analysis of rural middle-aged and elderly groups

Health is a major part of human welfare. The index system of common prosperity was constructed for middle-aged and elderly people in rural areas. Besides, the impart of health shocks and rural basic medical insurance on common prosperity was explored. The data for this study came from China Health and Retirement Longitudinal Survey (CHARLS) in 2013, 2015, and 2018. The finding shows that health shocks hindered the improvement of the common prosperity of the middle-aged and elderly in rural areas, among which daily activities produced the greatest negative effect. The heterogeneity analysis shows that health shocks have a stronger negative effect on the common prosperity of low-income groups than that of high-income ones. The shock of daily activity ability has the greatest influence on the middle-aged and elderly between 45 and 55 years old. However, acute health shocks have a strong negative effect on those aged above 56. The mechanism analysis shows that rural basic medical insurance can alleviate the health shocks to middle-aged and elderly people, but the effect is limited. In general, low-income groups benefit more. Therefore, China should speed up the promotion of the Healthy China Strategy and the reform of the rural basic medical insurance system, and prompt changes from an inclusive to a targeted policy to provide more precise safeguards for vulnerable groups.

Impact of smart health systems on the behavior of older adults under community healthcare

Background

With the trend of world population aging, a good community health care system will determine whether the elderly can get good medical conditions. How to improve the community health care system can study how the behavior of the elderly affects it.

Objective

This paper is based on the analysis of the current situation of population aging at home and abroad.

Methods

On the premise of analyzing the demand and behavior of elderly people seeking medical treatment and the function of community health service institutions. Literature research was conducted to analyze the influencing factors of community health care needs and elderly people's medical seeking behavior at home and abroad. Then the elderly in Tianjin were investigated by issuing questionnaires, and the law of medical treatment behavior of the elderly in Tianjin was calculated. Combined with the results of relevant investigations abroad, the common phenomenon is summarized. Finally, the analysis method of intelligent medical system is proposed, and the design process of system acquisition module and user usage mode are given.

Result

The smart medical system can bring great convenience to the elderly and community healthcare.

Discussion

It emphasizes the powerful functions of smart health systems and their future importance for the health care of the elderly.

Impact of Changing Socioeconomic Conditions on Family Caregiving Norms: Evidence from Japan

Eldercare is a major public health concern in many East Asian countries, including Japan, because of the ever-growing elderly population, and significant changes in family caregiving norms. The changes are due to global diffusion and the influence of socioeconomic and demographic shifts. Consequently, perceptions of the norm of family caregiving need investigation. We examined how demographic and socioeconomic factors influence the perception of family caregiving norms in Japan, using data from Osaka University's preference parameter study. According to the results of the probit regression, age, education, full-time employment, marital status, the number of sons and daughters, interactions between females and age and females and full-time employment, and parents' education are negatively related to the participants' perceptions of family caregiving norms. Our results suggest that people traditionally perceived as caregivers are less likely to have a positive attitude towards family caregiving, despite the government's efforts through Universal Long-Term Care Insurance, implemented in 2000. Therefore, authorities must reassess the role of families, explore alternative forms of community-based care, and provide more assistance to caregivers.

Effect of a Digital Literacy Program on Older Adults' Digital Social Behavior: A Quasi-Experimental Study

In South Korea, digital literacy education programs are expected to help its older population participate in online welfare services to increase their social support, self-esteem and well-being. This quasi-experimental study assesses the effects of digital literacy education on digital device usage among rural-dwelling adults aged 65 and above and evaluates the positive effects of digital literacy education on depression, happiness, quality of life, self-efficacy and cognitive function. A digital literacy education program and a customized questionnaire survey were conducted to evaluate smartphone use competency and the program's effects, respectively. We also conducted a chi-square test, paired t-test and difference-in-differences regression analysis. The experimental group showed a significant increase in smartphone usage and video recording capacity than the control group. The happiness and cognitive function scores for dementia screening increased significantly by a mean of 3.7 and 1.1 points, respectively, after digital literacy education. Cognitive function increased significantly by 1.305 points in the experimental group compared to the control group (β = 1.305, p = 0.05 *). Digital literacy education for older adults in rural areas greatly increased smartphone use, video recording capacity, happiness and cognitive function. Based on these findings, it is recommended that the government should implement digital literacy education for older adults in rural areas to increase their happiness and cognitive function.

Recent Declining Trend of Incidence Rate of Subarachnoid Hemorrhage in Shimane, Japan: The Japan Incidence of Subarachnoid Hemorrhage (JIS) Study

The “Izumo Study” revealed the incidence rate of subarachnoid hemorrhage (SAH) in Izumo City, Shimane Prefecture, Japan, from 1980 to 1998. However, no study has been published regarding the incidence of SAH in Shimane Prefecture after 1998. Most studies reporting the incidence of SAH in Japan have been conducted before 2000, although a few have been reported after 2000. This study aimed to assess the estimated age-adjusted incidence rate (AAIR) of SAH in Shimane Prefecture after 1998, following the Izumo Study. A retrospective study was conducted to identify the estimated AAIR of SAH in Shimane Prefecture, using the age-adjusted SAH mortality rate for this population from 1999 to 2017 and assuming that the case-fatality rate of SAH decreased by 0.7% annually from 45% in 1999 to 32.4% in 2017. We used linear regression analysis for trend to the estimated AAIR of SAH. Sensitivity analyses were also conducted by various case-fatality rates of SAH using assuming case-fatality rate based on previous reports. The estimated AAIR of SAH in Shimane Prefecture declined from 33.6 (95% confidence interval [CI]: 29.7-37.9) per 100,000 person-years in 1999, by 26.5%, to 24.7 (95% CI: 21.4-28.5) in 2017 (p < 0.01, r = 0.58). Declining trend of incidence rate of SAH in Shimane Prefecture from 1999 to 2017 was confirmed in this study.

Aging, generational shifts, and energy consumption in urban China

China is recognized as the largest energy consumer and is also the country with the largest and fastest-aging population. Ongoing demographic changes may reshape China's household-based energy consumption patterns because of the large gap in consumption behavior between the elderly and the young as well as varying attitudes toward the environment among generations. However, when the impact of China's aging population on energy consumption is projected, the heterogeneous cognitive norms of generations in the process of demographic transition are not well understood. In this study, we assessed the future impact of China's demographic transition on energy consumption using a proposed theoretical framework to distinguish between age and generational effects. Specifically, we used age-period-cohort (APC) detrended analysis to estimate age and generational effects based on China's urban household survey data from 1992 to 2015. The results indicated large differences in energy use propensity across ages and generations. The elderly and younger generations tended to be energy-intensive consumers, resulting in higher energy consumption in this aging society. Our results consequently show that future changes in China's elderly population will result in a substantial increase in energy consumption. By 2050, the changing consumption share of the elderly population will account for ∼17 to 26% of total energy consumption in the residential sector, which is close to 115 million tons of standard coal (Mtce). These findings highlight the need to interlace environmental education policies and demographic transitions to promote energy conservation behavior in children and youth for low-carbon, sustainable development.

Bilateral effect of aging population on consumption structure: Evidence from China

The deepening of aging population inevitably in China will exert a far-reaching influence on national consumption and economic transformation. Based on interprovincial panel data in 2000-2018, this paper measured the ratio of five survival and enjoyment consumptions in disposable incomes, reconstructed the indicators for upgrading the consumption structure, used the bilateral stochastic cutting-edge model, and decomposed the aging population to realize the net effect from the positive and negative effects generated by the consumption structure. The findings indicated that (1) aging population played a positive and negative bilateral effect on upgrading the consumption structure, in which the positive effect upgraded 14.04% of the consumption structure while the negative effect degraded 6.18% of the consumption structure. The comprehensive net effect upgraded 7.86% of the consumption structure. (2) From the perspective of the time effect, under the positive and negative effects of aging population, the consumption structure was upgraded 7.861% on average every year. (3) Regarding the regional effect, the promotion role of aging population was the highest in the eastern region, followed by the west. The middle was the lowest. By combining with estimation results of each province, the promotion role brought by aging population in the northeast and southwest was lower. Based on the above-mentioned research results, this paper proposed some advice for positively developing silver hair economy, promoting the improvement on the consumption structure according to circumstances, developing the perfect aging consumption market, exploring the consumption potential of the elderly, accelerating the urbanization development progress, and stimulating consumption growth relying on the Internet.

Relationship between Dietary Patterns and Subjectively Measured Physical Activity in Japanese Individuals 85 Years and Older: A Cross-Sectional Study

High-quality diets and regular physical activity (PA) are considered healthy behaviors (HBs). HBs are associated with many health outcomes and are expected to improve quality of life. Although implementing HBs is important, the relationship between dietary patterns (DPs) and PA has not been well investigated, especially among those aged ≥ 85. This study used data from the Tokyo Oldest Old survey on Total Health study to examine the relationship between DPs and PA in a cross-sectional study. The dietary survey used the brief self-administered diet history questionnaire to estimate the intake of 58 foods. After energy adjustment, principal component analysis was performed to identify major DPs. A validated questionnaire was used to evaluate PA, and linear regression analysis was used to investigate the association between DPs and PA, considering confounders. A total of 519 participants were included. Three major DPs (‘Various plant foods’, ‘Fish and mushrooms’, ‘Cooked rice and miso soup’) were identified. ‘Various plant foods’ was similar to DPs previously named ‘Healthy’ or ‘Prudent’, and its trend was positively associated with higher PA. This study observed the implementation of HBs even among those aged ≥ 85, suggesting that a trend toward a healthier diet is associated with higher PA.

Can an Eight-Session Multicomponent Physical Exercise Program Reduce Fall Risk and Fear of Falling among the Elderly?

In older populations, falls are responsible for decrease autonomy and increased pain and injuries. With aging, fall risk is multifactorial and associated with sarcopenia, impaired balance, falls themselves and psychological factors such as fear of falling. The objectives of the present study were: (a) to test the effects of a short multicomponent physical exercise program on fall risk and fear of falling; and (b) to analyze the relationship between fall risk and fear of falling. The participants were thirty-five older persons who were engaged in an eight-session physical exercise program. Balance (i.e., One-leg Balance Test, and Functional Reach Test), lower-limb endurance (i.e., Wall-sit Test) and fear of falling were measured before and after the multicomponent physical exercise program. Results indicated an increase in balance and a diminution of fear of falling after the end of the physical exercise program (p < 0.05). The program has an effect on lower limb endurance (p > 0.05). Gains in balance were correlated to the diminution of fear of falling (p < 0.05). An 8-week multicomponent physical exercise program based on balance is efficient to reduce fall risk and fear of falling among the elderly.

Heart failure with preserved ejection fraction: Squaring the circle between comorbidities and cardiovascular abnormalities

Heart Failure with preserved Ejection Fraction (HFpEF) is nowadays considered a major healthcare issue. According to forecasts two third of all Heart Failure patients will belong to this phenotype by year 2050, overwhelming those affected by Heart Failure with reduced Ejection Fraction (HFrEF). Both epidemiological and mechanistic studies support the concept that HFpEF represents true HF although aggravated by a collection of comorbidities. There is urgent need of improving its phenotyping due to the high degree of disease heterogeneity within HFpEF that lead to the failure of randomized clinical trials in demonstrating a remarkable impact of drugs in improving its morbidity and mortality.

The Behavioral Factors That Influence Person-Centered Social Care: A Literature Review and Conceptual Framework

The last decade has seen numerous policy reforms to emplace person-centered social care. Consequently, the public has been given more information, choice, and autonomy to decide how best they want to be cared for later in life. Despite this, adults generally fail to plan or prepare effectively for their future care needs. Understanding the behavioral antecedents of person-centered decision-making is thus critical for addressing key gaps in the provision of quality social care. To this end, we conducted a literature review of the psychological and health sciences with the aim of identifying the aspects that influence person-centered decision-making in social care. Using an established theoretical framework, we distilled nine behavioral factors―knowledge, competency, health, goal clarity, time discounting, familiarity, cognitive biases, cognitive overload, and emotion―associated with “Capability,” “Opportunity,” “Motivation,” and “Behavior” that explained person-centered decision-making in social care. These factors exist to different degrees and change as a person ages, gradually impacting their ability to obtain the care they want. We discuss the role of carers and the promise of shared decision-making and conclude by advocating a shift from personal autonomy to one that is shared with carers in the delivery of quality social care.

Prediction of Antidepressant Efficacy by Cognitive Function in First-Episode Late-Life Depression: A Pilot Study

The response rate of treatment for late-life depression (LLD) is only 25-60%. The cognitive impairment associated with LLD often affects the effectiveness of antidepressants and may has the potential ability to predict response. This study seeks a biomarker for baseline cognitive function to predict efficacy of antidepressants. Sixty patients diagnosed with LLD received escitalopram or sertraline treatment for 8 weeks. Clinical symptom was measured using Hamilton Depression Rating Scale-17 (HAMD-17) and cognitive function was measured using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), Trail Making Test (TMT) before and after 8-week treatment. Patients were divided into treatment effective group (TE) and treatment ineffective group (TI) according to reduction rate in scores of HAMD-17 after treatment. Thirty-eight matched healthy controls (HC) were assessed using RBANS and TMT. There was significant decrease of score of RBANS and increase of score of TMT in patients with LLD compared with HC. Regression analysis revealed that change in HAMD-17 score was significantly positively associated with baseline score of picture naming, figure copy, digit span, and delayed memory. The preliminary findings suggested that working memory, attention, visuospatial, language function, and delayed memory should be examined further as a means of providing the useful objective biomarkers of treatment response.

CLINICAL TRIALS REGISTRATION

[www.ClinicalTrials.gov], identifier [ChiCTR2100042370].